Medicine Politics Skepticism/critical thinking

Mitt Romney, health insurance, and the myth that no one ever dies because of lack of health insurance

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.


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.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

398 replies on “Mitt Romney, health insurance, and the myth that no one ever dies because of lack of health insurance”

The question “does anyone die earlier because of lack of insurance” doesn’t even pass the smell test.

Suppose the converse is true, and people live about the same length of time whether they are insured or not. Why, then, does anyone bother to get health insurance?

Does non-emergency health care serve any purpose whatsoever? Clearly it does and Mitt is talking nonsense.

While Romney’s statement is certainly out of touch (limiting itself to acute care only), recall that during his term as governor Massachusetts enacted its own universal health care law. Presumably he does see the benefit of reducing financial disincentives to getting ongoing care and early diagnosis, but chose not to mention that in this particular sound bite.

As one of them libruls, I had hoped that underneath all the hard-right bluster needed to secure the Republican nomination, Romney might at least be a competent technocrat. Those hopes appear to have been ill-founded.

“So Mitt, if it doesn’t matter whether anyone has insuance, why did you create a policy in Mass where people were required to buy insurance or pay a penalty?”

For kicks and grins?

Hopefully this won’t end up like the comment section on your friend’s healthcare post!

I’m a filthy socialist from Britain, so my brain is boggled by a “developed” country that institutes fees for being born, then continues billing until the last breath.

Mittens is either deluded or a liar. Not sure which is worse. I have… I had American friends who’ve died due to lack of money. 21st century USA. A place where needing oxygen has to be weighed up against needing to pay rent.

That was a different Mitt, mindy. The one that was for stem cell research, that one that said “I believe that abortion should be safe and legal in this country. I believe that since Roe v. Wade has been the law for 20 years, that we should sustain and support it. I sustain and support that law and the right of a woman to make that choice.”

The one that stated in a letter to the Log Cabin Republicans he was in favor of “gays and lesbians being able to serve openly and honestly” in the military.

The one that said “I’m proud of what we’ve done. If Massachusetts succeeds in implementing [Romneycare], then that will be a model for the nation.”

Clearly it’s some other Mitt Romney running for president–version 2.0.

The one that said “I’m proud of what we’ve done. If Massachusetts succeeds in implementing [Romneycare], then that will be a model for the nation.”

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?

“See, it was OUR idea, and the president just borrowed it. Vote for us, because we are the ones with ideas! The president also followed through on my idea to bail out the US automakers. These are all MY ideas, not his!”

For some reason, I don’t see that campaign being all too successful.

Clearly Mitt is lying for political points. That puts him in a very large majority group of politicos. Its his lack of math skills that worry my more. Using the emergency room for primary care has huge negative liabilities.
$$$ Requires hospitals to employ more staff.
$$$ Requires patients to wait for care making them sicker and causing them to miss work.
$$$ Requires hospitals to eat costs and raise fees for insured patients. $5 aspirin, etc.
$$$ As Orac notes, lack of insurance delays action by many causing treatable conditions to be less so and at far greater cost.

Anecdote alert: On a Sunday one June, I got fever and chills and a red line appeared on my leg next day. The internet said go to emergency NOW. Wife drove me over on a Monday evening and I waited 6+ hours before I was through triage and began receiving treatment. Meanwhile the red line had moved north many inches. And I HAD insurance.
Cellulitis was diagnosed next day and I spent 3 more days in a hospital bed on intravenous antibiotics watching the line retreat and fade. The crowd of sick folks in emergency delayed my treatment and caused me to spend more time (according to the doctor) in hospital. Had I been seen quicker, I might not have needed to even be admitted. A huge cost my insurance picked up that raises their costs and eventually, my and everyone else’s copays.

Way to screw up the math Mitt. Way short on empathy too.

“So Mitt, if it doesn’t matter whether anyone has insuance, why did you create a policy in Mass where people were required to buy insurance or pay a penalty?”

Easy. Because it scored the political brownie points it needed to. He correctly deduced that a majority of voters in that state favored such a health care plan. His policies are *solely* built around what he thinks will best advance his political career.

Glad you wrote this. As a Canadian I find it hard to swallow the way things are done in the U.S.- one of the highest infant mortality figures in the world, not a great life expectancy compared to other countries and probably all too many “Scotts.” We spent (Canada in 2009) our lowest amount of health costs on docs (relative to hospitals and pharmaceuticals). Perhaps docs could take less money there? (I know there are lawsuit problems). Hospitals could be less hotel-like? Talking to some friends from Texas I was kind of sickened by their choices when shopping for hospitals to give birth at. Jesus, I mean women have been giving birth for eons and we don’t really need fountains and 5-star hospitals that look like hotels.
I will admit a few friends have gone over to the US for angioplasty re. their MS. The private system does encourage innovation. They did find a lot of improvement -not placebo presumably since improved eyesight can’t be faked- but one re-stenosed so obviously the corrections seem to be short-lived for some and the problem needs more study.
Interesting parallel between studying insured/non-insured and vacc non-vaccinated. I think in light of your country having one of the highest infant mortality rates and the most aggressive infant vaccine schedule at least more animal model studies need to be done to compare safety (or tease out the variables in studies of the many who have already opted to not vaccinate).

Multifarous Mitt, the American Janus-

Erving Goffmman wrote that people present themselves to the public one way and perhaps are privately quite a different person ( later on, he wondered if there was anything at all beneath the surface) So is there any *there* there, Mr Mitt?

This creature seems to have been outed through a spy video of his interaction with wealthy donors, next he speaks conservatively to socially and economically conservative partisans and later on, more moderately to a wider audience. Maybe he does Janus one better.

From what I’ve seen, I think he’s all about money and he stiffly manoeuvres himself around that fact by continuously talking about how charitable he is and how much he cares for his country . For a supposedly adroit businessman, he seems to have trouble with mathematics and communication. And I’ve seen logs with more empathy.

But here is the killer for me: the reliance upon trickle-down and de-regulation to stimulate a flagging economy- maybe he’d mimic the creative stylings of Mssrs Reagan or Bush; recently PM David Cameron brilliantly argued that governmental cutbacks were appropriate in an economic downturn. I’m sure that will work out really well.

So like elburto, I’m a socialist too. And a Keynesian. If you keep cutting taxes for wealthy people, there’s no guarantee that they will create jobs or even keep the money in the national economy- they can put it aside or invest overseas.

The guy basically wants lower taxes to augment his own wealth although he doesn’t pay high tax rates to begin with: he is supported by extremely wealthy people and might not have an inkling of how the other half lives. I think that wealthy people are not doomed to being clueless about the less fortunate but in his case, I don’t know whether it’s a choice or reflects a disability. Young children attribute poverty and wealth to personal characteristics, as they get older they tend to implicate more environmental and social causes. Not everyone gets more liberal in this way apparently.

jen — I realize you have a particular axe to grind against vaccines, but please, even if you were right, you would be addressing an anthill while a mountain stands next to it. Same with stents; I agree the science behind those is still a bit murky, but that’s not the main problem here. The main problem in the US has nothing to do with the quality of care or the vaccine schedule or any of that — it’s to do with the appalling reality that a huge percentage of Americans have little to no access to the excellent health care that we have here. We’ve got MRIs in strip malls, for goodness sakes. But all that means precisely squat if you don’t have a way to pay for it.

Babies die, mothers die, young people die, old people die, needlessly and in far too much pain, all because they are in a position of choosing between health care and rent or food or utilities. Each state sets a limit on the maximum income a person can receive and still qualify for assistance; in the state of Mississippi, it’s so low that if you make any money at all, you will pretty much not qualify. And even if you do qualify, the system doesn’t cover much. Prenatal care? Nope; very few states provide any sort of assistance for that — and those that do, it’s usually just Planned Parenthood, which is now under assault in the name of preventing abortions, without any proposals to replace this vital service to expectant mothers. The teen pregnancy rate is a factor as well, of course; babies born to teen mothers are much less likely to survive long because they are more likely to have problems.

I have health insurance. My babies had regular checkups until they’d regained their birthweight, and then after that they had periodic checkups during the first year, then bi-annual checkups, then annual. If there had been failure to thrive, it would have been noted and dealt with. But if I didn’t have health insurance, would I have taken them in for all those checkups? At $130 a pop, that’s doubtful. Anything causing failure to thrive would likely be addressed not via a regular checkup but in the emergency room, when the child’s health finally crashed and there would be much less that could be done about it.

So whether stents or vaccines are worthwhile is really not the main problem in this particular debate. There are far too many Americans who would like to have to worry about which vaccines to take or whether or not to get a stent, because it would mean they had some sort of choice in the matter. As it stands, for the most part the only choice they have is to skip them all, because otherwise they’ll go bankrupt. Wait a bit longer on that stent; maybe it’ll clear up without it, and then you’ll be able to afford to buy the kids new school clothes this year, that actually fit and don’t have patches on the patches. People argue about whether or not various breast cancer treatments are effective, while far too many women are crossing their fingers and hoping so they don’t have to fork over three months rent to pay for testing. We need to keep studying the effectiveness of all interventions, but we also need to address this serious problem that for too many people, it doesn’t even matter since they can’t afford it anyway.

For the TL;DR version:
Vaccines or no vaccines, this is something we should be able to agree on, Jen. Inability to pay for health care is killing people. That’s something we could fight together for.

As our most esteemed and gracious host observes, alt media thinks that less access to SBM might actually be healthy.

There’s no cloud obscuring this silver lining**, I catch a glimpse of them rubbing their greedy, little hands together because if people are too poor for SBM perhaps they are primed for *health care* ( instead of *sickcare*, i.e. SBM) provided by THEM.

If you check out Adams’, Null’s or Mercola’s stores at their websites: so many of the products offered are “immune- enhancing” or meant to be used as stopgap preventive medicine : Adams’ new store ( @ Natural News) includes a preparedness section with herbal ‘medicine cabinets’ of varying sizes to address any health problems you might encounter: obviously you don’t have to save them for total societal collapse.

** to THEM, ot in reality

Calli, I totally agree with you. I was just pointing out that the private system does encourage some innovation. Also with respect to vaccines I just brought it up since Orac had an interesting parallel between studying insured/uninsured.
I cannot for the life of me understand how Mitt can say the things he does with a straight face. I also just don’t get how they square it (not being for universal care) with their religious beliefs. I’m pretty sure (and I consider myself to believe in God but not be super-religious) Jesus would stand for universal healthcare. It is worth fighting for.

Mark Hoofnagle at denialism has a series of posts examining the health care systems of various wealthy countries, including the US.

The other countries reviewed have systems ranging from actually socialist, such as the UK’s NHS, to regulated but privately-run, such as the Netherlands’, which if memory serves most closely resembles what PPACA could lead to.

Since on average almost every other wealthy country spends approximately half what the US does on health care, and gets comparable health outcomes, it seems to me that the US could certainly change its present system without compromising on what certainly is high-standard care (when you can afford it).

If insurance doesn’t matter to outcomes, then Mittens should have Ann drop all insurance coverage. And the horsie, too.

Might be tough on Ann, but I gotta say — with one friend who can’t afford an electronic wheelchair (and who has no insurance) and thus can’t leave her house, up agaisnt Ann Romney talking about how great horseback riding is for her….and then to hear that insurance doesn’t matter when having a platinum-plated, diamond-encrusted insurance plan obviously *does* matter for Mrs. Mittens….it pisses me off.

Cover everybody, end of story. It’s the only civilized thing to do.

I strongly suggest folks wander over to TED . com and look up some of Hans Rosling’s earlier presentations. He’s done great work mining public databases for multiple countries and plotting over time how their commitment to economic expansion or health care played out over the following years. Countries that invested in health care had both larger overall economic growth and more stable economies, where countries with an economy only focus shoot up initially then plateau and straggle for a long time. I’m not doing his “Gapminder” presentations justice, they’re great, please check them out for yourself.

Perhaps one of the problems I see with some of the analysis is the grouping of insured vs. uninsured. Being insured unfortunately isn’t necessarily the same as being able to afford healthcare when you are talking about skyrocketing premiums and deductibles. Just something potentially clouding the waters…


the U.S.- one of the highest infant mortality figures in the world

Nonsense, not even close! Infant mortality in the US is 5.98 per 1000 births. There are over 170 countries with higher infant mortality than the US with Afghanistan the worst with 121.63. I’m sure healthcare could be improved in the US but grossly exaggerating matters isn’t helpful.

BTW the main reason for the slightly higher infant mortality rate in the US as compared to other developed countries is the relatively higher rate of premature birth, not poor health care. I could have sworn I have pointed this out to you before. Perhaps it was someone else.

Count me as a Massachusetts resident who was pretty pleased with Governor Romney, but can only view Candidate Romney as completely off his rocker.

I hate having to try and decide between one bunch of clueless morons who think that Medicare’s just fine the way it is vs. another bunch of delusional idiots who think that defaulting on our national debt is a viable political strategy, the Earth is 7000 years old, and AGW is a hoax.

Neither “do nothing” nor “do something, but who knows what it will actually be” is a viable option, but they’re the only two on the table.

BTW the main reason for the slightly higher infant mortality rate in the US as compared to other developed countries is the relatively higher rate of premature birth

Is it just the rate of premature birth, or is it that the US is more proactive in trying to save premature births, and not just filing a 26 wk death as a miscarriage or neonatal death, and not included in infant mortality?

I know there are differences in standards for different countries and I don’t know if that is reflected in your link.

krebiozen, thanks for the link. I don’t mean to derail the topic as Calli pointed out but there must be statistics to compare pre-term and normal birth baby mortality rates (US “last 3 average was even poorer at 7.07). The US has mandated a hep b at birth series which is significantly different from other countries. The WHO states that more than 110 countries have adopted a national policy of immunizing all infants with hep b. There is no straightforward list and I can tell you that in Canada even though this is the formal line recommended by certain medical associations, the only province that immunize infants against hep b are Nunavut and NWT. I looked at the schedules.
I see that MIller, Goldman have looked at the issue (Infant Mortality Rates Regssed Against Number of Vaccine Doses Routinely Given). Even though they say preventing pre-term births is essential to lowering IMR’s, they also note that “nations such as Ireland and Greece, which have very low pre-term births compared to the US, require their infants to receive relatively high number of vaccine doses (23- including hep b at birth in both those countries) and have correspondingly high IMR’s. Therefore reducing pre-term birth rates is only part of the solution to reducing IMR’s.”
The main issue at hand though is universal healthcare which I believe is the right thing.

Is it just the rate of premature birth, or is it that the US is more proactive in trying to save premature births, and not just filing a 26 wk death as a miscarriage or neonatal death, and not included in infant mortality?

Some advocate this but our infant mortality rate is evidence of our failing healthcare system, as when you break it down state-by-state you see how reflective it is of economic disparity. The infant mortality rate in Massachusetts (4.9) for instance, rivals that of any other country in the world, whereas as you spiral down towards the Mississippi (10.9) it is more comparable to Latin American and eastern European post-soviet states. This isn’t due to saving more premies or having a lower age of viability. It’s a failure to invest in prenatal care and screening as well as worsening poverty. Even within states doing well overall there are huge disparities between white infant mortality and that of minorities. Look at the Kaiser data, it’s fascinating.

I don’t recall Mr. Romney saying “it doesn’t matter whether anyone has insurance”. That sounds suspiciously like a strawman. If someone can point out where he said that, or something very much like it, I will, of course, retract and apologize.

Mr. Romney is quite wealthy and may very well underestimate the hardship that paying for routine medical care imposes on those less well off.

I am a socialist, as well. Lawrence O’Donnell an MSNBC TV journalist, explains what being a socialist means to him:

O’Donnell called himself a “practical European socialist” in a 2005 interview.[2] Despite regularly expressing support for regulated capitalism and mixed economies, O’Donnell again declared himself a “socialist” on the November 6, 2010 Morning Joe show, stating: “I am not a progressive. I am not a liberal who is so afraid of the word that I had to change my name to ‘progressive’. Liberals amuse me. I am a socialist. I lie to the extreme left, the extreme left of you mere liberals.”[31] On the 1 August 2011 episode of The Last Word, O’Donnell further explained, “I have been calling myself a socialist ever since I first read the definition of socialism in the first economics class I took in college.” O’Donnell went on to state that what he means by calling himself a socialist is.

Not that we choose the socialist option every time but we do consider socialism a reasonable option under certain circumstances; in fact, under many circumstances. As any introductory economics course can tell you, there is no capitalist economy anywhere in the world, and there is no socialist economy anywhere in the world, not even Cuba. We are all mixed economies; that is, mixes of capitalism and socialism, and we all vary that mix in different ways. China has more capitalism, and a lot more capitalism, than has Cuba, but it also has a lot more socialism than we [the United States] do. Our socialist programs include the biggest government spending programs: Social Security, Medicare, Medicaid, as well as welfare, and the socialist program I hate the most, agriculture subsidies. Yes, I’m a socialist, but I hate bad socialism, and there is plenty of bad socialism out there, just like there is plenty of bad capitalism out there, like the capitalism that pollutes our rivers or makes health care too expensive for so many people. I can argue this because every side of this is true: capitalism is good, capitalism is bad; socialism is good, socialism is bad; all of those things are true at the same time. That’s why we have a mixed economy, an economy in which we are trying to use the best, most efficient forms of capitalism, and the best, most efficient forms of socialism, where necessary. So my full truth is I am as much a capitalist as I am a socialist; but since we live in the only mature country in the world where “socialist” is considered such a dirty word that no one would dare admit to being one, I feel more compelled to stand up for the socialist side of me than the capitalist side of me.[32]

Some advocate this but our infant mortality rate is evidence of our failing healthcare system, as when you break it down state-by-state you see how reflective it is of economic disparity

Doesn’t it also correlate strongly with racial demographics?

Denice- Cameron’s cuts are going fabulously! Things are on the up and up.

Child poverty – up

Fuel poverty – up

Domestic violence – up

Hate crimes* – up

Depression and other MI diagnoses – up

Repossessions – up

Complaints against the NHS – up

I could go on, but frankly, I’m depressed enough. Cameron thinks we should be aiming for US-style welfare and healthcare systems. I think we should be aiming at his head.

*Against people with disabilities. Cameron’s govt has blamed our economic woes on disabled welfare claimants. Violence and harassment against PWD has trebled, suicides have increased, and almost 40 of us die every week after being refused disability benefits. Several are so ill that they die during, or on the way out of their “medical” assessment.

Many have received their “You are fit for work ” notices on the morning of their own funeral, while lazily lounging in a wooden box in an attempt to avoid aforementioned work.

Sure, the previous government started the ball rolling, but as Cameron’s campaign was built around his role as the father of a disabled child (who’d died soon before). As a man who was terribly afraid for the safety of PWD, especially children, under a Labour house.

Camoron and Rmoney are Randroids from the same factory, without a shred of conscience or a molecule of empathy between them.

Next week’s New Yorker cover pokes at Romney’s flip flops. So far, nothing on health care.

…and then to hear that insurance doesn’t matter when having a platinum-plated, diamond-encrusted insurance plan obviously *does* matter for Mrs. Mittens….it pisses me off.

It’s called “I’ve got mine, s___w you”. Very Republican.

I formerly worked at one of the UK’s leading cancer hospitals, in part dealing with the deaths in hospital. When reviewing case notes, delays in treatment could be due to relative delays in initial diagnosis, or possibly poor management in their local centre (since some patients had rare cancers which only very specialist centres had real experience with, this was not a huge surprise). However, the largest problem with delayed treatment was usually to do with initial presentation of the patient. Men were historically the worst (and cases of lung cancer would have often only a short period of time from diagnosis anyway), but I do remember the awful case of a former nurse who ignored a lump in her breast, to the point where it was the size of a large coin. It was concluded that she had simply lived in denial.
However, at no time did I ever come across anyone who died because they could not afford to see a doctor, because there is no charge to see a doctor under the NHS. As a father of two young children, one of which has asthma (inherited from me), I am profoundly glad of this, as was the Swiss based British business man who I remember at the hospital who had basically spent all that he and his family had on treatment. He simply changed from a private to an NHS patient – the care was identical, but at least he was not going to be bankrupt or turned away.
The barrier to entry by charging, both for primary and Hospital care makes no sense – it simply delays treatment until it is often too late.

Unfortunately, our current government has decided that the Us system, which delights our right wing politicians and think tanks for its ideological purity, and therefore we might end up with similar horror stories to the one in the article.
If the BBC website allows it, have a look at a two part series called ‘Health Before the NHS’ . It shows how awful the system was before 1948, and how the idea of patient payment ,charities and a patchwork of care simply did not work.
It’s also interesting to see both how private patients were much better treated, and how much many more established doctors fought against the formation of the NHS, using exactly the same arguments that still exist in the US. They were wrong then, and such ideas are still wrong now. They are also expensive, incoherent and inefficient.


It’s a failure to invest in prenatal care and screening as well as worsening poverty. Even within states doing well overall there are huge disparities between white infant mortality and that of minorities. Look at the Kaiser data, it’s fascinating.

While I entirely agree with you about the importance of prenatal care and screening – I’m a Brit and have worked for and supported the NHS for most of my working life – I don’t think the facts support your views in this case. Why do Blacks do so much worse than Whites in Mississippi yet Hispanics do better? Are Blacks and Whites more socially deprived than Hispanics? There is something else going on here, and I don’t think it’s quite as simple as you paint it.

The more I have dug into this issue, the less clear-cut it seems: teenage pregnancy, obesity, prematurity and low birth weight are significant factors which also correlate with social deprivation. There is a good discussion of these issues in this paper which points out that the US actually does better with low birth weight babies than Canada, but has significantly more of them which pushes up the average infant mortality rate.

To clarify my last comment, I don’t think providing good health care for people who are suffering health issues due to social and economic deprivation is enough, any more than providing emergency health care for people with chronic illnesses is enough. I’m somewhere to the left of lilady on this, I suspect.

Why do Blacks do so much worse than Whites in Mississippi yet Hispanics do better? Are Blacks and Whites more socially deprived than Hispanics?

What’s the size of the Mississippi Hispanic sample?

What’s the size of the Mississippi Hispanic sample?

“Total Births of Hispanic Origin 1,513”, so not huge, as you might expect, but big enough to achieve statistical significance, I would guess, and IIRC the same trend is seen in other states as well. Preterm births in Whites and Hispanics were around 14%, in Blacks 22%. Low birthweight in Hispanics 6.9%, in Whites 9.1% and in Blacks 16.4%. That must surely account for a substantial proportion of the difference in infant mortality. Percentage of mothers beginning prenatal care in the first trimester in Hispanics is 73.1%, in Whites 89.6% and in Blacks 77.3%. So more Black mothers get 1st trimester prenatal care than Hispanics, but infant mortality in Blacks is more than twice that in Hispanics.

So more Black mothers get 1st trimester prenatal care than Hispanics, but infant mortality in Blacks is more than twice that in Hispanics.

Well, there’s certainly something going on. What I was vaguely wondering about was the relative mobility of the populations. One might speculate that the Mexican immigrant population has a return base, which could select for those in comparatively stable situations to remain. This speculation is entirely a product of my own experience with a few folks who work in the neighborhood, though.

@ Krebiozen:

“To clarify my last comment, I don’t think providing good health care for people who are suffering health issues due to social and economic deprivation is enough, any more than providing emergency health care for people with chronic illnesses is enough. I’m somewhere to the left of lilady on this, I suspect.”

Wanna bet, Krebiozen?

See my posts on *another blog* …and my dissing of *GOGs* (Greedy Old Geezers) who are on Medicare

@ lilady:

Believe it or not, I may be to the left of both of you: I don’t think that we’ll ever really get anywhere unless we go far BEYOND health care… to education.

Notice I can be the blithe socialist and still make money in the market : business should be regulated and citizens’ basic needs should be guaranteed to a certain level in wealthy countries.

There has to be a way we can sell the idea that predominantly middle class societies benefit rich people because there is a large consumer base to buy your products and services and you live in a better place in many ways. It’s like Henry Ford’s idea: pay workers enough so they could purchase the cars they make- on a wider scale.

@ elburto:
It is awful: that’s what happens when children of privilige run social policy mindlessly- not that all wealthy people are like those two. I hope you feel better: his reign as PM can’t last forever. Although a few years can feel like forever.

Wanna bet, Krebiozen?

Definitely not! I just wanted to be clear that my skepticism about the influence of the quality of healthcare on infant mortality is a reflection of my political stance, and you seemed a handy reference point, having just declared your socialist position 😉 I’m not sure how we would objectively measure our respective distances left of center anyway. Feet, meters, Bolshevinches?

I meant, “is nota reflection of my political stance”. Time for me to be asleep.

JGC: Version 2? Nah, we’re up to version 5.5, at least.

Jen: I don’t think you’re very familiar with the US. The “risks” of the Hep B (or any vaccine) do not outweigh the many, many factors that come into play in the first year of life. First of all, there’s pregnancy, which brings someone into the clutches of judgy, judgy ob/gyns, who may or may not be actually invested in the patient, and at the worst, may choose not to save the mother’s life. And that’s if you can *afford* prenatal care.
If one’s lucky enough to have a healthy baby, the parents have to chose between one parent (usually the mother) sacrificing their career, or putting the kid in day care. A lot of parents try to save here, and, in my state, we’ve had a big problem with unlicensed and overcrowded daycares.
Then there’s the premie problem. A lot of premies have respiratory and heart problems. My mom, who works with neo-nates, has had at least two patients who were on the organ transplant list. One girl got her transplant, the other didn’t.
Finally, I agree that Jesus would probably be cool with universal healthcare. However, God isn’t.

Just got in from a drive on highways where there was a lot of reactionary nonsense on billboards, etc. Some major pin-headery – pompous tea party “scientist” gonna *fix* our public schools, prosperity & jobs for everyone, and diet-based cancer treatment, too.
Refreshing to read today’s insolence and the thread. I live in an area with steep political gradients. I live in a good spot, but you don’t have to go far & and it gets ugly quickly.
IWW, eh? soshlists, too. Oh my. It’s good to be home

There has to be a way we can sell the idea that predominantly middle class societies benefit rich people because there is a large consumer base to buy your products and services and you live in a better place in many ways. It’s like Henry Ford’s idea: pay workers enough so they could purchase the cars they make- on a wider scale.

Well, my socialist brothers and sisters, I do suspect that Narad is probably to the left of all of us: more power to him!

On a lighter note:
today’s TMR features a post by Ms Money in which she advises a mother of a newborn ( with GI issues) about a “clean diet and organic food” as well as lecturing her on allergens, toxins, vaccines and immunology. She wants to prevent another case of autism from occuring- she tells her friend what she wishes SHE knew when her own daughter was born.

Fast forward: at 13 months, the boy is diagnosed with PDD. AND the mother questions Ms Money’s ideas about the vaccine-autism hypothesis, calling that idea’s chief promotor “an idiot” and his paper “garbage”. Money is angry that a person could have such strong views without EVER having read AJW’s paper herself or doing “research” on the topic: this new Mom just takes the mass media’s and experts’ word for granted,” falling prey to rampant propaganda”- another viictim of the mis-information campaign.

In addition, she complains that many people who write or comment on blogs ( I wonder who they might be?) are so adamant WITHOUT fact checking or doing their own “research”.
I guess they just dream up their odd theories and data.

Dam Olmsted does his usual shtick @ AoA. on expert witnesses.

I don’t which entry is more hilarious.

PoliticalGuineapig, I totally agree with you that there are many factors that come into play where prenatal and baby wellness are concerned- I have heard horror stories of people in the US who don’t have care or have to pay exhorbitant amounts for that care. I wonder if the hospital portion (fancy, high-grade hospitals with fountains etc.) could cut down health care costs or even doctor’s salaries (though I know the US has a very litigious atmosphere these days). I don’t think the hep b issue is small for many, though. It seems kind of like the straw that broke the camel’s back for many. A lot of people seem to be very worried about bonus-payments for vaccine compliance being tied in with universal health care. As I said in Canada we have universal health care and even if the WHO states that we have a hep b for infants official policy there are only two provinces that have hep b on the schedule for infants.

…they play/and they sing and clap and they play/when they get all your coin on the drum/ then they that you’re on the bum.

I can think of vaccines and diagnostic tests (for things like cancer, for instance) as the simplest way of debunking the claim that nobody has ever died from lack of health insurance.

But they’re right: No “one” has ever died from lack of health insurance; it’s probably far more than that.

Jen, where are these fancy hotel-like hospitals? They can’t be very common.

The spousal unit had a knee replacement at one of our two county medical centers recently, and I attend monthly meetings at the other. The lobbys are nice but once you get to the wards and the offices everything’s more like the local Chevy dealership than the Ritz. And we’re in a pretty prosperous area.

(The food was about what could be expected, too).

On a lighter note:
On another lighter note Temple Grandin has had her brain scanned.

The Boing-Boing writer notes:

Some scientists think that the common differences we do keep seeing — especially the bit about the larger brain volume — might be a clue that what eventually becomes autism actually begins in the womb.

There will be butt-hurt.

jen, so your solution to the problems with high cost of health care in the US involves scaring parents out of using a preventative health measure (hep B vax)?

Brilliant. Are there any issues you won’t try to twist into an anti-vaccine agenda?


Jen, where are these fancy hotel-like hospitals? They can’t be very common.

That was our experience at the Mayo Clinic. The lobbies were very nice, but the actual working part of St. Marys Hospital was just like the any other hospital. The room was just like the one son was in at our local university hospital. The food spouse and I had at the cafeteria was like any other institutional eatery, with perhaps a few more low fat and gluten free options.

Though one of their brochures did say there are luxery suites at a much higher price. They are not covered by insurance. It looks like one way to get extra funds to help pay for those who cannot pay (like the woman who we help take her stuff from the hospital shuttle to the motel room that she was paying for with vouchers from the Mayo’s social worker), since it is actually a non-profit medical organization.

Narad: Did you ever run into my cousin? I think she was a member of the IWW, and I know she was a card-carrying Communist. Lovely little old lady, who was going to protests on her scooter until she was 90.

THS: Do you come from Wisconsin? I was on a road trip last week and I wore out my middle finger. It’s gotten so bad I’m

Jen: I think vaccines have to be included in universal health care because people won’t get them otherwise. My state had a whooping cough epidemic, and I’m pretty sure there were only two reasons for it: Wakefield, and the fact that the population that wasn’t vaccinating was very, very poor. As for hep B, I do think it’s neccessary. Most people with Hep B won’t even know they have it until they start experiencing renal failure. I don’t know about you, but dialysis is not on my to-do list.
This time around you do seem to be participating in good faith, so I’m trying to be nice. But I’m also going to give you a warning: if you say one word about ADD or autism, the gloves will be coming off.

Orac is tentative in criticizing the article by Megan McArdle, who in my view deserves a considerably higher concentration of Insolence ™. See:

I post this in support of Orac’s analysis, which I think is improved by the proper perspective on this person’s … searching for a word … “work.”

Shay and Chris, I don’t know the names of the hospitals in Texas but these people described them as being like 5 star hotels – amazing food, beautiful decor, fountains.
I believe specialists make double what our docs do here (ie. orthopedic surgeons) and family physicians make significantly more. All these things are what make up the cost of healthcare- doctors, hospitals and pharmaceuticals.
I saw in one discussion where a man said he paid $9000,00 for a CT scan in the US (15 minutes of imaging) and then paid only 1,200.00 at a private facility in BC. That’s quite a difference and greedy insurance companies can be thanked for that.
Chemmomo and Pgp, I’m not even going to go there about what I think of the necessity of hep b vaccination at birth, I just mentioned it as one of the factors (more mandated vaccines and bonuses for docs who get a certain standard of vaccine compliance) as one of the big issues for quite a few people when it comes to universal healthcare who would welcome it otherwise.

Herr Doktor, thank for the reference to Temple Grandin’s brain. She is an incredible woman.

While we are on the topic of political organizations, are you a Botialist?

Oooh that last sentence was convoluted. Basically, there seem to be a lot of people who are nervous about universal healthcare for reasons to do with vaccination compliance, whereas they don’t seem to be as concerned if they have private insurance companies.

The lobbies were very nice, but the actual working part of St. Marys Hospital was just like the any other hospital.

That’s interesting. A few years ago in the UK, I worked for a hospital that was part of a large private medical organization, i.e. non-NHS, for a couple of months. I had a good nose around while I was there. The private rooms (no wards) were lovely, the hospital set in beautiful leafy woodland and the food, at least the food the staff ate, was excellent. We even got free tea and coffee.

However, the laboratory I worked in was using a computer system that appeared to have traveled through a time warp from the 1980s, in fact it was far more primitive than the system I was using in an NHS lab in 1986. It had a text interface, for goodness sake. Unbelievable. I also discovered the analyzer I was assigned to hadn’t been serviced in years and was giving the wrong results.

My impression was that appearance was everything, but under the surface and behind the scenes things were not as good as the NHS, and to my surprise the pay the lab staff got was lower than the equivalent NHS pay (I was working as a locum through an agency, so was thankfully being paid considerably more).

Of course if anything went badly wrong the patient was sent to the nearest NHS hospital, where often the same consultant would use NHS resources to clean up the mess.

Sorry, jen, this makes no sense

they don’t seem to be as concerned if they have private insurance companies

If this were true, we wouldn’t have an active anti-vaccine movement here in the land of the free from universal healthcare, would we?

Basically, there seem to be a lot of people who are nervous about universal healthcare for reasons to do with vaccination compliance, whereas they don’t seem to be as concerned if they have private insurance companies.

Living in the UK I don’t remember ever meeting anyone who was at all concerned about vaccines, or anyone who wanted to see an end to universal healthcare. My GP was running low on flu vaccine last week when I went for my shot, and I had to use all my persuasive powers to convince the nurse I needed it (I have been having episodes of coughing, wheezing and turning blue lately, so I think the vaccine is wise), so I don’t think uptake is low in my area. Just saying.

Wouldn’t private health insurers be more likely to refuse you coverage, or quibble about reimbursement, if you were not up to date with your recommended vaccinations? The thing about universal healthcare is that it’s universal, in theory at least.

Krebiozen, the Mayo Clinic is private, but it is still a non-profit. Due to its reputation it attracts lots of wealthy patients, whose names adorn plaques in the lobbies that they help fund. It also includes a health clinic system and medical school.

Rochester, MN is very different kind of town.

Krebiozen, I am not sure about the private insurers, I just know that many people seem to equate universal healthcare with a lot of negative things- forced procedures etc. Here in Canada I just don’t see that happening. My family can opt for the kind of treatments that we want, in consulting with our doctor. We aren’t “forced” to do anything. Most people are happy with our system, albeit some wait times are too high (for example for colonoscopies).

Narad: Did you ever run into my cousin? I think she was a member of the IWW, and I know she was a card-carrying Communist. Lovely little old lady, who was going to protests on her scooter until she was 90.

My “new” downstairs neighbor (scare quotes because she’s been in the building for ages but only just moved close to me), an octogenarian, was a long-time organizer, so there might be but a handful of degrees of separation. She’s very much cut from the Faith Petric cloth. John Prine had to use her piano when he hadn’t one of his own.

Still, we’re not communists. Not even anarcho-syndicalists, really.

When I looked up luxury or elite hospitals in Texas I found Methodist Hospital and St. Luke’s Episcopal -queen size beds, granite counters, DVD/CD players…

Jen, why don’t you link to them like did to the Mayo’s suites? It says on that website that insurance will not cover most of it.

Are the luxury parts for everyone, or only the elite in those two hospitals?

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