The 2012 election campaign is in full swing, and, for better or worse, health care is one of the major defining issues of the election. How can it not be, given the passage of the Patient Protection and Affordable Care Act (PPACA), also colloquially known as “Obamacare,” was one of the Obama administration’s major accomplishments and arguably the largest remaking of the American health care system since Medicare in 1965? It’s also been singularly unpopular thus far, contributing to the Republican takeover of the House of Representatives in the 2010 elections, as well as the erosion of Democratic control of the Senate. Whatever the true benefits, costs, and drawbacks of “Obamacare,” there have been sum unbelievably stupid things said about it, and I’ve even documented some of them by opponents of the PPACA, including the claim that Obama’s fixin’ death panels for grandma. Amusingly, the “Health Ranger” (a.k.a. Health Danger) Mike Adams really hates Obamacare, to the point of proclaiming shortly after it was passed into law that the PPACA would produce a health care dictatorship and doom America to Pharma-dominated sickness and suffering. He even called it a “crime against America.”

Unfortunately, laying out enough napalm-grade flaming stupid to defoliate the entire Amazon River basin is not limited to clueless wonders like Mike Adams. There are other clueless wonders out there who don’t seem to understand the real world. Unfortunately, one of them is running for President. Yes, I’m referring to Mitt Romney, who late last week made a statement so brain-meltingly out of touch with the real world that even I had a hard time believing that he actually said it. Ironically, enough, a mere couple of days after Mitt Romney put his cluelessness on display for the world to see, there also appeared a tear-inducing op-ed piece published yesterday in the New York Times by Nicholas Kristof entitled A Possibly Fatal Mistake, which described in a very personal story about a friend of his the health impact of not having health insurance for those millions of people.

As politically charged an issue as whether the government should provide universal health care for its citizens and how much we as a society should be willing to pay for it is (at least in this country; it doesn’t seem to be particularly controversial in most other developed countries, particularly those in Europe), the relationship between health insurance and, well, health is a question that can be addressed scientifically, which puts it right smack dab within the purview of science-based medicine. What to do about it, in contrast, is a matter for politics and public policy. Think about it in much the same way as anthropogenic global warming. Science tells us that it is happening and suggests strategies to mitigate it. Which of these strategies we choose is a matter of politics and policy.

So first let’s examine the question.

The clueless versus the human

Before we discuss the evidence regarding the health effects of being uninsured, let’s look Romney’s statement and why it resulted in so much blowback. Romney made his assertion during an interview with the editors of The Columbus Dispatch:

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,'” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

He pointed out that federal law requires hospitals to treat those without health insurance — although hospital officials frequently say that drives up health-care costs.

Romney was referring to the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal law passed in 1986 under the Reagan administration that requires hospitals to provide care to anyone needing emergency treatment regardless of citizenship, legal status, or ability to pay. Hospitals may only transfer or discharge patients requiring emergency care after stabilization, when their condition requires transfer to a tertiary care hospital, or against medical advice. It is highly unlikely that any person who has ever worked in an emergency room or cared for the uninsured would make such a statement. Emergency rooms are not equipped to treat complex conditions; all they can do is to treat the acute problem. In addition, tertiary care hospitals receive a lot of patients admitted under EMTALA, who are transferred at the drop of a hat. Well do I remember my days as a surgery resident rotating in the county hospital, when we used to joke about the routine near-inevitable Friday afternoon phone calls from private hospitals asking to transfer patients who had failed a wallet biopsy. We even knew what time was the “witching hour,” when we were most likely to get such calls. Of course, the problem with EMTALA was (and is) that there were no provisions for reimbursement for uncompensated care. Basically, hospitals were (and, for the most part, still are) forced by law to eat the costs of caring for the uninsured. It’s an incredibly inefficient and irrational system. Yes, it does make sure that most people can get at least emergency care, but it makes no provisions for any treatment for long term care that can’t be provided in emergency rooms or as inpatients.

Since completing fellowship, I have held faculty positions in two of the 41 NCI-designated comprehensive cancer centers in the U.S., both of which take care of a lot of uninsured patients. I’ve seen more women than I can remember who waited far longer than they should have to see a doctor for their breast cancer because they couldn’t afford to see a doctor or were afraid of how much it would cost even to do a biopsy. Over the years, all too often my patients have been symptomatic for quite some time, and when they finally do present their tumors are larger, more difficult to treat, and more likely to kill them. They represent the female equivalent of Kristof’s uninsured friend Scott, who is the human face of the issue discussed in his NYT op-ed and tells his story:

In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.

Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”

I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)

The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.

A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.

I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”

I realize that right now I’m referring to my anecdotal experience. However, one anecdote is that of a man who gambled and lost because health insurance was too expensive. The rest is my experience in a highly specialized field in a city with high unemployment and poverty. It is quite possible that such experience can be misleading, and certainly one of the key messages we promote on this blog is that anecdotal experience is inherently potentially misleading. (That’s why it’s the primary evidence used by promoters of unscientific or pseudoscientific medicine.) In a way, Kristof’s friend’s story would seem to confirm Romney’s statement, at least on the surface. Scott did, after all, end up getting excellent medical care for his stage IV prostate cancer, and, although he probably could have afforded health insurance if he had stretched a bit, did make a choice not to purchase insurance. But, then, as I said, anecdotes can be misleading.

The evidence

Before we get into the data itself, it is not much of a stretch to imagine that not having health insurance would result in worse health outcomes. What I am trying to say using “science-based medicine-speak” is that the hypothesis that people without health insurance will be more likely to have health problems and die unnecessarily than people who have decent health insurance is a hypothesis with a fairly high degree of what we in the SBM biz refer to as prior plausibility. After all, if you’re uninsured, you’re less likely to see a physician except when you get sick, less likely to be able to pay for your medications (particularly if they are expensive), and less likely to undergo routine preventative care. It’s thus plausible that being uninsured would be associated with an increased risk of death or poor health outcomes. None of this means we don’t have to do the research and look at the evidence; all it does is to suggest hypotheses to test and emphasize that these hypotheses have a reasonable chance of being consistent with the data. Also, this question is difficult to study because of all the potential confounders. After all, not having health insurance is associated with a lot of things that could be contributing to mortality, such as lower socioeconomic status, substance abuse, and the like.

Even twenty years ago, this question was of intense interest. One of the seminal studies examining the relationship between health insurance and health outcomes was published in JAMA by Franks et al., who prospectively followed 4,694 adults older than 25 years who reported they were uninsured or privately insured in the first National Health and Nutrition Examination Survey (NHANES I), a representative cohort of the US population from initial interview in 1971 through 1975 until 1987. They found a 25% higher risk of mortality in the uninsured after adjusting for age, smoking, alcohol consumption, obesity, education and income. This effect was evident in all sociodemographic health insurance and mortality groups examined.

In 2002, the Institute of Medicine estimated that over 18,000 Americans between the ages of 25-64 die annually because of lack of health insurance, a number comparable to the number who died of diabetes, stroke, or homicide in 2001. Among the conclusions of this report:

  • Uninsured adults are less likely than adults with any kind of health coverage to receive preventive and screening services and to receive them on a timely basis. Health insurance that provides coverage of preventive and screening services is likely to result in greater and more appropriate use of these services.
  • Uninsured cancer patients generally are in poorer health and are more likely to die prematurely than persons with insurance, largely because of delayed diagnosis. This finding is supported by population-based studies of persons with breast, cervical, colorectal, and prostate cancer and melanoma.
  • Uninsured adults with diabetes are less likely to receive recommended services. Lacking health insurance for longer periods increases the risk of inadequate care for this condition and can lead to uncontrolled blood sugar levels, which, over time, put diabetics at risk for additional chronic disease and disability.
  • Uninsured adults with hypertension or high blood cholesterol have diminished access to care, are less likely to be screened, are less likely to take prescription medication if diagnosed, and experience worse health outcomes.
  • Uninsured patients with end-stage renal disease begin dialysis with more severe disease than do those who had insurance before beginning dialysis.
  • Uninsured adults with HIV infection are less likely to receive highly effective medications that have been shown to improve survival and die sooner than those with coverage.
  • Uninsured patients who are hospitalized for a range of conditions are more likely to die in the hospital, to receive fewer services when admitted, and to experience substandard care and resultant injury than are insured patients.
  • Uninsured persons with trauma are less likely to be admitted to the hospital, more likely to receive fewer services when admitted, and are more likely to die than are insured trauma victims.
  • Uninsured patients with acute cardiovascular disease are less likely to be admitted to a hospital that performs angiography or revascularization procedures, are less likely to receive these diagnostic and treatment procedures, and are more likely to die in the short term.

In 2008, the Urban Institute updated the IOM numbers by applying the methodology used by the IOM to more recent Census Bureau estimates of the uninsured, and estimated that in 2006 there were 22,000 excess deaths that could be attributed to lack of health insurance. The Urban Institute also suggested that the IOM analysis might have underestimated the number of deaths resulting from being uninsured. Its rationale was as follows:

The underlying longitudinal studies on which IOM relied did not specify the impact of insurance coverage on mortality by 10-year age groups. Rather, they documented the relationship between insurance and mortality across the sum total of all surveyed age groups. The IOM’s methodology implicitly assumed that insurance reduces mortality by the identical percentage for each 10-year age band, which the underlying research did not show. More grounded in the research would be an application of differential mortality estimates to all adults age 25–64, as was done for those longitudinal studies, rather than separately to each age group within this range. For 2000–06, this alternative approach raises the estimated number of excess deaths by an average of 20.5 percent a year.

In 2009, in a study from Harvard Medical School and the Cambridge Health Alliance, Wilper et al. published updated estimate of excess mortality associated with lack of insurance in the American Journal of Public Health. This analysis used methodology similar to that of Franks et al. applied to the third National Health and Nutrition Examination Survey (NHANES III), specifically 9,004 patients between ages 17 and 64 with complete baseline data for interview and physical examination. They found that the hazard ratio for death for the uninsured was 1.40 (confidence interval 1.06 to 1.84) compared to those with private health insurance. This particular study is the source of a rather famous number: 45,000 patients die due to lack of insurance each year. This particular study is at the high end of the estimates of excess deaths associated with lack of health insurance, which is why it not surprisingly often comes in for the most criticism, particularly given that it was supported by a partisan group, Physicians for a National Health Program. That’s why I tend to view this study as an outlier, but even outliers can sometimes tell us something. Whether the Harvard study was an outlier or not, that same year, the IOM updated its 2002 report. One of its conclusions was:

In contrast, the body of evidence on the effects of uninsurance on adults’ health has strengthened considerably since 2002. Numerous studies have addressed some of the methodological shortcomings of past research. As discussed further below, 17 observational and 13 quasi-experimental rigorous analyses have reported significant findings related to health insurance and adults’ health (Table 3-3) (McWilliams, 2008). The quality and consistency of the recent research findings is striking. As would be expected, health insurance is clearly most beneficial for adults who need medical attention, particularly for adults with common chronic conditions or acute conditions for which effective treatments are available. Furthermore, national studies assessing the effects of near-universal Medicare coverage after age 65 suggest that uninsured near-elderly adults who are acutely or chronically ill substantially benefit from gaining health insurance coverage.

There are 13 recent studies on the health effects of health insurance coverage for children, including 5 studies that used quasi-experimental methods (Aizer, 2007; Bermudez and Baker, 2005; Cousineau et al., 2008; Currie et al., 2008; Howell et al., 2008a). These studies suggest that health insurance is beneficial for children in several ways, resulting in more timely diagnosis of serious health conditions, fewer avoidable hospitalizations, better asthma outcomes, and fewer missed school days (Aizer, 2007; Bermudez and Baker, 2005; Cousineau et al., 2008; Currie et al., 2008; Damiano et al., 2003; Fox et al., 2003; Froehlich et al., 2007; Howell and Trenholm, 2007; Howell et al., 2008a,b; Maniatis et al., 2005; Szilagyi et al., 2004, 2006).

But that’s not all. Since it’s my specialty, I’ll pick a recent study published this year examining the outcomes of 2,157 hospital admissions for women with spinal metastases from breast cancer. Analyses were adjusted for differences in patient age, gender, primary tumor histology, socioeconomic status, hospital bed size, and hospital teaching status. The investigators found that women operated on for spinal metastases from breast cancer tended to do worse and have a higher risk of death if they were uninsured than if they had private insurance. The authors concluded that the poorer outcomes observed among the uninsured were primarily due to the uninsured patients being significantly more likely to have a nonelective hospital admission and present with myelopathy. Although this study had some limitations, namely that it couldn’t account for lesser quality private insurance (for instance, plans with high copays and/or poorer coverage) and variations in Medicaid eligibility by state. Also, the database used only includes in-hospital data and therefore couldn’t examine long-term outcomes.

Since surgery is also my specialty, I thought I’d also point out that there is considerable evidence that being uninsured or underinsured is associated with worse outcomes after surgery. For example, a recent study published in the Annals of Surgery from LePar et al. at the University of Virginia examined outcomes from 893,658 major surgical operations and found that mortality was considerably worse in Medicare, Medicaid, and the uninsured than they were in patients with private insurance. Adjusting for age, gender, income, geographic region, operation, and 30 comorbid conditions eliminated the outcome disparity for Medicare patients, but Medicaid and uninsured payer status still independently conferred the highest adjusted risks of mortality.

In fact, the list of conditions and procedures for which being uninsured is associated with poorer outcomes and higher mortality goes on and on: cardiac valve surgery, surgery for colorectal cancer, breast cancer treatment and outcomes, trauma mortality (including among children), and abdominal aortic aneurysms, to name a few. Moreover, analysis of survey data from patients who were uninsured but then became old enough to be enrolled in Medicare suggests that “acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.” In summary, there is a large and robust body of evidence suggesting that people do, in fact, die because of lack of health insurance.

Not so fast…

Of course, for a question as complex and prone to confounders as whether lack of health insurance is associated with poorer outcomes, including mortality, there are always those who are not convinced by existing observational data. Certainly, lack of health insurance can be a marker, not a cause, for poor health and subsequent poor outcomes, and teasing out the various confounding factors is not a trivial task. Perhaps the most widely cited study questioning this relationship was featured prominently in an oft-cited article in the lay press by Megan McArdle in The Atlantic entitled Myth diagnosis. It’s a study by Richard Kronick published in Health Services Research in 2009 that questions the IOM report from 2002:

These results demonstrate that if two people are otherwise similar at baseline on characteristics controlled for in the model presented in Table 3, but one is insured and the other uninsured, their likelihood of survival over a 2–16-year follow-up period is nearly identical. Further, I show that survival probabilities for the insured and uninsured are similar even among disadvantaged subsets of the population; that there are no differences for long-term uninsured compared with short-term uninsured; that the results are no different when the length of the follow-up period is shortened; and that there are no differences when causes of death are restricted to those causes thought to be amenable to the quality of health care.

Basically, Kronick found no relationships between insurance status and mortality. While this study was large (600,000 subjects) and controlled, it is also an outlier, just as much as the Harvard study is an outlier. Again, that doesn’t mean it was a bad study; outliers can often tell us something, and what Kronick seems to be telling us is that the magnitude of the effect on mortality associated with lack of insurance might not be as large as previously thought. Might. It is, remember, just one study, as large as it might be. McArdle might refer to Kronick’s study as “what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality,” which sounds incredibly impressive, but the simple fact is that no single study can provide the answer, particularly to question as complex as whether having no health insurance status is associated with increased mortality and poor outcomes. Kronick’s study also has a significant problem that was pointed out in this post by Ezra Klein, namely that people in poor health are more likely to seek health insurance, which would tend to obscure any positive relationship between health insurance and health status.

McArdle also makes another argument against such a relationship:

This result is not, perhaps, as shocking as it seems. Health care heals, but it also kills. Someone who lacked insurance over the past few decades might have missed taking their Lipitor, but also their Vioxx or Fen-Phen. According to one estimate, 80,000 people a year are killed just by “nosocomial infections”—infections that arise as a result of medical treatment. The only truly experimental study on health insurance, a randomized study of almost 4,000 subjects done by Rand and concluded in 1982, found that increasing the generosity of people’s health insurance caused them to use more health care, but made almost no difference in their health status.

I hate to say it, but McArdle is drifting rather close to Gary Null territory here, in which she seems to be arguing that whatever benefit having decent health insurance might convey, it’s about the same as the harm that “conventional” medicine does. In other words, her argument seems to be that providing people more access to health care will cause as much harm as benefit, making it a wash whether one is insured or not. Of course, that argument cuts both ways, if you accept estimates of over 100,000 “deaths by medicine” per year in that it would imply that having health insurance confers a benefit in terms of mortality reduction that is much larger than the numbers we have would suggest, making the imperative to improve health care coverage and decrease medical errors a much more reasonable conclusion from such an argument than concluding that striving for universal coverage would not reduce mortality. Be that as it may, more problematic is that like many proponents of dubious medicine and science, McArdle cherry picked the literature, choosing one study that is an outlier and a thirty year old study from the RAND Corporation that showed what she wanted and in essence dismissed the rest. In refuting McArdle, by J. Michael McWilliams, MD, PhD, Assistant Professor of Health Care Policy and Medicine at Harvard Medical School and an associate physician in the Division of General Medicine at Brigham and Women’s Hospital points this out and speculates:

How many lives would universal coverage save each year? A rigorous body of research tells us the answer is many, probably thousands if not tens of thousands. Short of the perfect study, however, we will never know the exact number.

Indeed.

Policy implications

The very term “science-based medicine” was chosen intentionally. Medicine itself is not a science. It can’t be. There are too many other factors that influence treatments, including patient preference, resource allocation, and level of skill of individual practitioners, to name just a few. Our central thesis is that medicine should be based on science and that the best health care is based on science. My purpose in writing this post was not to advocate for any specific solution to the problem of the uninsured, although people who know me know my politics and my position on the matter. Rather, it is to lay out the science studying the question of the relationship between health insurance status and health outcomes. While we do frequently say that correlation does not necessarily equal causation, in some cases the correlation is so tight that it strongly suggests causation. This is one such case. Given that there is no ethical way ever to do a randomized clinical trial in which people are randomly assigned to be insured or uninsured, much as is the case for examining health outcomes between vaccinated and unvaccinated children, we are forced to rely on observational and quasi-experimental data. Those data support the hypothesis that providing health insurance to as many people as possible is associated with better health outcomes and that lack of insurance is associated with poorer health outcomes. That is the science. When someone like Mitt Romney claims that no one ever dies from lack of insurance in the U.S., he is demonstrably mistaken, and, in fact, his even saying such a thing so confidently is strong evidence that he does not know what he is talking about.

What we as a society decide do with the results of the science examining this question is less a matter of science than it is of politics and policy.

Comments

  1. #1 Mephistopheles O'Brien
    October 24, 2012

    Krebiozen – re: rights. Let’s assume we agree those are perfectly reasonable rights, just like the right to free speech or the right to worship (or not) as you choose. You have the right to an adequate standard of living – does that mean that others have the obligation to provide it? Do others have the obligation to provide your soapbox on Speaker’s Corner? Do others have the obligation to provide your church and your transportation to it?

    Or is it “from each according to his ability, to each according to his needs?”

  2. #2 Mephistopheles O'Brien
    October 24, 2012

    Politicalguineapig – you’r speaking now in terms of utility and cost benefit, something that can certainly be debated.

    I do not favor a private police force because I believe it can be reasonably shown that a public police force provides a substantial benefit for the society as a whole. I also believe that (well known cases to the contrary) private police forces are more likely to be used in abusive ways. I have no particular thoughts on private fire fighting companies – I would expect they could do a fine job, but have no issue with our current fire departments. They provide an important benefit not only to the people who own buildings that catch on fire, but to those who have nearby buildings. The history of cities burning down suggests that good fire departments – publicly run or privately run – are indeed useful.

    What about private ambulance services? There are many cities that do not have municipal ambulances and use private companies for that. Is that a basic service the government should provide?

    Why is health care such a basic service that the government should/must supply?

  3. #3 Mephistopheles O'Brien
    October 24, 2012

    Lest I be misunderstood – I have no strong opinions about universal health care. What I’m trying to explore is why people couch this in terms of morality, fundamental (inalienable?) rights, barbarism, criminality, and so on. It may well be a good idea; it’s certainly a compassionate thing to do that would benefit many – at a cost. Why is it immoral, criminal, or barbaric to state otherwise?

  4. #4 Narad
    October 24, 2012

    Really? Because a significant contingent of early US settlers were Puritans, and many of their writings were influential.

    You’re right; I let my irritation get the better of me. What I was mainly thinking about was the highly exclusionary character of the movement and its prompt splintering thanks to the same sort of squabbling that made them a pain in the tokhes in Dutch exile. That, and that the Great Migration wasn’t that great.

    I will give them the promotion of education for the sake of literacy; as for Max Weber’s take, I’m not so sure.

  5. #5 Calli Arcale
    October 24, 2012

    The morality of universal health care is debatable. I think the point of a government is to address inequities of various kinds. People cannot be expected to come to the defense of our nation effectively, so we field an army to do that job. Private roads are of limited effectiveness; a turnpike will only go where and as far as its owner feels inclined, and probably won’t serve areas that aren’t profitable for it, so our government steps in and builds and maintains roads for us. Communities which can’t afford decent schools get state funding, which includes money from wealthier areas, ensuring that poorer communities have a shot at a decent education. Private law enforcement is pretty much insane, since of course they will have their employer’s interests at heart rather than the community’s, so government takes care of that too, as well as the establishment of a judiciary and a penal system.

    Should health care be added to that? Should we make it the responsibility of our government to make sure everyone has at least some minimum standard of health care?

    I think it would be beneficial. How much is our GDP affected by reduced productivity of sick or injured workers? How much welfare spending is needed only because of preventable disability? How much less money would Medicare need to spend if people stayed in better health before they qualified for Medicare, by getting their conditions detected and treated earlier? And how much money would it save the rest of us, those of us who are currently insured, by making hospital care less expensive? Universal health care would reduce the cost of health care, by removing the massive drain of minor conditions being treated in the ER because it’s the only option for too many folks.

    Honestly, even ignoring the moral question, I think universal health care, or at least single-payer health care, makes sense for our government. Not because it’s the right thing to do, but because it would save money and improve our nation’s productivity.

  6. #6 lilady
    October 24, 2012

    @ Mephistopheles O’Brien:

    I worked as a public health nurse. I worked, and I still reside in a County, which has diverse populations . We cared for people in our seven satellite clinics who were uninsured, underinsured, on Medicaid and who were undocumented immigrants. I felt then, and still feel, that we provided a medical home for these patients. Many of the patients came to us for aftercare after they had been treated in our County hospital. No one was ever turned away.

    Isn’t it a good thing, that our County hospital and County public health clinics provided preventive health care and ongoing health care for pregnant women, young babies and older people, who were uninsured? Isn’t it far better to provide immunizations and to treat emerging health problems, in their early stages, instead of hospitalizing people for advanced cancers, diabetes, and cardiac problems?

    Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?

    What about the *silent killers* (elevated blood glucose levels, hypertension and hyperlipidemia) that go undiagnosed and untreated due to lack of insurance? Do we as a society want people to go into major organ failure or lose their eyesight due to undiagnosed and untreated glaucoma, because they lack insurance?

    I have familial hypercholesterolemia, and because I had medical insurance my condition was monitored…but untreatable. I was enrolled in one of the early Lipitor trials by my private physician. When the trial was unblinded, my cholesterol level was 180 mg/dl…down from 400 mg/dl. What would my health status be today, if I didn’t have insurance coverage?

    I’ve had medical coverage for my entire life and eternally grateful that I was able to provide that coverage for my children. I was able to afford the extraordinary costs associated with my disabled son’s medical care, that were not covered by my medical insurance. I also have great empathy for those who are uninsured and underinsured, because I know only too well the devastating consequences of not having coverage for preventive care…for diagnosing of diseases and disorders in their early stages…before they become life-threatening/incurable.

    Yes, we have finite resources.

    Yes, we should stop playing international cop and look to cut our military budget.

    Yes, we should try to educate people about the limits of medicine (“If we can put a man on the moon…why can’t we cure cancer?”).

    Yes, we shouldn’t have Sarah Palin who panders to ignorant oldsters, by labeling counseling by your physician about end of life care as “death panels”.

    Yes, I should end my sermon now. 🙂

  7. #7 Krebiozen
    October 24, 2012

    Mephistopheles O’Brien,
    I’ll probably regret discussing politics, but anyway…

    Let’s assume we agree those are perfectly reasonable rights, just like the right to free speech or the right to worship (or not) as you choose. You have the right to an adequate standard of living – does that mean that others have the obligation to provide it?

    If they are able to, yes, “in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control”. I have always been very happy for some of the taxes I pay being used to help others in need, with the knowledge that I have the same safety net should I ever need it. I’m happy to vote for a political party that supports such a system

    Do others have the obligation to provide your soapbox on Speaker’s Corner? Do others have the obligation to provide your church and your transportation to it?

    Of course not. Is that a slippery slope argument? I don’t think I’ve ever seen anyone suggest such a thing. There is a huge difference between providing someone the basic essentials of life, and providing them a soapbox to preach from or a church to worship at.

    Or is it “from each according to his ability, to each according to his needs?”

    That has always seemed a perfectly reasonable maxim to me. Of course when Marx coined that phrase he was positing a utopian future in which there were enough resources available to provide for everyone’s basic needs; a bit like the present really. I do understand that many Americans tend to get a little excited by any suggestion of communism or indeed socialism, but I don’t really understand why.

    Maybe I should explain my position a bit further. I consider than in any transaction in which one party makes a profit, the other party by definition makes a loss. This means that the rich do not “make” money, they find ways of persuading some people to sell their labor for less than it is worth and/or other people to buy goods or services for more than they are worth. The word “entrepreneur” literally means “between-taker”, that is a person who makes a profit by buying from one person at one price, selling to another at a higher price and pocketing the difference – isn’t getting rich that way that pretty much The American Dream? It is IMO glorified theft in a system enforced, ultimately, out of the barrel of a gun.

    Requiring those who have stolen the money of the poor to give a little back to provide for those worse off than them doesn’t seem too outrageous to me. Refusing to do so while they suffer and die as a result does seem barbaric to me.

    I do understand that I have a somewhat unusual attitude and I don’t expect anyone to agree with me.

  8. #8 Politicalguineapig
    October 24, 2012

    Mephistopheles: Basically, health care should be provided by the government because the government benefits from a healthier populace. It’s the same as public education: most democratic governments need educated citizens. (Major reason I believe the US will revert to facism in my lifetime.)

    While religious/private services are an option, would anyone trust a private fire-fighting company? Or an ambulance that required bribes before treating anyone? And I’m not even going to go into the problems with hospitals run by churches.

  9. #9 JGC
    October 24, 2012

    Something else to consider–a lot of conservatives seem to have the strange idea that in the absence of UHC they won’t be required to contribute to the cost of providing healthcare for those lacking insurance, sufficient private resources, etc. It’s a myth: we’re all doing so, just inefficiently, in the form of increased insurance premiums, higher hospital and doctors’ fees, lower productivity as a nation, etc.
    Regardless of whether or not one has a fundamental right to health care, it makes economic sense to adopt a system like the UK’s, which delivers equivalent (or in some instances superior) care for a smaller per capita outlay.

  10. #10 Mephistopheles O'Brien
    October 24, 2012

    Politicalguineapig – People certainly have dealt with private ambulances and fire fighters. They’ve also dealt with private garbagemen, private telephone companies, private power companies, private water companies, and various other “basic services”. Sometimes governments contract with these vendors, allowing for local monopolies; sometimes they regulate multiple vendors and let them compete for business. As a trivial example, I have a choice of two different garbage haulers where I live.

    Why would you think a private ambulance company would necessarily take bribes?

    Let’s talk food for a second. There are no government run grocery stores or restaurants where I live. I know of government run liquor stores in another state, but I guess that would be a government run basic service. I can go to a choice of large and small vendors, even to individual farmers. I generally trust them.

    I agree there could be benefits from universal coverage, run by the government. Will you agree, on the other hand, that being government run is no guarantee of quality, efficiency, or cost effectiveness?

  11. #11 Calli Arcale
    October 24, 2012

    Politicalguineapig — ambulances requiring bribes: see also, Romania. Although they ostensibly have national health care, in practice the system is so corrupt that bribery is normal practice almost everywhere. You have to pay to have your sheets changed at the hospital. Under the table, of course, since bribery is illegal (but universal). Unfortunately, a national health care system will tend to reflect the government which produces it. If bribery is socially acceptable, and the government declines to adequately fund the system, then bribery is inevitable.

  12. #12 Edith Prickly
    I hesitate to wade into this discussion, but....
    October 24, 2012

    This is a really good article from a few years ago comparing the Canadian and American health care systems that touches on a lot of the issues raised in this thread: http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i

  13. #13 Edith Prickly
    October 24, 2012

    As well, some reports from the OECD on US healthcare costs: http://www.oecd.org/unitedstates/BriefingNoteUSA2012.pdf
    http://www.oecd.org/els/healthpoliciesanddata/HealthSpendingInUSA_HealthData2012.pdf

    As a Canadian I will freely admit to a bias in favour of a publicly-funded healthcare system – there are certainly things about the Canadian system I would improve, but on the whole it works. The main failure I see in the US system is the expense – the health outcomes are roughly the same as other industrialized countries, but Americans are paying far more for care and for too many people the costs are economically ruinous. Other people up the thread have noted that the government ends up paying anyway for the results of this situation – from both a practical and moral standpoint, doesn’t it make more sense to provide basic health care coverage for everyone?

  14. #14 Politicalguineapig
    October 24, 2012

    Mephistopheles: Sure, and some of those private companies have worked out, and a lot more of those companies haven’t. Google Bolivia and ‘private water companies’ sometime to see how wrong things can go.

    What makes you think privately run ambulances wouldn’t take bribes? Also, why would you think that they would be willing to treat everyone? I already have to keep an eagle eye on any pharmacists I interact with when I try to pick up a certain prescription. If I see a cross around their necks, I will not be sticking around. If I have to consult a doctor and she has any visible religious symbols on her person or in her office, I will probably not return, since I would probably receive sub-par treatment at best.

    I’d agree that there is no guarantee that a government run agency will be efficient or cost-effective. But you’re completely ignoring the fact that private agencies have no obligation to be efficient or cost-effective either. Heck, ethics are a hindrance in the private sector.

  15. #15 Politicalguineapig
    October 24, 2012

    Testing…one..two three.

  16. #16 Politicalguineapig
    October 24, 2012

    Good, I didn’t italicize the internet 🙂

  17. #17 Narad
    October 24, 2012

    Let’s talk food for a second. There are no government run grocery stores or restaurants where I live.

    A closer parallel might be SNAP (“food stamps”), and farm subsidies are nothing to sneeze at, either.

  18. #18 Denice Walter
    October 24, 2012

    @ Politicalguineapig:

    I am entirely intrigued by your statement concerning the pharmacist’s/ doctor’s religion as expressed by religious symbols**:
    has anyone ever treated you unprofessionally by introjecting his or her own beliefs into your treatment plan,
    behaving scornfully or judgmentally ( I’m assuming re contraception) OR
    are your worries more influenced by widespread conservative Christianity in your local area? Others’ experiences? Perhaps in effect, a prevalent anti-feminism?

    At any rate, I have personally only lived in extremely liberal areas so I have no idea- but really, it sounds awful.

    ** I sometimes wear a silver charm (from a museum of archeology) that is an octagonal shield with a central cross within a circle: my Irish friend asked, “Is that Anglican or Witch?”
    -btw- she knows I’m atheist.

  19. #19 Autismum
    http://autismum.com/
    October 24, 2012

    It will be three years next week since the NHS put me and DH back together after a terrible RTA while we were beginning out honeymoon. The surgery, hospital stay, aftercare (including home visits from nurses and physio therapists) didn’t cost us a penny. I am so grateful for our NHS though, yes, it is a bit creaky and is used a political tool far too often.
    @Politalguineapig
    Even within a system like the NHS there is room for judgemental dispensing practices, unfortunately http://news.bbc.co.uk/1/hi/uk/8586344.stm

  20. #20 Chris
    Neither here nor there...
    October 24, 2012

    Mephistopheles O’Brien:

    Let’s talk food for a second. There are no government run grocery stores or restaurants where I live. I know of government run liquor stores in another state, but I guess that would be a government run basic service.

    You obviously do not live on a military base with a commissary or post/base exchange. By the way, to go on Narad’s comment, they do accept food stamps. The lowest of the low of the enlisted personnel are not paid enough to support a spouse and family that many actually have (like my high school classmates who were Army wives, very young persons). At least they have medical benefits (and even it has limitations).

    By the way military commissaries are strange places. The last time I shopped in one was when I was in college and still had my dependent ID. There arrows painted on the floor to show the direction one must go down the aisle. I actually did not find it odd. That was over thirty years, and that particular building was torn down when the Navy base was turned into a city park.

  21. #21 Chris
    October 24, 2012

    “There arrows” should be “There were arrows.” Argh… there may be more errors.

  22. #22 Politicalguineapig
    October 24, 2012

    DW: No, I haven’t actually experienced any discrimination about contraception. I have encountered one rather snotty physician- I might be fat, but I am aware that veggies exist and I like them.

    I do spend a lot more time then I should on the internet, and I spent a lot of that time hanging around feminist blogs. I’m currently avoiding them because they make my anxiety level shoot up. Because of them, it’s hard to shake the idea that ob/gyns are either fundamentalists or perverts. And I suspect most pharmacists as being closet fundamentalists until proven not.

    I live in a fairly liberal area- in my particular neck of the woods, it’s mainly old hippies, hipsters and Somalis.
    Because of the locations of the various music clubs, the latter two often cross paths.(“Street blocked off again-another music festival.” In October, “mommy, why are all the white people bloody?”) Thankfully, they’re quiet and get on with their lives-unlike freakin All you need to know about it is that it’s where Rep. Bachman got her start. I could go into details, but that would probably be a dozen blog posts, and this ain’t my blog.

  23. #23 Politicalguineapig
    October 24, 2012

    *Stillwater* Aaaaaargh.

  24. #24 Narad
    October 25, 2012

    There arrows painted on the floor to show the direction one must go down the aisle.

    Ah, you remind me of one time when I was maybe seven years old and, on a trip, my uncle took us to a Norfolk PX. I thought it was even cooler than the employees’ store at the Sears, Roebuck Merchandise Building (which was larger), where my grandmother long worked.

  25. #25 OleanderTea
    October 25, 2012

    @ Denice Walter:

    …are your worries more influenced by widespread conservative Christianity in your local area? Others’ experiences? Perhaps in effect, a prevalent anti-feminism?

    OOoooh, me! Me! Though this may be beyond anti-feminism.
    I grew up in and remained in the South (y’all) until a few years ago.

    When I developing terrible menstrual cramps out of the blue (I’d never had cramps before, thought girls made them up to get out of gym), my GP was concerned and referred me to an OB-GYN. This was supposed to be a really good OB-GYN.

    Doc did the exam and asked me questions. Upon learning that at the ripe old age of 25 I was unmarried and didn’t have children, the doctor said that I should get married and have a baby because “Having a baby would cure the problem.” And then, I kid you not, he went on to say that a pretty girl like me shouldn’t have a problem finding a nice husband.

    I’m only sad that I didn’t kick him in the head during the exam.

  26. #26 Lawrence
    October 25, 2012

    @OT – sounds like he certainly deserved it. I have a hard time talking with my Dad (when we do talk – once in a blue moon) in Tennessee, because he has gone so far to the right in his thinking about everything (believes Rush’s word is God & such nonsense).

    There are areas of this country that seem to really want to pull things back into the 19th Century.

  27. #27 Shay
    October 25, 2012

    Politicalguineapig — I’m not sure I see the point of choosing a doctor based on their belief system (or lack thereof). Believer = knuckle-dragging bigoted loon was laid to rest during the discussion on battlefield acupuncture, I thought.

    (My primary care physician is a Christian, my opthalmologist is Hindu. Haven’t noticed that their religious beliefs make them sub-par practitioners).

  28. #28 Politicalguineapig
    October 25, 2012

    Shay: A man (which I assume you are) would get completely unbiased care. Oddly, Christianity doesn’t have a problem with viagra, vasectomies, or urological procedures. After all, according to the Abrahamic religions, men are people and women are just..jars. As for eyes- there’s yet to be a religion that has a problem with vision. Or, if there has, it died out.

    As for the stereotype of believers- I’ll start treating believers as intelligent people when they start acting like it as a whole. Until then, I’ll treat them as loons until proven otherwise.

  29. #29 Narad
    October 25, 2012

    As for eyes- there’s yet to be a religion that has a problem with vision. Or, if there has, it died out.

    Not that this prevents veneration of self-enucleation, such as Soordas in Hinduism and St. Lucia in Catholicism.

  30. #30 herr doktor bimler
    October 25, 2012

    there’s yet to be a religion that has a problem with vision

    Sun-eating?

  31. #31 lilady
    October 25, 2012

    @politicalguineapig:

    I think you ought to step away now, from your comments that *appear to be* stereotyping other people according to their gender and their religious beliefs.

    I’m a Christian and many of the doctors that I and my family members have consulted with, are males…some of them actually have deeply-felt religious beliefs in a variety of faiths. 🙂

  32. #32 Shay
    October 25, 2012

    @Politicalguineapig

    I guess you’ll be treating me as a loon from now on, then.

    You kind of remind me of some of the senior (male) officers I worked for on active duty (few, thankfully) who automatically assumed that since I belonged to a large and very visible demographic that I must not know what I was doing. It got kind of annoying, having to prove myself just because I was a woman.

    Given the highly diverse population with which I work, I can’t afford to be that judgmental. You walk in, I check your creds, you’re ok with me.

    (Until you screw up).

  33. #33 THS
    oops, I hope this didn't post twice
    October 25, 2012

    Just was on the phone with a push-poll about “Obamacare” and a big emphasis on US budget costs & deficits. On the basis of the wording of the questions, I think the poll was from the Karl Rove crowd. It was recorded for quality control or something and they took my name. There were loaded yes/no questions so I went on & on in some detail & I kept it clean but I suspect I was a bit intense. I know I was. Of course I got off topic. Asked if I was satisfied with O-care, I pointed out it that the health care system could be much better reformed but the right-wing offers nothing.
    In my rattlings I emphasized, among other things, the importance of science education, basic science infrastructure, investment in science, that sort of thing. I’m sure she thought I was off the rails when I pointed out the the Republican attitude toward science is unpatriotic. (for those who take issue, I maintain that reality is patriotic) I ended by urging the nice but probably frustrated young woman (by voice) to become more educated in scientific matters. I described myself as a moderate.

  34. #34 THS
    later on
    October 25, 2012

    Of course, with, for example, RFK Jr. & vaccines, etc.I know the Democrats have a vocal science-nitwit crew, too.

  35. #35 lilady
    October 25, 2012

    @ THS:

    You must live in a swing state, where both candidates are concentrating their efforts. I’m in a blue state and haven’t received any of those calls, since Romney was nominated.

    President Obama was on the Leno Show last night for quite a long time…he was delightful.

  36. #36 Jud
    October 26, 2012

    I am aware of many Americans being nervous of “Obamacare” in that if they don’t accept certain interventions- prescriptions, vaccines etc. then services will be denied them.

    Unlike (nearly?) anyone else here, I’ve actually read the Affordable Care Act. There is nothing – absolutely nothing – in it about “forced interventions,” much less about denial of services contingent on such. This does not even rise to the level of being one of the popular wrongheaded delusions about ObamaCare. It is very definitely a fringe wrongheaded delusion. Just who are your parents hanging out with?

    And about Terry Schiavo – Have you ever been in the terribly sad and stressful position of having to make end-of-life decisions about a loved one? If you have, then imagine the entire Canadian Parliament trying to horn in on that decision, and happily bringing down a rain of reporters and public invective on you as well. And you’re the one who supposedly objects to forced government interventions?

  37. #37 Politicalguineapig
    October 28, 2012

    Shay and lilady: You two are in the ‘proven otherwise’ category.I apologize for any offense. As I may have mentioned in another thread, I tend to categorize people in order to figure out how I should interact with them. I admit, I sometimes miscategorize people (most of my friends are in demographics I wouldn’t interact with except for the accident of education.) Since I’m not good at people, I haven’t seen much reason to scrap the catalog system.

  38. #38 lilady
    October 28, 2012

    @ politicalguineapig: I *know* you didn’t mean to offend any religion or the male gender.

    Most of my doctors are males…it just worked out that way…including my GYN. (Both babies wee delivered by male OBs).

    When my son was release from the NICU at 10 weeks old, we had nurses who visited each day…some were nuns.

    His first PT, Sister Helen, who was a nun-registered nurse-physical therapist, taught me in my home to do passive-range-of-motion and other therapies. She became one of my dearest friends…and she was a feisty lady…just like me. When my husband was around, we would duck out the door to have cigarettes and some glasses of wine. She went with us to a fundraiser at my son’s early intervention program where she proceeded to dance with all of us…greater dancer.

    What I am saying to you is, people are people…they are inherently good and the ones that you meet in the medical field are, with rare exception, very dedicated and caring.

  39. #39 MI Dawn
    Awaiting Hurricane Sandy while visiting in No VA
    October 28, 2012

    @Jen: Your in-laws may be delightful people, but they are listening to the same loons who probably declare that girls only get Gardasil so they can run out and have sex all the time. Having read most of the Obamacare act (shorter to type as a title, anyway…), and yes, I *do* work in health insurance, I have not heard ANY insurer say that there will mandated vaccines, mandatory statins, whatever. The health insurance companies will be required to COVER such things, but the members who have the insurance will not be required to have them. Those members may be held liable for a higher premium, but they will not be held down and forced to accept any health care they don’t want.

    I think that’s only fair. I don’t think we should have to pay for those who leech off the ones who try to stay healthy. There are those – infants, disabled, elderly, those who can’t be vaccinated for health reasons – who deserve consideration. But those who can and don’t should have to pay more to cover in case they need treatment for preventable illnesses.

    I would be no happier for my own healthy child to avoid preventative healthcare and leech off the group (fortunately, that isn’t a concern; they both are very conscientious about maintaining good health care practices, vaccines up to date, etc).

    OT: For those of us in Sandy’s reach – please take care!

  40. #40 Mephistopheles O'Brien
    October 28, 2012

    Politicalguineapig,

    What makes you think privately run ambulances wouldn’t take bribes?

    I never said they wouldn’t. You said “Or an ambulance that required bribes before treating anyone?” Where’s your evidence that they would require bribes (outside of locations where bribery is endemic, as Calli Arcale properly points out)?

    Private ambulance firms that I’m aware of do charge a fee. You can either get insurance for that ambulance service or be prepared to pay.

  41. #41 Mephistopheles O'Brien
    October 28, 2012

    Chris,

    You’re correct, it’s been a long time since I’ve been in a commissary, exchange, galley, or mess.

    You’ll note that medical benefits that go to our armed forces are provided as part of their total compensation for employment . They are quite generous by non-military standard, and rightly so. We ask the members of the armed forces to do very dangerous work with a much higher likelihood of illness or injury than expected of an overwhelming majority of those privately employed.

  42. #42 Antaeus Feldspar
    October 28, 2012

    Shay and lilady: You two are in the ‘proven otherwise’ category.I apologize for any offense. As I may have mentioned in another thread, I tend to categorize people in order to figure out how I should interact with them. I admit, I sometimes miscategorize people (most of my friends are in demographics I wouldn’t interact with except for the accident of education.) Since I’m not good at people, I haven’t seen much reason to scrap the catalog system.

    Have you ever thought that perhaps “the catalog system” is part of what makes you bad at people?

    First of all, gross descriptors such as “male” or “religious person” rarely give you any real information about who that person is.

    Second of all, when you place someone in a role, they often pick up on that and respond to that role. If you jump to the conclusion “this is someone who’s probably because of their sex/race/religion going to be unfriendly to me” then guess what, they’re likely to be unfriendly to you because you’ve already slotted them into that role.

    Thirdly, ever hear of confirmation bias? Maybe you’ve run into someone who a) doesn’t match the expectation you have of them based on their “category”, and b) doesn’t succumb to the pressure you’re putting on them to fulfill the “role” you expect. But because you expect them to fit into that stereotype, you don’t see who they actually are, you just see what you expect to see.

  43. #43 Politicalguineapig
    October 28, 2012

    lilady: What I am saying to you is, people are people…they are inherently good and the ones that you meet in the medical field are, with rare exception, very dedicated and caring.

    I deeply dispute the first half of that sentence. For some reason, you remind me very much of my aunt, another relentless sunny-side-up optimist.

    Anteaus: Thing is, I know why I’m bad at people. It’s not because of the catalog system; it’s because I was really shy as a kid and smart. Naturally I had a tough few years until I figured out that the best thing I could do for myself was underachieve, be aloof and get as strong as possible.
    The best thing I did for myself was cultivate a reputation as ‘the tough chick’ in high school. Oh, and learn the art of the little white lie. Everyone says ‘be yourself’ but that’s terrible advice. Even my friends don’t need to know the real me.
    I’m polite to everyone. Regardless of race, ethnicity, religion or where they register on ‘are they going to bomb this place’ scale. (I work at a Science Museum, and we get a fair number of lost evangelicals.We have dinosaurs, which I’m sure rank pretty high on God’s shit list.)
    And yes, I’m aware of confirmation bias.But if I give them no hint of how I expect them to act, obviously, they won’t pick up on it. On the other hand, if I go into every interaction blind, I won’t be able to execute an escape plan if things go bad.

  44. #44 insurancebroker
    USA
    October 29, 2012

    Nice Article related to health insurance .Thanks for Sharing..I can’t understand why the Obama campaign does not constantly reference this. Are they afraid to say, “We implemented Mitt Romney’s healthcare plan” because they think Romney will embrace it as a selling point? ??????????

  45. #45 ChrisP
    October 29, 2012

    That link from insurancebroker looks like spam to me.

  46. #46 Marry Me, Mindy
    October 29, 2012

    The link might be spam but the comment is spot on. So spot on, in fact, it is a copy of something I said above.

    An exact copy that is.

  47. #47 lilady
    October 29, 2012

    @ politicalguineapig: If you venture on to this blog and start with generalizing remarks about white men, people of various religions and doctors…you should be prepared to accept how commenters react and post back at you.

  48. #48 flip
    Late as usual
    October 29, 2012

    The discussion of ‘Obamacare’ always leads me to the popular generalisation: only in America.

    From the outside, in a country with universal healthcare, I admit to being utterly unable to fathom the problems with the overall idea of having more healthcare for more people. (I will agree the details are important and done wrong, it’s useless. Nor is the system here perfect)

    Oddly enough, I’ve been accused of being a ‘slave’ by a libertarian for thinking that my taxes go towards better healthcare with more freedom to choose how I receive it. I am still unable to fathom the logic behind that comment, and they weren’t inclined to explain it to me – considering that I was so much of a ‘slave’ that I couldn’t possibly change my mind even if reasons were laid out in front of me.

    The strange reasoning that goes with this stuff eludes me. Especially since I have never ever worried about affording a trip to the doctor, ER, specialist, pharmacist or test facility. And I’ve done many of those things…

    Actually, the weirdest thing to me is that health insurance is coupled with employment. Give me your tired, poor, hungry… and then ensure that when they get sick, they can’t get help because they’re tired, poor, hungry – and unemployed!

    Having said all of that, it’s clear from Orac’s post that things are a little more complicated (as always) than they seem and that my ideology needs to be tempered with a bit more skepticism. I’m actually surprised the mortality is so ‘low’ for uninsured people. … I do love this site, it’s always teaching me something. 🙂

    .. Is it me or was the Dispatch article written badly: it seemed all over the place veering from one thought to the next and then back to the first thought.

    @Lilady

    Thanks for posting that Lawrence O’Donnell stuff. I am in total agreement with his sentiments.

  49. #49 lilady
    Still somewhere in the northeast and still have my electric power
    October 29, 2012

    @ flip:

    “….Actually, the weirdest thing to me is that health insurance is coupled with employment. Give me your tired, poor, hungry… and then ensure that when they get sick, they can’t get help because they’re tired, poor, hungry – and unemployed!…”

    http://www.libertystatepark.com/emma.htm

    I’m a registered “Independent” and I always vote my conscience. Why is that my conscience/inner voice tells me to vote for the “Democrat” candidate?

    I’ve been a *Lefty* for eons and damn proud of my voting record.

  50. #50 Politicalguineapig
    October 29, 2012

    Flip: I think the low mortality rate might be because a lot of uninsured people are in their twenties. Sis knows a lot of people without health insurance, and I know a few too- since a lot of people our age work low-paying jobs without benefits, or they forgo the insurance entirely.

    Mephistopheles: Again, ETHICS ARE A LIABILITY IN THE PRIVATE SECTOR. Of course privately run ambulances will take bribes, since there’s no rule against it. Another thing; what happens if someone strays into an area where there are only privately run ambulances, has no insurance, no cash, and has a seizure,an insulin crash or an anaphylatic attack? Obviously, they’ll die on the street. I think we can both agree this isn’t a good thing, right?

  51. #51 flip
    October 29, 2012

    @Lilady

    Hope you keep your power!

    I am what most in the US would consider a rabid lefty. I don’t think I’ve ever voted for either of the two main parties in my life. — Council elections generally don’t present info on party affiliation, but you can usually look it up or work it out from what they say about themselves on the forms.

    Funnily enough, the more I read of science blogs and other things, the more I realise I’m probably centrist in a lot of areas, if not right-wing in others. But then, the right-wing party of my country – Australia – likes the ideas of putting bibles in the hands of school children. Compulsorily. On the other hand, our atheist female Prime Minister doesn’t want to introduce gay marriage despite the majority of voters wanting it. … Sigh… And this is why I vote third party.

  52. #52 flip
    October 29, 2012

    @PGP

    That kind of makes sense, except it almost seems too simplistic to be true. But then I’ve never paid attention to mortality stats for countries with UHC, so I’ve never had anything to compare it to. I guess in my head, I just always expected it to be high – and when confronted with real stats was surprised.

    (By the way to anyone who is still here, am I wrong in feeling like Sid is going to turn up at any moment?)

  53. #53 Mephistopheles O'Brien
    October 29, 2012

    Politicalguineapig – you’ve obviously had no particular dealings with the private sector and have filtered that through collectivist dogma.

    Businesses DO have ethics. They spend a great deal of time training people on ethics. They have to have ethics as a matter of self defense, as well as having them imposed from without. Were business truly to act completely unethically, they would not only likely fall afoul of existing laws and regulations, but would also likely inspire new regulations. Customers have little patience with totally unethical companies as well, if they have a choice (and in most cases they do).

    Your amusing vision of how private ambulance companies work is a case in point. First, it IS illegal for them to take bribes – otherwise it wouldn’t be a bribe, now, would it? If they were found doing such a thing in the areas I’m aware of, there would be a substantial outcry and a reckoning. Just because they’re private doesn’t mean they’re unregulated. Also, they don’t demand cash up front – they send you a bill.

  54. #54 lilady
    October 29, 2012

    @ Mephistopheles O’Brien:

    As far as I know, cities in the United States have municipal ambulance corps. All the costs to operate those ambulances, (purchase and maintenance of ambulances, supplies and paid EMTs) are borne by the taxpayer through property taxes, local sales taxes and, in NYC, Income Taxes).

    Suburban areas often have “volunteer” (non-paid), firefighters/EMTs aboard their firefighting equipment and well-equipped ambulances. Costs associated with firefighting, rescue and ambulance services are paid for by property taxes and local sales taxes.

    My son frequently was transported via these “volunteer” ambulances. I never received a bill and no bill for these services was ever sent to my insurance company.

    Large teaching/tertiary care hospitals have their own ambulances for transferring patients between hospitals and for transferring a patient to a rehab center/nursing home. Specialty tertiary care hospitals have “mobile ICU ambulances” staffed with physicians and nurses. The patient/patient’s medical insurance company will be billed for these ambulance services.

    I required the use of a private ambulance to transport my son from the hospital to my home when he was encased in a hip spica cast for a supracondylar fractured right femur. After five weeks in the cast he was transferred on a gurney to and from his orthopedist’s office for X-rays and a consultation. After 10 weeks in the hip spica cast, he again was transferred via private ambulance to the hospital for cast removal and to start rehabilitation. The private ambulance costs were billed to me and my private insurance company.

    People who are wheelchair-bound do use ambulettes for non-emergency hospital visits and for trips to physicians for care. Ambulette services are a “covered” medical necessity.

    There is a small subset of patients who “abuse” municipal and volunteer ambulances…for non-emergency trips to hospital emergency rooms. The municipal and volunteer ambulances will take you to the hospital, but will bill you for those trips. Those people should not take advantage of these services for their “convenience”, because it may result in delays for medical care for patients with serious medical problems.

    I never heard of any ambulance staff who expected a bribe or demanded a bribe, to transport a patient.

  55. #55 Politicalguineapig
    October 29, 2012

    Flip: I probably *have* oversimplified it. I suspect that twentysomethings aren’t all of the uninsured; there’s bound to be a few middle-aged people who think they can scrape by until the next job or until they retire. And a few families that are entirely uninsured too.

    Mephistopheles: Look, dude, I read the newspapers all the time. From Blackwater to Lehman Bros to Solyndra and Enron, ethics are pretty lacking all across the spectrum of industries; I don’t need anyone else to point out what I see with my own two eyes.

    I cited the case of someone dying on the streets because that’s what would happen, Mr. Randroid. Heck, in my state, we just had to shut down an overzealous accounting firm that was visiting people in the hospital and demanding money. I suppose you approve of that too.

    I am by no means a collectivist: Communism is good theory but bad practice, and people aren’t naturally cooperative. In my political leanings, I’m actually a monarchist. Hey, it’s what the people want, even if they don’t know they want it.

  56. #56 flip
    October 29, 2012

    I’m not a monarchist. I think it’s nuts that Australians still pay tribute to an old woman in a hat who has no political power and no interest in having said power. The only time she seems to be involved in anything here lately is if her grandkids do something or if she has one of her jaunts to receive flowers and dine with politicians.

    Feel free to tell me how I really just “don’t know [I] want it”.

  57. #57 Narad
    October 29, 2012

    I probably *have* oversimplified it. I suspect that twentysomethings aren’t all of the uninsured; there’s bound to be a few middle-aged people who think they can scrape by until the next job or until they retire. And a few families that are entirely uninsured too.

    It’s not as though there’s any particular reason to resort to what one “suspects”: 2004, 2011.

  58. #58 Narad
    October 29, 2012

    I cited the case of someone dying on the streets because that’s what would happen, Mr. Randroid.

    I will further note that this particular insult does not correspond to anything that I’ve seen from M.O’B. The question “why healthcare” advanced previously hardly merits a petulant “Randroid” line.

  59. #59 Antaeus Feldspar
    October 29, 2012

    PGP, you just don’t seem to grasp an important fact: finding one, or five, or twenty, or even a hundred instances of “person/entity from category X behaving in manner Y” does not justify a generalization “people/entities from category X behave in manner Y as a rule.”

    I understand how it can seem like it’s far better to have the illusion of knowledge (“ah, this person’s from England! I know that until proven otherwise they’re stuck in Victorian superstition!”) than the reality of not knowing everything that’s important to know. But I really don’t think you realize how hateful some of the things you say are, and I don’t think you have realized that your “category system” is just plain woo. It may provide an illusion of control but when it leads to hurting those around you, it can’t be justified.

  60. #60 Shay
    west of Sandy
    October 29, 2012

    “there’s bound to be a few middle-aged people who think they can scrape by until the next job or until they retire.”

    No…there are a lot of non-twentysomethings without health coverage because they fall into the working poor category and they don’t “think they can scrape by.” They simply can’t afford to pay for insurance and it’s not provided by their employers under the system that is currently in place. This not a decision made lightly. They’re choosing between healthcare and rent/food/car payments and not so much gambling as resigning themselves to the inevitable.

    In re: ambulance companies. While there are some private ambulance companies here, the bulk of ambulance services in this area, both rural and urban, are provided by paid or volunteer fire departments (tax-supported). Privately owned ambulance companies must abide by the regulations of their industry or face criminal charges.

  61. #61 lilady
    October 29, 2012

    @ Mephistopheles O’Brien…PGP reads the newspapers all the time…aren’t you impressed?

    I’m sorry I provided some helpful *hints* to PGP on this thread and on the other thread months ago, when she went off the rails.

  62. #62 Politicalguineapig
    October 29, 2012

    Narad: Sorry, I do know I vastly oversimplified, but I’ve been sick and am still not running at full capacity. I would’ve remembered to run a google search eventually.

    Mephistopheles: Sorry. At this point, my patience is wearing very thin with libertarians and righties.

    Anteaus: Do you really think I’m socially inept enough to actually *say* anything like that in real life? Nope. Like I said, I’m polite. I don’t say much at all really.
    Yeah, I can’t control everything in a social situation; however, I can control who I interact with (for example, using headphones and reading a book on the bus) and the level of interaction (like not looking men in the eye ever.) Heck, I can even control the level of info my friends have on me. There are three kinds of people, the winners, the losers, and the just getting by. I am not a winner, so I continually have to keep up the charade of getting by.
    As for British people, it’s not so much that they’re stuck in superstition, as they’re stuck in the whole Victorian moral code. There’s a lot of that here, too.

    Shay: I would have remembered that eventually. I don’t have a lot of friends outside my age group,so I was using my peers as an example.
    Since I’ve lived in one city all my life (county and public ambulances mostly) I didn’t know private ambulance companies existed in the US, or that they had rules. I still maintain that public ambulances are superior, since they have to treat everyone, and private ambulances can pick and choose.

  63. #63 Shay
    October 30, 2012

    As for British people, it’s not so much that they’re stuck in superstition, as they’re stuck in the whole Victorian moral code.

    You are stuffing an entire nation into a one-size-fits-all category.

    I didn’t know that private ambulance companies existed in the US, or that they had rules.

    Dammit, kid, EVERY industry has rules! And in most localities ambulances are sent out from a central dispatcher who will usually contact the closest ambulance service to the address of the person requesting help, be that service public or private.

  64. #64 Alain
    October 30, 2012

    @PGP

    perhaps you already said it somewhere sometime but I have to ask….you’re categorizing quite a lot so would you be autistic by any chance?

    Alain

  65. #65 Antaeus Feldspar
    October 30, 2012

    Anteaus: Do you really think I’m socially inept enough to actually *say* anything like that in real life? Nope. Like I said, I’m polite. I don’t say much at all really.

    I think you’re socially inept enough not to realize that talking to us is real life. I think you’re socially inept enough not to realize that to pretend you are treating someone as an individual and inwardly condemn them because they belong to a “high-risk category” in your “system” is not “polite” any more than manure with candy sprinkles on it becomes “candy.”

  66. #66 Politicalguineapig
    October 30, 2012

    Alain: Officially speaking, I have ADHD, an anxiety disorder, and some depressive tendencies. I share a lot of similiarites with a couple of friends who have Aspergers, but I’ve never been diagnosed as such. I have been considering being screened for it.
    Shay: I know every industry has rules, but compliance is always an issue.
    Anteaus: I think this is a generational thing. Despite how much I use social networks, I don’t see them as ‘real life.’ Real life is meatspace only, and I present quite a different personality there then I do on the net.
    Again, how are they going to know? They can’t see inside my head, and I am quite good at acting.

  67. #67 Krebiozen
    October 30, 2012

    PGP,

    As for British people, it’s not so much that they’re stuck in superstition, as they’re stuck in the whole Victorian moral code.

    I barely escaped losing a keyboard to a mouthful of tea there. Good grief, have you been to Britain? If not, how did you come to this extraordinary conclusion? Do you think we all wear top hats and talk like Jeeves and Wooster?

    You could hardly be more wrong. Though it’s nothing to be proud of, British people are the most sexually promiscuous among industrialized nations. I’m assuming that by “Victorian moral code” you mean “sexual restraint, low tolerance of crime and a strict social code of conduct” as Wikipedia puts it.

    Here are a few more facts about Britain and British people that might change your mind.

    In the UK, 47% of children are born to unmarried parents, a ten-fold increase over the past 100 years, and the divorce rate has increased 170 fold. Over a quarter of British women had sex before the age of 16, according to the Health Survey for England. About 10% of the adult population is cohabiting, with about 40% being married.

    Somewhere between 10% and 15% of people in the UK attend church regularly (compared to 43% in the US), though among my friends the only ones who go to church other than for weddings and funerals are African or from the Caribbean, or Muslims who attend a mosque.

    Tolerance of crime is hard to measure, but in the UK 154 per 100,000 of the population is in prison, compared with 96 per 100,000 in France (though someone convicted of a crime is 7 times more likely to go to prison than in the UK) and 754 per 100,000 in the USA.

    We Brits may still be a bit reserved and many of us seem to require large amounts of alcohol before we feel comfortable expressing our feelings, but the Victorian moral code became terminally ill during the Edwardian era, and died and was buried during WW2, 60 years ago.

  68. #68 Denice Walter
    October 30, 2012

    @ Politicalguineapig:

    I hope you don’t think that I’m overstepping any boundaries here- so pardon me in advance:

    people- all people- use ( unconsciously) the characteristics of how memory itself works to abstract and categorise, developing rules about how the world works – including how people behave, think and interact ( Social Cognition). Usually this decreases the amount of information they need to manage. Stereotyping is one of these short cuts and it is one of the cognitive traps we can fall into – we also “fool ourselves” as the late, great physicist once said. It is perhaps a natural ability that we possess.

    If you limit your exposure to people you might not learn that there are exceptions and complications to these rules. A psychologist phoned hotels ( Allport, long ago) about whether or not they would accept Chinese guests- most said no. When the experimenter later visited in person with the Chinese visitors, reactions were quite different.

    One of the problems with anxiety is that if there is a constant, discernible level that is uncomfortable, a person will attempt to find ways of avoiding experiencing more of it and thus suffering more. Some of the ways to self-protect ourselves limit exposure to others socially as well as physicallyy. Obviously, this will assist you by reducing anxiety but it also limits your experiences and social contacts. As you probably already know, anxiety and depression are intrinsically linked together in a nasty little dance. So by staying away from the dance, you miss a lot of the music.

    Belief systems -including religions,spiritualism , even woo- are also ways that people use to soften the blow of mortality, the diificulties of life and to give people a handle on controlling uncertainty about themselves and others. I could go on. Probably for weeks, but you don’t want that.

    I view social networks and virtual interaction as being real: as in face-to-face interaction, we can pick and choose what we reveal to others. Maybe we can try on different aspects of our selves like we do in a clothing store’s dressing-room before we ‘purchase’ what we like most. I think that we all have a variety of suits that we wear, based on the occasion. More socially relaxed individuals have an easier time of it- social adroitness might involve costume changes.

    Basically, we’re all in the same boat: using what we think and how we think- especially about other people’s thinking ( recursive thought)- to relieve our common woes.

    I think that you have possibilities and shouldn’t sell yourself short: maybe your personality on the net is closer to your real one- you aren’t afraid to say what you mean and stand by your beliefs. That’s a step in the right direction.

    We’re all works in progress. By alligning yourself with reality-based thinking you’ll find that you may have more allies that you think- although they may not agree with you on other issues.

    A real-life example:
    I come from a family with agnostic/ atheistic beliefs going back more than 100 years: one of my best friends is a Catholic , who goes to church and prays. I am not sure how much of that is attributable to up-bringing ( Ireland), her own personality or the fact that she lost a close family member to terrorism – which has truly shaped the course of her life over the past 35 years or so.

    For some reason we understand each other, even though our votes might cancel each other out.

  69. #69 Denice Walter
    October 30, 2012

    And -btw- I’m proud of my trans-Atlantic family, education and relationships.

  70. #70 Narad
    October 30, 2012

    Allport, long ago

    Looks to have been LaPiere. [/pedantry]

  71. #71 Denice Walter
    October 30, 2012

    @ Narad:

    I think I may have gotten it via Allport.

    @ Krebiozen:

    None of those ‘most promiscuous’ countries should really hand their heads in shame too much because it may reflect enlightened attitudes about women..
    We women are equally self- assured enough to sleep around as much as men.

  72. #72 Denice Walter
    October 30, 2012

    HANG their heads i shame…

  73. #73 Denice Walter
    October 30, 2012

    @ Krebiozen:

    And about that alcohol thing:
    one of my ancestors created a very special product to deal with social anxiety- gin. He sold a recipe to a large company, making money which he invested wisely in other relatives’ projects.
    One of my aunts married a poor relation of a famous Irish whiskey maker and my cousin married a poor relation of a famous American pharmaceutical producer.
    So we’ve done our part.

    Supposedly we’re not the only animal that sefl-medicates- I expect you’ve run into that..I don’t have the references here now.

  74. #74 Narad
    October 30, 2012

    Supposedly we’re not the only animal that sefl-medicates

    Something something reindeer urine.

  75. #75 Denice Walter
    October 30, 2012

    @ Narad:

    Oh I’m waiting for Kreb’s take. I’m sure he knows about this.

  76. #76 Alain
    October 30, 2012

    @ PGP,

    Consider getting screened if you can have access to service which may likely help you.

    Alain

  77. #77 Mephistopheles O'Brien
    October 30, 2012

    lilady – I’ve made the points I care to make to PGP, it’s clear she doesn’t agree, and that’s OK.

    And for what it’s worth, the cities of Tulsa and Oklahoma City contract with a private, not for profit firm to provide ambulance services. A board appointed by the govenrments of those cities oversees the operations. See http://www.emsaonline.com. I’m not sure if this falls in to your description or not.

  78. #78 Politicalguineapig
    October 30, 2012

    Enough about me, back to health insurance. I submit the following ideas for your consideration: that we’ve tried the private sector approach, and it’s failed.
    That a government run health care system is often (and almost always) superior to the private sector health care system, and finally that it’s never going to work in the US because we’re too diverse. Note that all the countries where government health care systems work are mono-culture. Discuss.

  79. #79 Alain
    October 30, 2012

    I’d wager that a government regulated health care system would work. There is a few countries having private run hospital & insurance but everyone has a choice of government run health insurance or insurance from the private sector.

    Alain

  80. #80 Alain
    no italics
    October 30, 2012

    I’m off to school, see ya later.

    Alain

  81. #81 Politicalguineapig
    October 30, 2012

    Anteaus: Southern states are very different from the northern states. Most of them deliberately undermine the safety net because their voters won’t be using those nets, and dislike those who do.

  82. #82 Mephistopheles O'Brien
    October 30, 2012

    Define “failed” in this context.

  83. #83 Politicalguineapig
    October 30, 2012

    Basically, private health care has priced itself out of reach. I’d say it’s failed by not being able to serve the intended population.

  84. #84 Mephistopheles O'Brien
    October 30, 2012

    What is the intended population? Who set that,and who set the success conditions?

  85. #85 flip
    October 30, 2012

    @PGP

    How is America more diverse than European countries or Australia/New Zealand? Those countries have immigrant populations, Indigenous populations, etc etc.

    In fact, one reason I suspect the naturopath exists at my local pharmacy is because I also live in a highly Asian-populated area. There is no end of woo here; private and public health insurance; and no end of high-quality SBM as well.

    … Discussing differences of point of view is nice and all, but do your statements come with evidence? Saying the north is different to the south is like saying chalk is different to cheese. Both are true, but not entirely relevant to implementation of universal health services. Equality is equality no matter where you live.

  86. #86 Krebiozen
    October 30, 2012

    Denice,

    We women are equally self- assured enough to sleep around as much as men.

    I’m sure that’s true, though being physically smaller and more easily intimidated they are also prone to coercion. I also think that promiscuity, like drug abuse, may be a symptom of misery and a lack of self-respect, and in the UK is often the result of excessive alcohol and or drug consumption, sadly.

    Supposedly we’re not the only animal that sefl-medicates- I expect you’ve run into that..I don’t have the references here now.

    I have seen it argued that recreational drug use of some sort is a human universal, and if you include nicotine, caffeine and betel nut that’s probably not far from the truth, though I have come across some people who won’t even consume caffeine.

    Incidentally I was in an Indian store today and browsed through the large selection of betel nut and ready-made paan (betel mixed with lime and spices) they had. I got to enjoy chewing betel for a few weeks in India – I noticed a mild but quite pleasant effect from it, though it does have serious long-term health effects so is best avoided. It is used by hundreds of millions of people in Asia, and many die from their habit.

    As for animals, many like to get drunk on naturally fermented fruit. As Narad mentioned reindeer are very keen on fly agaric mushrooms (I could digress into a discussion of urine-drinking, soma and the popularity of urinopathy in India). Then you have cats getting high on catnip and valerian, squirrels and others eating cigarette butts, monkey smoking cigarettes and probably other examples of animal drug use I have forgotten.

    Then you have the experiments on rats and other animals hooked up to various drugs with an iv infusion and a lever they can push to self-administer a dose. If allowed unlimited access to the drug they will keep self-administering drugs like cocaine and amphetamines, but not so much opiates, curiously, until they die.

    On the non-psychoactive drug front, again IIIRC, I think some other higher primates eat plants that kill intestinal parasites, and maybe even rub themselves with leaves that repel fleas and lice.

    We’re not so different from other animals in some ways.

  87. #87 Krebiozen
    October 30, 2012

    Note that all the countries where government health care systems work are mono-culture. Discuss.

    The London borough in the UK where I live has a population of 240,000 people. They are 38% White British, 30% South Asian, 17% Black (African or Caribbean), 5% White Other (mainly Eastern European), 2% Chinese and 1% Irish. It’s not a monoculture at all, quite the opposite, but the government healthcare system here generally works OK. Other parts of the UK are more monocultural but cities are generally pretty diverse.

  88. #88 Shay
    October 30, 2012

    “Note that all the countries where government health care systems work are mono-culture. Discuss.”

    That’s going to be news to Canada.

  89. #89 Narad
    October 30, 2012

    Note that all the countries where government health care systems work are mono-culture. Discuss.

    It might be more straightforward to identify the countries where “government health care systems” don’t “work” and go from there. And you’re in no position to start issuing classroom assignments.

  90. #90 Alain
    on the phone
    October 30, 2012

    you know, one way of making universal health care is to have a commity setting the price of medical procedures. the committee would include key stakeholders to ensure a fair price for everyone. that would leave the place for public and private insurance which would compete for prices and other features.

    Alain

  91. #91 Politicalguineapig
    October 30, 2012

    Flip: Saying the north is different to the south is like saying chalk is different to cheese. Both are true, but not entirely relevant to implementation of universal health services.

    Actually it is quite relevant. The northern states are quite different, culturally and politically then the southern states. For instance, to begin with, in the north, people like to live in the cities, and in the south, cities are to work in, not live in.More people go to church in the south, and they’re less likely to travel then northerners. In the north, education is valued, in the south experience (in anything, including years) trumps education.

  92. #92 flip
    October 31, 2012

    @Alain

    Here we have government oversight on pricing of medications. Many are set to ensure they don’t get too high. These usually only apply to common medications though.

    @PGP

    I see nothing in your statement that would effect how UHC would be implemented nor why anyone of a particular area would have more or less complaint over how it is implemented.

    Nor do I see how it applies to other countries and their implementation of it, especially given the comments about monocultures.

    Firefighters do not behave differently according to whether they’re in the city or not, and ambulances do not turn up to churches more than secular areas. Which was my point: universal healthcare is exactly that – universal.

    Do you have anything other than strange stereotypes to offer?

  93. #93 flip
    October 31, 2012

    @Alain

    Forgot to add the link to the pricing:
    http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/pricing.jsp

    I really should read that properly, but I’m multi-tasking and supposed to be working right now. If I’ve overstated the regulation, let me know.

  94. #94 Alain
    October 31, 2012

    @ Flip,

    Thanks for the ressource, you didn’t overstate it.

    good luck with multitasking.

    Alain

  95. #95 herr doktor bimler
    October 31, 2012

    Note that all the countries where government health care systems work are mono-culture. Discuss.

    Sadly, here in New Zealand that claim would attract more ridicule than discussion.

  96. #96 Narad
    October 31, 2012

    For instance, to begin with, in the north, people like to live in the cities, and in the south, cities are to work in, not live in.

    There comes a time at which renting a backhoe is not the brightest idea.

  97. #97 ChrisP
    October 31, 2012

    Actually it is quite relevant. The northern states are quite different, culturally and politically then the southern states. For instance, to begin with, in the north, people like to live in the cities, and in the south, cities are to work in, not live in.More people go to church in the south, and they’re less likely to travel then northerners. In the north, education is valued, in the south experience (in anything, including years) trumps education.

    Seriously?

  98. #98 ChrisP
    October 31, 2012

    flip, the price of pharmaceuticals is only subsidised by the government if they get on the PBS. To be on the PBS they must be recommended by the PBAC. The PBAC will consider the cost and efficacy of a new drug with respect to existing treatments before making a recommendation.

  99. #99 Shay
    October 31, 2012

    PGP: Your most recent stereotype of North vs South, among other breathtakingly ill-informed assumptions, completely overlooks the huge chunk of the population that lives in rural areas in the North and Midwest.

    There are of course some assumptions that can be made about the political and cultural differences between North and South but you seem to be getting your information from old Dukes of Hazzard episodes.

  100. #100 Krebiozen
    October 31, 2012

    you seem to be getting your information from old Dukes of Hazzard episodes

    BBC costume dramas from the 1970s too I suspect.

  101. #101 Narad
    October 31, 2012

    Your most recent stereotype of North vs South, among other breathtakingly ill-informed assumptions, completely overlooks the huge chunk of the population that lives in rural areas in the North and Midwest.

    It’s really flabbergasting, as though the question “I wonder whether there might be a big pile of data on travel behavior a few keystrokes away” never even bubbled to the surface. Or the question “What does this assertion have to do with the point I imagine myself to be trying to establish in the first place?”

  102. #102 Shay
    the flat as a pancake central Illinois corn and soybean fields
    October 31, 2012

    I grew up in Detroit. I now live in a village of 850 people. There are more cows in this township than humans and that is not hyperbole.

    Our little town has everything in common with the rural Southeast where I was stationed for five years, and nothing in common with Chicago (except of course for our stupendous track record in governors. Three of the last five are in jail).

  103. #103 TBruce
    October 31, 2012

    Canada a monoculture?
    Let’s see, one quarter of the population speaks French as their first language and periodically flirts with forming a separate nation. Big Asian- ancestry and immigrant population in BC and southern Ontario. Large aboriginal population in Saskatchewan and the Territories, with the Territory of Nunavut being predominatly aboriginal. Also Newfoundland, a colony of the UK until 1949 with a distinct culture and dialect.
    As a born-and-bred British Columbian, I lived in Ontario for a year and felt out of place the whole time. I was glad to come back.
    Incidentally, our health-care system has its problems, but on the whole it works very well.

  104. #104 flip
    October 31, 2012

    @ChrisB

    Thanks, I knew there was a catch somewhere…..

  105. #105 Denice Walter
    October 31, 2012

    Here’s where language can be used to precisely illustrate our beliefs about other groups of people:
    as kids become adolescents, they begin to use more qualifers in speech rather than simple dichotomies- e.g. conservatives are MORE LIKELY to believe that small government is best; people who live in cities are MORE LIKELY to be accepting of diversity et al. Notice I didn’t say ALL.

    So if you look at statements like these that have political/social ramifications, you might be able to find polls that illustrate the relationships between groups and ideas. Correlations can run from 0 to 1 ( + or -) and percentages can run from 0% to 100%. We can quantify this. Numbers change how we understand material.

    Some of our friend Pgp’s beliefs may be somewhat accurate.. we can check these out. If we use language more carefully, it’s easier to express what we really mean and what we find in the real world that serves as evidence for our beliefs – all debatable, of course.

    When you read a study about people’s attitudes or political beliefs, it usually isn’t cut-and-dry, although there may be trends. Stereoptypes serve as a shortcut to make judgments about how another person might feel but may be based on over-generalisations- thus they work against you at least part of the time.

    Suppose my previous example about city dwellers’ attitudes toward diversity was based on a set of polls that showed 60% of city dwellers were more tolerant ( based on a specific questionaire) vs only 40% of non-city dwellers: that would definitely tell us that the two groups are different generally but it certainly leaves out a whole lot of people.

  106. #106 lilady
    Still somewhere in the northeast and still have my electric power
    October 31, 2012

    Romney has a FEMA problem…and he doesn’t need Bush’s FEMA director Michael Brown (“Heckuva Job Brownie”) to comment about FEMA.

    http://www.nydailynews.com/blogs/the_rumble/2012/10/romney-cant-run-from-his-comments-on-fema

    Just heard from our friends in Germany. She’s an American citizen. She mailed her absentee ballot to Michigan…a swing state…for the reelection of Obama-Biden.

  107. #107 Politicalguineapig
    October 31, 2012

    The point is that universal healthcare in the US will always be a pipedream because there is no real US culture. There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea. Like, take public education. In theory, each state agrees it’s a good idea. However, many states underfund it and are willing to rob or undermine the education system at any opportunity. I suspect we’d see much the same with universal health insurance.

  108. #108 Narad
    November 1, 2012

    The point is that universal healthcare in the US will always be a pipedream because there is no real US culture.

    You are once again invited to address the list of counterexamples to your “argument.”

    Like, take public education. In theory, each state agrees it’s a good idea. However, many states underfund it and are willing to rob or undermine the education system at any opportunity. I suspect we’d see much the same with universal health insurance.

    You seem to be, like, confusing Medicare with Medicaid.

  109. #109 ChrisP
    November 1, 2012

    There is no real culture in Australia, yet there is universal health care. Why then should the absence of culture be a barrier to universal healthcare?

    When universal health care was introduced to Australia in 1974 (it started operation in 1975) a lot of people were opposed to it, including many doctors and several state governments. All it took was the Federal Government to introduce universal health care.

    By the time the government changed in late 1975 to one that was ideologically opposed to universal health care, they were unable to do more than tinker with the system because of its popularity with the public.

    So I don’t think your argument holds water.

  110. #110 flip
    November 1, 2012

    @PGP

    The point is that universal healthcare in the US will always be a pipedream because there is no real US culture. There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea.

    Yeah because no *other* country in the world has that problem. /end sarcasm

    I reiterate: you have anything other than strange stereotypes?

    @ChrisP

    There’s no real culture here? Hmmm… that must come as a surprise to my artist colleagues. 😉

    No matter how right wing the right-wingers get here, absolutely no one would win a sit in politics if they were to state they’d get rid of UHC.

  111. #111 ChrisP
    November 1, 2012

    flip, I don’t know. My artist friends would suggest Australians are by and large an uncultured lot only interested in football, meat pies and beer.

  112. #112 flip
    November 1, 2012

    Haha – yes, there’s way more interest in footy than in the arts.

    I suggest that your friends are thinking of an Aussie stereotype though. I live in what’s usually considered the cultural hub of Australia. We have plenty of culture, and plenty of people enjoy both sports and arts. And, as I keep trying to point out: a hugely diverse population made up of immigrants, from Europe to Asia and others.

    To say there’s no culture here is incredibly ridiculous.

  113. #113 Denice Walter
    November 1, 2012

    It’s important to remember that stereotyping works like semantic memory works- e.g. when you think of what a dog is, you imagine some type of generic creature of a particular size, that has fur and barks- a dog ‘prototype or ‘average’- not all dogs are that size, have fur or bark. Some of the research in this area sounds like an updated philosophy course… ideas, images, concepts, categories

    So we have convenient sterotypes/prototypes about groups of people: in actuality, cultures are diverse and fall along salient dimensions like *urban/ rural*. City dwellers have something in common; there is also a dimension that involves higher education, another about business culture. Most of us @ RI live in English-speaking areas or speak English. These dimensions interact and overlap.

    Australia has large modern cities with ethnic subcultures. And UNIVERSITIES..The outback is very large but very sparsely populated. People may form their ideas about other cultures from pop culture and movies.

    Not that beer and football are rarities.Beer and football are ALL over-btw.

  114. #114 Krebiozen
    November 1, 2012

    I think PGP is talking of mono vs polyculture, rather than the presence or absence of culture in the sense of arts etc..

    There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea.

    At one time most Americans agreed that the Constitution was a good idea. You already have universal Federal laws that (almost) everyone still agrees are a good idea. If you can agree that laws against murder, theft etc. etc. are a universally good idea, why is it impossible to agree that some sort of UHC is?

  115. #115 flip
    November 1, 2012

    @Kreb

    I agree – but the point I’m trying to make is that the diversity of immigrants, viewpoints, religion, etc here is enough to create diversity in a range of ways culturally, politically, etc. We’re no different to the US, and yet UHC works here despite differing viewpoints, approaches to medicine (ie. SBM or woo), small/large government arguments, etc.

    I just use the arts as an example because I’m involved in it and know just how ridiculously diverse our culture is from that point of view.

    @DW

    Likewise I agree that stereotypes are instinctively used by us. However, we also know that stereotypes are often wrong and used as an excuse for racism, sexism, etc and an unwillingness to look further. We can acknowledge this but it seems PGP wants to ignore the fact that their stereotypes are not only wrong, but irrelevant to the implementation of a health care system. — As I keep pointing out, even if you hate the idea of using public health care, you can still get yourself private assistance. In fact, I’ve used both. If you don’t want it, don’t use it. If you need it, you can – that’s the whole point of UHC.

    (Yeah, preaching to the choir at this point…)

  116. #116 herr doktor bimler
    November 1, 2012

    I think PGP is talking of mono vs polyculture, rather than the presence or absence of culture in the sense of arts etc..
    “There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea.”

    A comparison could be made with Europe, which is not sufficiently integrated into a single economy to sustain a single EU-wide health-care system. It may be that the regional economies within the US are more what PGP is getting at than the regional sub-cultures.

    But we come back to Canada as the counter-example; surely the differences (both culturally and economic) between Alberta and Quebec and Nova Scotia — not to mention the Territories! — are wider than anything in the US.

    Are there any polls showing virulent opposition to UHC within particular US regions? Seems to me (as an ignorant outsider) that all the opposition and the financial lobbying of politicians are coming from vested interests who are doing so well out of the current dysfunctional system.

  117. #117 Denice Walter
    November 1, 2012

    @ flip:

    I’ve found that sometimes data helps people to understand diversity and can help undermine stereotyping or using shorthand over-generalisations.
    Bizarrely enough, people often stereotype themselves as being a certain type of person or having a particular lack of ability, shutting the doors on many potentially rewarding experiences and friendships.

  118. #118 herr doktor bimler
    November 1, 2012

    Bizarrely enough, people often stereotype themselves as being a certain type of person or having a particular lack of ability, shutting the doors on many potentially rewarding experiences and friendships.

    I continue to stereotype myself as “Someone who doesn’t enjoy folk-dancing”.

  119. #119 Krebiozen
    November 1, 2012

    I suspect there’s usually a bit of misdirection going on with issues like this. If you don’t want people looking too closely at an issue, couch it in emotive language, and frame it in ways that divide people. For example, call it “socialized medicine” instead of “universal health care”.

    I would like to know how much money health insurers are making out of the current system? We are told that Americans pay more per capita than anyone else for, on average, lower quality health care. Since I think I’m right in stating that most US health insurers are not-for-profit organizations, perhaps the relevant question is, where on earth is all that money going? Cui bono?

  120. #120 Mephistopheles O'Brien
    November 1, 2012

    herr doktor,

    But we come back to Canada as the counter-example; surely the differences (both culturally and economic) between Alberta and Quebec … are wider than anything in the US.

    Have you ever been to bayou country or compared New Jersey to Wyoming? I won’t say that Canada is less culturally diverse than the US, but i don’t think it’s more.

    And, yes, I’ve been to Canada.

  121. #121 Denice Walter
    November 1, 2012

    @ herr doktor bimler:

    I was once able to entirely avoid a Highland Folk Dance Festival despite being in the same town on the same date.

    However, I wasn’t so lucky with the Norwegian Folk Dance Festival: they were out of doors and not confined to one small area. The risks of travelling, I suppose.

  122. #122 herr doktor bimler
    November 1, 2012

    Have you ever been to bayou country or compared New Jersey to Wyoming?

    I have not even watched ‘Southern Comfort’.

  123. #123 Krebiozen
    November 1, 2012

    I wasn’t so lucky with the Norwegian Folk Dance Festival

    I was terrified by a Morris Dancer as a small child. Rural Cambridgeshire and Essex was swarming with them back then, IIRC [shudders].

  124. #124 herr doktor bimler
    November 1, 2012

    A Life with Bells On was an entertaining movie.

  125. #125 Narad
    November 1, 2012

    You already have universal Federal laws that (almost) everyone still agrees are a good idea. If you can agree that laws against murder, theft etc. etc. are a universally good idea, why is it impossible to agree that some sort of UHC is?

    These examples are not federal laws.

  126. #126 Mephistopheles O'Brien
    November 1, 2012

    I have not even watched ‘Southern Comfort’.

    I have drunk Southern Comfort and lived to tell the tale.

    It was hell in there.

  127. #127 Mephistopheles O'Brien
    November 1, 2012

    Krebiozen,

    If you don’t want people looking too closely at an issue, couch it in emotive language, and frame it in ways that divide people.

    Indeed, like calling universal health care a moral imperative or human right, perhaps? Or saying it’s immoral not to provide “affordable” health care? Or saying that not providing universal health care is “barbaric”?

    Just saying it cuts both ways.

  128. #128 Narad
    November 1, 2012

    I have drunk Southern Comfort and lived to tell the tale.

    Try Yukon Jack. (I have a soft spot for this stuff, but it arises from an event involving Irish who also combined Baileys Irish Cream with dairy in milkshakes, so it’s probably best left alone.)

  129. #129 Narad
    November 1, 2012

    Indeed, like calling universal health care a moral imperative or human right, perhaps?

    Are you willing to embrace the “I’ve got mine, so go away” approach or not?

  130. #130 Mephistopheles O'Brien
    November 1, 2012

    Narad,

    Thanks! Your comment of “I’ve got mine so go away” is yet another example. Much appreciated.

  131. #131 Denice Walter
    November 1, 2012

    @ Krebiozen:

    Your comment causes me to wonder if we both perhaps relish N. African, Middle Eastern and S. Asian culture because we don’t enjoy seeing big, white people like ourselves dancing about and being folksy. ( In foreign cultures, you don’t always know enough details to appreciate its awfulness, I suppose, only natives can).

    AND NOW:
    back to our political debate…

  132. #132 lilady
    November 1, 2012

    @ Krebiozen:

    ” Since I think I’m right in stating that most US health insurers are not-for-profit organizations, perhaps the relevant question is, where on earth is all that money going? Cui bono?

    But they are no longer not-for-profit organizations. For the most part they are big business now. Their executives are well-compensated, receives bonuses, they are corporations that are listed on the stock exchanges…and they have to answer to their stockholders who expect nice returns (dividends) on their investments.

    http://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association

    “Blue Cross is a name used by an association of health insurance plans throughout the United States. Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice-president of Baylor University’s health care facilities in Dallas, Texas.[5] The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally.[5] The American Hospital Association (AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960 the AHA commission was superseded by the Blue Cross Association. Affiliation with the AHA was severed in 1972.

    The Blue Shield concept was developed at the beginning of the 20th century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.[6] The first official Blue Shield Plan was founded in California in 1939. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans.

    In 1982 Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association.[7]

    Prior to the Tax Reform Act of 1986, organizations administering Blue Cross Blue Shield were tax exempt under 501(c)(4) as social welfare plans. However, the Tax Reform Act of 1986 revoked that exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation but entitled to “special tax benefits”[8] under IRC 833.[9] In 1994, the Blue Cross Blue Shield Association changed to allow its licensees to be for-profit corporations.[4] Some plans[specify] are still considered not-for-profit at the state level.”

    Here’s Wellpoint, which is just one of many the Blue Cross/Blue Shield affiliates that are now “for-profit” corporations.

    http://en.wikipedia.org/wiki/WellPoint

  133. #133 Mephistopheles O'Brien
    November 1, 2012

    Are you willing to embrace the “I’ve got mine, so go away” approach or not?

    And just for the sake of argument, why is “I feel guilty about having mine, so you have to give away yours” so noble?

  134. #134 lilady
    November 1, 2012

    Here’s Wellpoint’s listing on the NYSE. I’d say that is a big business stock.

    https://www.google.com/finance?client=ob&q=NYSE:WLP

  135. #135 Krebiozen
    November 1, 2012

    M.O’B.,

    Indeed, like calling universal health care a moral imperative or human right, perhaps? Or saying it’s immoral not to provide “affordable” health care? Or saying that not providing universal health care is “barbaric”?

    I take your point, but you could argue that those are simply opinions. That’s not quite the same as inventing a term like “socialized medicine” simply because a lot of people will associate it with socialism and will oppose it in a knee-jerk reaction, which is what appears to have happened.

    Narad,

    These examples are not federal laws.

    In that case I have been misinformed and now I am confused. Aren’t there federal laws against homicide and theft? I know individual states have their own laws but I thought federal law overruled them, as it appears to in the case of medical marijuana, or is it more complicated than that?

  136. #136 Krebiozen
    November 1, 2012

    lilady,
    I was looking through the Blue Cross Blue Shield Association financial reports earlier, after I asked my wife for the name of a large US health insurer and she suggested them. I found it hard to believe Wikipedia when it says their revenue in 2008 was only $320.5 million, or about $3 per person they insured, but maybe that’s just the association and not their members. I got bogged down in incomprehensible financial jargon and gave up.

    It would be interesting to know how much money goes to insurers in total, including employees, non-profit or not. It’s like the amount of money paid to managers in the UK NHS, which many people suggest is unnecessarily spent on bureaucracy instead of front line health care.

    If an efficient UHC system could be built from scratch, I’m sure everyone would pay less, but unfortunately that’s not really practical in the real world, and politicians end up tinkering with the huge existing bureaucracies.

  137. #137 lilady
    November 1, 2012

    @ Krebiozen: Do the NHS managers make this much money (salary, stock grants and stock options)?

    http://www.ibj.com/compensation-dips-slightly-for-wellpoint-brass/PARAMS/article/33623

  138. #138 Mephistopheles O'Brien
    November 1, 2012

    Krebiozen,

    One could also argue that socialism is merely a label (indeed, one that some people are proud of) for a philosophy that says that people who earn money should contribute to the welfare of those who don’t.

    My thesis (if it may be called such) is that such terms are used for two purposes:
    1. to demonstrate strong feeling; and
    2. to demonize or denigrate those who argue against you.
    If one is to counter the statement that “it is criminal” to have people in society who cannot afford some specified level of health treatment then one must first distance ones self from being a criminal. Same with “it’s barbaric” or “it’s immoral”. Even then, the maker of the original statement is able to fall back and say, “well, you’re just barbaric/criminal/immoral/selfish/et. c.” to any who would argue the contrary position.

    This is why I ask “Says who?” and “what’s your evidence for that?” and in extreme cases “Check your data!”. Well, I more state “check your data” than ask.

  139. #139 Narad
    November 1, 2012

    In that case I have been misinformed and now I am confused. Aren’t there federal laws against homicide and theft? I know individual states have their own laws but I thought federal law overruled them, as it appears to in the case of medical marijuana, or is it more complicated than that?

    There are (well, for murder at least), but they’re very narrowly tailored to the purview of the federal government. There is no federal preemption in the sense of drug laws.

  140. #140 Narad
    November 1, 2012

    And just for the sake of argument, why is “I feel guilty about having mine, so you have to give away yours” so noble?

    I ain’t got none, but that’s neither here nor there. I’m trying to pin down what you now seem to be dancing around.

  141. #141 Mephistopheles O'Brien
    November 1, 2012

    Narad – I’m not dancing around anything. I’m trying to understand why people are placing such a moral imperative on government provided health care as opposed to other vital services that might be provided by the government. I have not expressed an opinion of my own about whether or not government supplied health care is desirable or undesirable.

    My apologies for my previous statement. In light of your most recent message, I’d like to amend that to ask: what’s so noble about saying “I don’t have anything so you owe me”?

  142. #142 Narad
    November 1, 2012

    If I may work backward,

    I’d like to amend that to ask: what’s so noble about saying “I don’t have anything so you owe me”?

    I’ve said no such thing. I supported a single-payer system when I had insurance, and I continue to do so. I certainly don’t expect that any such thing is going to occur, and I know people who have been in far more dire need of health care than I am.

    I’m trying to understand why people are placing such a moral imperative on government provided health care as opposed to other vital services that might be provided by the government.

    Do you imagine this to be a continuum or merely a bucket in which everything that might be on the table is equally worthy of attention?

  143. #143 Alain
    November 2, 2012

    offtopic for a little moment.

    Regarding Wakefield appeal today, is there some new document that I should read (there was supposed to be something today).

    Alain

    back on topic

  144. #144 Mephistopheles O'Brien
    November 2, 2012

    Narad,

    I believe it to be a continuum. i believe it is possible to reasonably disagree where on that continuum it is imperative that government provide services, but that there has to be a line. Of course, once you’ve picked that line, then one may reasonably say that everything on one side is in the bucket and everything on the other side is out. So maybe I believe in a bucket. Or is that beyond the pail?

    I don’t understand why health care must fall on the “government must provide this” side of the line.

    And my apologies (again) if I attributed arguments to you that you did not express. On the other hand, your paraphrase of the Pink Floyd song “Money” (“I’m all right, Jack, keep your hands off of my stack.”) suggested you were doing the same to me…

  145. #145 Mephistopheles O'Brien
    November 2, 2012

    By the way, “single payer” does not necessarily have to be government provided. It could be a government sanctioned monopoly.

  146. #146 Alain
    November 2, 2012

    More on topic,

    Tonight, I requested a package of information about private health insurance which is just starting to be offered to resident of Canada. Now if such insurance plans become more popular, it will forces them to react to the increasing number of private doctor who may likely charge for higher premium (there was a few recent events in, IIRC, 2008-2009 where doctors where in negociation with the Quebec’s government regarding salaries).

    This is the reason I stand behind a commitee of key stakeholders setting the price of medical procedure regardless if it come from the private or the public sector. This will enable sane competition between the insurers.

    Alain

  147. #147 Mephistopheles O'Brien
    November 2, 2012

    Alain,

    Because I’m in an argumentative mood tonight, would you also suggest a committee of key stakeholders to determine the price of automobiles, butter, or audio downloads? What criteria are they to use, and why are these more desirable than an open market approach?

  148. #148 Alain
    November 2, 2012

    🙂

    I’m not knowledgeable enough about the free market to weight in except the lexus doctor will likely offer better care compared to the toyota doctor and insurance will likely charge me a higher premium for going to the lexus doctor.

    Alain

  149. #149 Alain
    November 2, 2012

    BTW, I’m protecting my ass because I’m on disability so I get to deal with excellent doctor with very limited ressources as in McDonald.

    Alain

  150. #150 Alain
    November 2, 2012

    Incidentally, I’m in Montreal tonight because I have an appointment with my primary care doctor this afternoon and under the current regime, I get to see her for a 15 minutes med check and not much more than that but given the occasion, I’d like to have some more time with her but I have to weight that with my ability to pay.

    Alain

  151. #151 lilady
    November 2, 2012

    @ Mephistopheles O’Brien

    We already have the DRGs being used to determine reimbursement rates for hospitalizations…for the people who are covered under a National Health System (Medicare recipients).

    http://en.wikipedia.org/wiki/Diagnosis-related_group

    And, how about the EuroDRG Project?

    http://en.wikipedia.org/wiki/Diagnosis-related_group

    Many of us Democrats and Liberals, wanted a National Health Care System (a.k.a. “Medicare” for everyone)…we have *settled* for the Affordable Care Act.

    Along with that National Health Care System, there *should be* meaningful tort reform…which is doable if the costs of future lifelong medical care is covered under a National Health Care System.

    One other thing. Could we stop calling it *government-provided* health care? It’s our income taxes and payroll deductions that pay for Medicare Part A (only). Medicare recipients pay for Parts B (according to their adjusted gross income) and pay for Part D (drug coverage).

  152. #152 Narad
    November 2, 2012

    Regarding Wakefield appeal today, is there some new document that I should read (there was supposed to be something today).

    They usually don’t update the status until the day after at the earliest, so it’s unknown whether the court reporters made their deadline last I checked. There probably wouldn’t be anything to read anyway; it just starts the next clock (to the 30-day deadline for Wakefield’s appeal brief).

  153. #153 lilady
    November 2, 2012

    BTW, MO’B…I’ve got “mine”. I’m on Medicare and I don’t believe in “mine and scr*w you”.

  154. #154 Narad
    November 2, 2012

    I don’t understand why health care must fall on the “government must provide this” side of the line.

    Perhaps you could provide examples of things that you do think fall on that side so that some sort of comparison could be made.

  155. #155 Alain
    November 2, 2012

    Thanks Narad (re Wakefiled pun intended) and Lilady (for the excellent bit of information regarding price of procedures).

    Alain

  156. #156 lilady
    November 2, 2012

    Oops, I cannot link to the EuroDRG Project…just “Google” it.

  157. #157 Chris
    Neither here nor there...
    November 2, 2012

    M O’B:

    I have drunk Southern Comfort and lived to tell the tale.

    A few weeks ago I found the thirty-plus year we had in the cupboard. I took a sniff of the almost full bottle and wondered why we had it, then I poured it down the drain.

  158. #158 lilady
    November 2, 2012

    @ Alain: Reuben on The Poxes blog has an article you might be interested in (Dachel’s crass use of hurricane Sandy).

    If you post there, please observe Reuben’s policy of not “naming names”, so that he avoids the carpet-bombing Spam from the “bot”. 🙂

  159. #159 Alain
    November 2, 2012

    I agree with pretty much everything he (Reuben) is saying but I don’t feel the need to comment.

  160. #160 Alain
    November 2, 2012

    @lilady, Have a good night.

    Alain

  161. #161 flip
    November 2, 2012

    There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea

    Thinking of this, the best and simplest rebuttal is: people disagree everywhere about everything. Yet we still manage fine with democratic governments, large federal and state services, and commitment to a justic system that enforces laws that affect everyone.

    Saying the US can’t agree and therefore UHC won’t work is pretty much special pleading.

    @DW

    Yes, as always education is the magic bullet 🙂

    I stereotype myself into all sorts of categories. Mostly not good ones. And I also hate folk dancing 😉

    @MOB

    Has it ever occurred to you that some people through no fault of their own, can’t afford many services that would actually make their life better – and therefore actually enable them to earn money and *get off* the government services faster/stop requiring so much from charities?

    I think the idea of barbarism comes from the ‘veil of ignorance’ argument. Pretend you’ve got two babies, one born to a rich family and one to a poor family. Why does the baby of the poor family have to suffer more hardship simply because their parents can’t afford medical bills?

    It’s the same reason we all pay for roads and why we all pay for schools and we all pay for police, etc etc. In general these services on average raise the quality and quantity of citizens/employees.

    Having said that I do agree that the emotional language gets used by all and I hope I have avoided using it.

    I’m trying to understand why people are placing such a moral imperative on government provided health care as opposed to other vital services that might be provided by the government.

    You’ve just set up a false dichotomy. And a strawman.

    what’s so noble about saying “I don’t have anything so you owe me”?

    It’s not noble. As someone who is currently requiring financial assistance, because my health is so bad, I can tell you I wake up every day hating it, knowing it lowers my self esteem, hating asking for handouts and knowing even more that without it I will not be able to function. I don’t think anyone owes me. I do on the other hand feel extremely grateful.

    This is no different than asking your friends for help in a time of need – and wishing fervently to get back on your feet fast so you can repay it. I’d gladly pay for 100 people’s health bills if it means that mine are covered once when I can’t afford it. As someone pointed out above, you pay into the scheme hoping you don’t need it, but knowing it’s there if you do; and this is different from private insurance how?

    Oops, there’s that emotional language. I think at this point I should state: I’m biased 😉

  162. #162 Krebiozen
    November 2, 2012

    lilady,

    Do the NHS managers make this much money (salary, stock grants and stock options)?

    [Falls off chair] Not that much no. A hospital trust chief executive is paid about £200,000, or around $320,000.

    Emotive/moralistic language or not, it doesn’t seem right to me that someone in the health care industry can be paid $13.3 million when so many people are suffering because of a lack of basic medical care. There are many things in the world that seem wrong, but in many cases the solutions are impractical for one reason or another. In the case of US health care, as Orac concluded above, it seems likely that “providing health insurance to as many people as possible is associated with better health outcomes and that lack of insurance is associated with poorer health outcomes”. There are several examples of practical and effective solutions to this problem in the form of countries with UHC. It’s the reluctance of some to adopt any of these solutions that upsets and angers me.

    If Mitt Romney had a different solution to the problem, I might feel differently, but he apparently doesn’t even recognize there is a problem, as he promised in the third presidential debate that the first thing he will if he is elected President is to scrap Obamacare. It seems to me that Romney will make the problem worse. That’s why I find it hard to avoid emotive language in this area; these are decisions that have serious and life-changing effects on people, including some of my family.

  163. #163 Krebiozen
    November 2, 2012

    I forgot to say to M.O’B. – I greatly appreciated the “So maybe I believe in a bucket. Or is that beyond the pail?” joke.

  164. #164 Denice Walter
    November 2, 2012

    I also like “beyond the pail”.. lots.
    ( I should note that a ‘descendant’ of the ‘Great Uniter’ has managed to sow disunity amongst us… not really)

    About emotional speech, we all know how lawyers used it in the case of eyewitness testimony- ” How fast was the car going when it SMASHED into the other car?” ( E. Loftus) It affects how you remember as no one has a videotape-like memory to playback.

    But also in a relatively wealthy society, people might choose to live in a way that eliminates grinding poverty and thus, be willing to pay for assistance to those who aren’t doing as well. Is that more moral? I don’t know, it might be a way to make themselves feel better and live perhaps in a more stable society. Perhaps providing social services and stipends stoke up a sluggish economy and might even lead to increased profits in particular sectors.

    Maybe at heart even our concern for others might be self-serving.

  165. #165 epador
    Pacific NW
    November 2, 2012

    It seems disingenuous to slam a Romney quote and not consider whatever the Romney Healthcare Plan for the Nation (or whatever the hell he calls it), but that is about par for the course when ORAC slips into political discussions. Sadly you begin to resemble the hawkers of medical woo when you venture into political woo. You diss the studies that don’t support your position and promote the ones that do.

    I am also surprised that in my attempts to skim this very long post AND thread, I see nothing about the current “safety net” of medical treatment for the uninsured and underinsured.

    I was a privately practicing Medical Oncologist for 17 years and yet I made certain to know about and interface with my communities. I worked with the local Red Cross medical access programs and the County Health Centers even then. I shucked off the Oncology mantle and have been practicing Internal Medicine in the military, , VA and in Federally Qualified Health Centers (FQHCs) since. So I have a broad perspective of health care delivery from personal experience over 36 years of practice. FQHC’s provide access and quality care for un-insured and underinsured as well as those who otherwise have limited health care access (rural and isolated settings). You’ve got plenty in your neck of the woods, ORAC. I don’t see any mention of them or their history in your epistle.

    You might choose to forget that this program was quadrupled under the administration of GWB.

    The BO administration has increased spending, but proportionally not as much, and with a whole new set of strings. If people are dying because they CAN’T get care it might be because the health centers are forced to convert to EMR’s that are not fully developed AND decrease their productivity, and divert administrative and provider time and effort to meeting “Meaningful Use” and “Primary Care Medical Home” projects. These great sounding in theory but a nightmare for administrators and providers programs are diverting energy and money away from health care delivery in the short term. They may have some great long term benefits, but that remains to be seen.

    As far as most of my patients without insurance go, the major barriers they have to receiving good medical care are their attitudes, culture and lifestyle. Most of the fact checking for what the Obama Campaign has put out there as sob stories about uninsured patients have shown them to be disingenuous if not blatant lies. That’s not to say there are hard case stories out there, but there will be in any system of care you devise. From my perspective, on the front lines, for every one patient without insurance who is working hard, and trying to make something of themselves, I see 5 whose main goal in life is to find a way to qualify for disability and ride the gravy train for the rest of their life. The main complaint I hear from these 80% is that their last SSI hearing did not find them disabled.

  166. #166 Orac
    November 2, 2012

    As far as most of my patients without insurance go, the major barriers they have to receiving good medical care are their attitudes, culture and lifestyle.

    Evidence needed.

    Most of the fact checking for what the Obama Campaign has put out there as sob stories about uninsured patients have shown them to be disingenuous if not blatant lies.,

    Evidence from a third party source not connected with partisan political parties or movements needed.

    That’s not to say there are hard case stories out there, but there will be in any system of care you devise.

    Citation needed.

    From my perspective, on the front lines, for every one patient without insurance who is working hard, and trying to make something of themselves, I see 5 whose main goal in life is to find a way to qualify for disability and ride the gravy train for the rest of their life. The main complaint I hear from these 80% is that their last SSI hearing did not find them disabled.

    And I think that this about says it all about “your perspective.” Of course, one of the lessons of SBM is that a single practitioner’s personal experience can very easily be profoundly misleading. It’s true about whether a given treatment will work or not. It’s true about, for instance, Dr. Jay Gordon’s antivaccine views, in which he accepts his 30 years of “personal clinical experience” above objective scientific studies to support his fervent belief that vaccines cause autism, asthma, and a variety of chronic health problems. And it’s true about making conclusions like the ones you’ve just asserted to be true. Your argument, at its heart, is no different from Dr. Jay’s when bases his belief that vaccines cause autism solely on his own experience as a pediatrician.

    I think this post discusses how being “on the ground” can lead to a deceiving impression:

    http://scienceblogs.com/insolence/2006/02/24/impressive-science-failing-to/

  167. #167 lilady
    November 2, 2012

    I’m calling bullsh*t on epador’s remarks. See my comments up thread (October 24 th), about my experiences working as a public health nurse/clinician in seven satellite public health clinics, within my County’s department of health…

    “I worked as a public health nurse. I worked, and I still reside in a County, which has diverse populations . We cared for people in our seven satellite clinics who were uninsured, underinsured, on Medicaid and who were undocumented immigrants. I felt then, and still feel, that we provided a medical home for these patients. Many of the patients came to us for aftercare after they had been treated in our County hospital. No one was ever turned away.

    Isn’t it a good thing, that our County hospital and County public health clinics provided preventive health care and ongoing health care for pregnant women, young babies and older people, who were uninsured? Isn’t it far better to provide immunizations and to treat emerging health problems, in their early stages, instead of hospitalizing people for advanced cancers, diabetes, and cardiac problems?

    Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?

    Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?

    What about the *silent killers* (elevated blood glucose levels, hypertension and hyperlipidemia) that go undiagnosed and untreated due to lack of insurance? Do we as a society want people to go into major organ failure or lose their eyesight due to undiagnosed and untreated glaucoma, because they lack insurance?

    I have familial hypercholesterolemia, and because I had medical insurance my condition was monitored…but untreatable. I was enrolled in one of the early Lipitor trials by my private physician. When the trial was unblinded, my cholesterol level was 180 mg/dl…down from 400 mg/dl. What would my health status be today, if I didn’t have insurance coverage?

    I’ve had medical coverage for my entire life and eternally grateful that I was able to provide that coverage for my children. I was able to afford the extraordinary costs associated with my disabled son’s medical care, that were not covered by my medical insurance. I also have great empathy for those who are uninsured and underinsured, because I know only too well the devastating consequences of not having coverage for preventive care…for diagnosing of diseases and disorders in their early stages…before they become life-threatening/incurable.”

    Why don’t you tell us what the impact of Obamacare is for people who have pre-existing conditions, epador?

    Why don’t you tell us what the impact of Obamacare is for people who lose their private medical insurance, through the loss of their jobs, epador?

    How about discussing the “lifelong” caps on coverage for someone with a chronic or an acute serious illness, which are now removed, under Obamacare, epador?

  168. #168 Nineveh_uk
    UK
    November 4, 2012

    What are these “forced interventions/vaccines” of universal healthcare that Jen is going on about? I live in the UK, and have only ever had NHS treatment. All vaccines are voluntary. Some (TB, rubella) are given in schools, but a parental permission sliip must be signed – mine wasn’t because I was needle-phobic at the time, no problem. There is no vaccine requirement to attend state schools, as I understand there is in some areas of the US. Forced interventions/treatments? The only people who can be forced to have any treatment are patients with severe mental illness, or children who are not Gillick competent. I rather doubt that no 5-year olds are ever given medicine against their will in the US, and no people with severe paranoid schizophrenia admitted to hospital against their will. And then there’s the US case of Samantha Burton – if Jen’s relatives are afraid of forced intervention then they need to be told it is already there.

  169. #169 Narad
    November 4, 2012

    I rather doubt that no 5-year olds are ever given medicine against their will in the US, and no people with severe paranoid schizophrenia admitted to hospital against their will.

    I will risk veering off-topic, but it’s actually extremely difficult to achieve “involuntary” status in the current U.S. inpatient psychiatric model. (This is instantiated on the state level, but I think it’s fairly uniform.) The “informal” status that came about in the ’70s has effectively ceased to exist, leaving “voluntary” and “involuntary.” The former category carries some legal burden for the hospital on the off chance that someone who is chemically restrained and has limited phone access is going to wind up with a lawyer, but it implies assumption of the debt involved. Plus, they really want to get rid you as well. The “involuntary” category is where one has to go to court more or less to start with, and means state hospital, or “The Snake Pit,” to recollect the lurid film.

    What this means, in practice, is that care is not exactly provided well. The notion that mass “forced treatments” are anywhere in the vicinity of the real world is laughable.

  170. #170 Narad
    November 5, 2012

    (To tie that back in some fashion, I think the “informal admission” model was quite laudable. Inpatient psych, however, does not seem to be a money-making operation. I don’t know how it could really be effected without a single-payer system, and I don’t know that it could be even then. Still, the way things operate in the present is to let matters get so bad that they simply can’t be ignored any more.)

  171. #171 Jen
    November 5, 2012

    Ninevah, if you bothered to read some of my other posts, I (Canadian) am not concerned in the least about UHC. We have medical care (unencumbered by insurers) that works very well overall in Canada. As to vaccinations, we seem to be quite similar to Britain where they are basically voluntary as well. Kids can attend schools no problem if not vaccinated. We don’t do hep b at birth, similar to Britain. I sometimes wonder if that has just pushed things too far for parents in the US.- just a thought. Please don’t respond again stating that I am concerned about forced interventions. I. am. Not. It seems as though some Americans feel differently- although MI Dawn says it’s no biggie if you don’t want statins or vaccines, for example. I still think insurers add to the cost of care and 13 million is obsene

  172. #172 Jen
    November 5, 2012

    Ninevah, if you bothered to read some of my other posts, I (Canadian) am not concerned in the least about UHC. We have medical care (unencumbered by insurers) that works very well overall in Canada. As to vaccinations, we seem to be quite similar to Britain where they are basically voluntary as well. Kids can attend schools no problem if not vaccinated. We don’t do hep b at birth, similar to Britain. I sometimes wonder* if *that has just pushed things too far for parents in the US.- just a thought. Please don’t respond again stating that I am concerned about forced interventions. I. am. Not. It seems as though some Americans feel differently- although MI Dawn says it’s no biggie if you don’t want statins or vaccines, for example. I still think insurers add to the cost of care and 13 million payed to anyone in the healthcare industry is sick.

  173. #173 Narad
    November 5, 2012

    It seems as though some Americans feel differently, based on this story I attribute to random acquaintances my snowbird in-laws that I just thought I’d bring up and defend for a while but now find inconvenient, although I’ll go ahead and mention it another time.

    FTFY.

  174. #174 lilady
    November 5, 2012

    Jen…back again, eh?

    Up thread you were the one who injected herself into this thread with your anti-vaccine comments.

    Obviously, you are clueless about the science of immunology, virology, bacteriology and still clinging to that now thoroughly debunked theory of vaccine(s)-induced-autism.

    Ta-ta, for the third time.

  175. #175 Jen
    November 6, 2012

    Ninevah brought it up again, not me and mischaracterized my relatives as being afraid of forced medical treatments – they’re not – they are Canadian- their American friends (some) feel differently. LIlady and Narad, you sound bitter that some in US might fight UHC based on fears of having to follow certain medical protocols as part of the package- I think it was a legitimate point to bring up given the topic – if you don’t think so then that’s your problem. You remind me of kids who don’t want to hear some things just because you don’t like/agree with them.Try and have a nice day, though I doubt that’s possible- you both sound hopelessly miserable. MI Dawn – do you think insurers should be involved in primary healthcare? I don’t. Ta-ta.

  176. #176 lilady
    November 6, 2012

    Jen…show us where “forced medical procedures” (vaccines or any other “forced medical procedure”) shows up anywhere in the Affordable Care Act…or for that matter anywhere in this thread.

    Ta-ta, for the fourth time.

  177. #177 Jen
    November 6, 2012

    Lilady, since you think it’s so outrageous/ implausible that some people would be afraid of forced medical procedures in terms of UHC or any healthcare in the US for that matter then what would you call vaccination of newborn infants with hep b vaccine when parents have not signed consent for it or declined it, but see on medical records later that it was given?? (or even worse, threatened with CPS and having their baby taken away because they don’t want to have the neonate vaccinated with hep b ) Is that a) a medical ”mistake” the nurse made or b) veering into forced medical intervention territory? Or is anyone that says this has happened lying (I’ll help you out here- that’s highly unlikely).

  178. #178 lilady
    November 6, 2012

    You’re blabbering again Jen. Do try to stay on topic…we are soooo interested in your third-hand knowledge of how your in-laws Republican friends in Florida, feel about the Affordable Care Act.

  179. #179 Narad
    November 6, 2012

    you sound bitter that some in US might fight UHC based on fears of having to follow certain medical protocols as part of the package- I think it was a legitimate point to bring up given the topic – if you don’t think so then that’s your problem

    You haven’t demonstrated your assertion in any meaningful fashion. It’s merely a peg for you to hang antivax tinfoil-hattery on.

  180. #180 Jen
    November 6, 2012

    Lilady, it doesn’t show up in the affordable health care act (nor should it) but some people (rightly or wrongly) worry about it in the US. O.K. Narad, this concern doesn’t exist because you don’t want it to. I don’t know but maybe there is a poll somewhere that discusses concerns some Americans have about UHC. In Canada we find it works fine, more or less.
    @Lilady – you avoided my question as to unwanted hep b vacc to neonates- medical mistake (without consent) or forced intervention?

  181. #181 Jen
    November 6, 2012

    Narad, just saw a Wiki article- Public Opinion on Healthcare Reforms and a recent poll puts 45% of people concerned that government would decide on healthcare for elderly (a general concern) I am sure there are more specific polls re. Americans’ concerns (rightly or wrongly) about UHC. That would be a peg, buddy.

  182. #182 Lawrence
    November 6, 2012

    @Jen – I’m always confused by people have issues with “other people deciding their care” because right now, insurance companies have way more control over treatment decisions than the government ever would (especially since the Affordable Care Act is only about providing Health Insurance to Everyone – not dictating treatments).

    If you don’t have an issue in Canada, we certainly won’t have one here – unless, I guess, they try to make Tylenol mandatory, right Jen?

  183. #183 Narad
    November 6, 2012

    O.K. Narad, this concern doesn’t exist because you don’t want it to. I don’t know but maybe there is a poll somewhere that discusses concerns some Americans have about UHC.

    So, the idea is that you just assert it (and it was “many Americans,” remember), in the process tossing in vaccinations and the completely inexplicable “forced statins,” and now you’re down to “maybe there’s a poll somewhere,” all the while maintaining that I’m failing to face The Truth?

  184. #184 JGC
    November 6, 2012

    Lilady, it doesn’t show up in the affordable health care act (nor should it) but some people (rightly or wrongly) worry about it in the US.

    Thank you for calling attention to the fact people sometines are afraid of things that don’t exist.. But we’re aware of this already, as this particular false concern is analogous to the ubiquitous false concern that vaccines are associated with autism, where similarly, despite the fact that no evidence has’shown up’ (i.e., been found) to establish any such association many people ‘rightly or wrongly’ (and wrongly, as it turns out) worry one exists.

  185. #185 Narad
    November 6, 2012

    Narad, just saw a Wiki article- Public Opinion on Healthcare Reforms and a recent poll puts 45% of people concerned that government would decide on healthcare for elderly

    Perhaps you’d like to actually cite it, as searching on the phrase that you helpfully capitalized turns up nothing relevant.

  186. #186 lilady
    November 6, 2012

    Is this the Wiki article than “Jen” references?

    http://en.wikipedia.org/wiki/Public_opinion_on_health_care_reform_in_the_United_States

    (Possible, the worst of the worst Wiki articles I’ve ever wasted my time reading)

  187. #187 lilady
    November 6, 2012

    Lawrence…have you read anywhere that the ACA will make penicillin/cephalosporins *mandatory*? I’d rather take my chances with Palin’s “death panels”.

  188. #188 Narad
    November 6, 2012

    Is this the Wiki article than “Jen” references?

    Oh, for G-d’s sake, that’s “death panels.” It’s the opposite of Jen’s “forced interventions” claim.

  189. #189 Narad
    November 6, 2012

    (Actual poll question: PPACA “Will allow the government to make decisions about when to stop providing medical care to the elderly.” Ergo, “forced statins.” Sure thing. Nice job, Jen buddy.)

  190. #190 lilady
    November 6, 2012

    Narad…for me “mandatory” penicillin/cephasporins is a “death sentence” (highly allergic).

    BTW, I don’t have *a problem* with forced statins…I have familial hypercholesterolemia.

  191. #191 john clegg
    WIGAN LANCASHIRE ENGLAND
    November 7, 2012

    Come and live in england we are organised

  192. #192 Jen
    November 7, 2012

    @Lilady, ” you’re blabbering.” Well you are dodging/ avoiding. In the above case, where a nurse /doc administers hep b to a neonate without parental consent it would either be a mistake or a forced medical intervention, wouldn’t it? Oh but you don’t want to answer that. Laugh about Tylenol/ penicillins all you want. Pathetic.

  193. #193 Krebiozen
    November 7, 2012

    Jen,

    In the above case, where a nurse /doc administers hep b to a neonate without parental consent it would either be a mistake or a forced medical intervention, wouldn’t it?

    Technically I suppose it would be one or the other but since, as the CDC points out:

    Since the vaccine became available in 1982, more than 100 million people have received Hepatitis B vaccine in the United States and no serious side effects have been reported.

    Why would any rational parent object? Hepatitis B is very nasty indeed, and the vaccine is extremely safe. I just don’t see the problem. I wish hepatitis B was routinely administered here, in the UK.

  194. #194 Krebiozen
    November 7, 2012

    Hepatitis B vaccine, obviously.

  195. #195 MI Dawn
    November 7, 2012

    Hi, Jen. Actually, believe me, a signed consent IS required for the Hep B vaccine for the neonate in the hospital (at least, when I worked there). Any parent who says they didn’t know it was given is either forgetful or lying. In fact, though it’s been many years, I had to sign a consent for all the vaccines my children got (or they did, once they were old enough), and I got the information page with the vaccine, the risks, the benefits, side effects to watch out for, etc. I used private doctors and clinics and both treated vaccines the same way. I don’t know who your friends and inlaws talk to, but at least in my experience as a US citizen, I’ve never gotten a vaccine without giving consent.

    Oh – and parents are told about all shots (Hep B, Vitamin K) the baby is given in the nursery, as well as the eye drops. And they may decline any/all interventions as long as a release is signed, at least at the numerous hospitals I have worked in. And that includes all levels of society.

    And at the moment, I don’t know of ANY health insurance where people pay more for refusing vaccines, statins, etc. I do know of some groups (NOT the insurer, but the group buying the insurance) that put higher premiums on members who smoke, are overweight and don’t exercise, etc. But that has nothing to do with Obamacare. That’s been going on for at least 7 years that I know of. S

  196. #196 lilady
    November 7, 2012

    @ Jen: You are again interjecting your anti-vaccine views into this thread. I know you lurk here and have seen my posts directed to other trolls about the birth dose of hepatitis B vaccine.

    Do try to stay on topic and do try to avoid blabbering.

  197. #197 MI Dawn
    November 7, 2012

    Oh, and to answer your question: a vaccine – or ANY medication given without parental consent would be a medication error. The parent(s) would be told, an incident report filled out, and, depending on the severity of the incident, the nurse might be disciplined or terminated. Nursery nurses are not just randomly injecting any and all infants with vaccines.

  198. #198 lilady
    November 7, 2012

    @ MI Dawn:

    I recall one instance, related to me by an I.D. doctor at a local birthing hospital, where a mother attempted a home birth and then went to the hospital for delivery. She *might* have been attended by an amateur midwife or a nurse-midwife, who had failed to order a maternal hepatitis B surface antigen test during the pregnancy.

    Consequently, IIRC, when the mother balked at having her child immunized with the hepatitis B vaccine, and, in the absence of a maternal blood test result to determine the mother’s hepatitis B carrier status, hospital staff was quite insistent that the infant should receive the hepatitis B birth dose, before the infant was released by the hospital. When the situation was explained to the mother, she agreed to have her infant immunized with the birth dose of hepatitis B vaccine.

    Every State has department of health regulations in place that require OBs and nurse-midwifes to test expectant mothers for the presence of hepatitis B surface antigen. Every State has department of health regulations in place that require a copy of the maternal hepatitis B surface antigen laboratory test result to be sent to the birthing hospital, prior to the EDC.

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