Should We Allow The Uninsured To Die?

lpast said:

Nonesense my wife owned a large salon...all her employees made 40 grand and more 15 yrs ago...and only a couple of them chose to pay for health insurance even when reduced group rates were offered to them through my wife and they all could have afforded it...they didnt think they needed it...they all made good money but if something catastrophic happened only the richest could afford to pay it out of pocket.
Do you actually believe that anyone is going to follow ron pauls ideas...do you think for a second that they would ever be implemented....your pissing up a rope...hes nuts...not all his ideas are bad and some I agree with ...but the rest are too far out there.
Stop and think...right now today if doctors and hospitals werent subisidized with our tax money to take care of illegal immigrants health care, there wouldnt be but a couple of hospitals with the doors open out west...they would all be closed and doctors would flee the area in drove...Paul is a weaver...he throws out these great sounding plausible argument that a small segment wants to hear, that will never happen in 2012...pauls been spouting the same things for years and has never taken into acct the changing world.....I have to laugh when the same Ron Paul lovers railed on McCain as being to old and out of touch and the bow before Ron Paul and hes older and waaaaaaaaay more out of touch

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You don't understand the argument and it's not really worth my time explaining it all.

tessaesque said:

Cancer Survival Rates Vary by Country
Most Cancer Survival Rates in USA Better Than Europe and Canada » Secondhand Smoke | A First Things Blog
Cancer Survival - NYTimes.com

Heart disease deaths statistics - countries compared worldwide - NationMaster

You have to do some math on this one. Basically, strokes account for 25 of deaths in America, 7% in Canada, and I couldn't get the numbers for "Europe", which is how this site lumps them. My original claim came from a health book I have in storage, but this site shows the basics:
Stroke Statistics | Internet Stroke Center

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ALWAYS control for population variance if you want to better understand the influence of the health system on outcomes:






Here is what I wrote in another thread about breast cancer:


Breast cancers are not all the same in how they develop. One key difference is found in Estrogen Receptors:




The question that needs to be asked is whether there is population variance seen for the distribution of ER+ and ER- breast cancers.




Oh oh, there is population variance. Now the question shifts to "what does this mean?"





So, when black women develop breast cancer they tend to develop a more aggressive type which is more difficult to treat and which results in higher rates of mortality. International comparisons on breast cancer treatment outcome don't account for this at all. What's happening with a US-Norway comparison on breast cancer treatment outcomes is not a comparison of the financing systems of the two countries, but a comparison of white Norwegian women being treated successfully for predominantly ER+ breast cancers and US women, who are a mix of white women suffering from ER+ breast cancer with a more successful treatment regime in place and black women who have higher rates of ER- breast cancers which are more aggressive and result in higher mortality, and the outcomes for both groups (I'm leaving out Asian, Hispanics, Natives, etc just to simplify the point here) are mashed together and we look at American outcomes and then we presume that the difference in mortality arises from how we structure our health care model.

Breast cancer is just one example of how population variance skews international health comparison reports. Disease related population variance is seen for most diseases. This is why you need to control for population variance in these international comparisons, and that's not just for health reporting, you need to do it for things like poverty, for infant mortality, for educational outcomes, for crime, etc. Compare Norwegians to Norwegian Americans and you get a better understanding of how social programs, the focus of your study, are affecting outcomes. Don't do that and all you get is gibberish.

Two graphs from the CDC on Breast Cancer incidence rates and mortality

RiverDad said:

ALWAYS control for population variance if you want to better understand the influence of the health system on outcomes:

Here is what I wrote in another thread about breast cancer:


Breast cancers are not all the same in how they develop. One key difference is found in Estrogen Receptors:

Receptors for the female hormones estrogen and progesterone are another key personality feature of breast cancer.

These receptors are the eyes and ears of the breast cells, getting messages sent by the hormones and figuring out what to do with these messages. The hormones will tell the receptors to stimulate or "turn on" breast cell growth. Estrogen and progesterone can increase both normal and abnormal breast cell growth.

If a tumor is estrogen-receptor positive (ER-positive), it is more likely to grow in a high-estrogen environment. ER-negative tumors are usually not affected by the levels of estrogen and progesterone in your body. This is one time when hearing the word "positive" may really mean something good.

As ER-positive cancers are more likely to respond to anti-estrogen therapies. If you have an ER-positive cancer, you may respond well to tamoxifen (Nolvadex), a drug that works by blocking the estrogen receptors on the breast tissue cells and slowing their estrogen-fuelled growth​

The question that needs to be asked is whether there is population variance seen for the distribution of ER+ and ER- breast cancers.

Estrogen Receptor Breast Cancer Phenotypes in the Surveillance, Epidemiology, and End Results Database

ERN was correlated with premenopausal disease, black race, and poor prognostic factor groups, whereas ERP was associated with postmenopausal disease, white race, and favorable tumor characteristics.​

Oh oh, there is population variance. Now the question shifts to "what does this mean?"

Black women may be at increased risk for aggressive, difficult-to-treat triple-negative breast cancer, independent of their age and weight, researchers found.

Tumors that did not express estrogen or progesterone receptors or HER2 were three times more common among black women than among white women (P=0.0001), Carol L. Rosenberg, M.D., of Boston University Medical Center, and colleagues reported online in Breast Cancer Research.

The effect of race or ethnicity in the single center cohort did not vary with age and body mass index, suggesting that triple-negative disease "likely contributes to black women's unfavorable breast cancer prognosis," the researchers said.

Black women in the U.S. have an overall lower risk of developing breast cancer overall than their white peers, but their cancers are diagnosed at a higher stage, with a greater risk of recurrence and worse prognosis.

Prior studies have found a higher rate of triple-negative breast cancer in minorities including blacks. . . .

Overall, 20% of the women had triple-negative tumors while 72% expressed estrogen, progesterone, or both types of receptors. Some 13% were HER2 positive.

However, triple-negative breast cancer was not evenly distributed among racial and ethnic groups. Black women had a 30% rate of these aggressive tumors compared with just 11% to 13% in the other groups.

In a multivariate regression analysis, triple-negative status was three times more likely among black than white women (95% confidence interval 1.6 to 5.4).​

So, when black women develop breast cancer they tend to develop a more aggressive type which is more difficult to treat and which results in higher rates of mortality. International comparisons on breast cancer treatment outcome don't account for this at all. What's happening with a US-Norway comparison on breast cancer treatment outcomes is not a comparison of the financing systems of the two countries, but a comparison of white Norwegian women being treated successfully for predominantly ER+ breast cancers and US women, who are a mix of white women suffering from ER+ breast cancer with a more successful treatment regime in place and black women who have higher rates of ER- breast cancers which are more aggressive and result in higher mortality, and the outcomes for both groups (I'm leaving out Asian, Hispanics, Natives, etc just to simplify the point here) are mashed together and we look at American outcomes and then we presume that the difference in mortality arises from how we structure our health care model.

Breast cancer is just one example of how population variance skews international health comparison reports. Disease related population variance is seen for most diseases. This is why you need to control for population variance in these international comparisons, and that's not just for health reporting, you need to do it for things like poverty, for infant mortality, for educational outcomes, for crime, etc. Compare Norwegians to Norwegian Americans and you get a better understanding of how social programs, the focus of your study, are affecting outcomes. Don't do that and all you get is gibberish.

Two graphs from the CDC on Breast Cancer incidence rates and mortality

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I've defended you in the past, by why in the holy hell must you make EVERY SINGLE POINT about race? It is neither pertinent nor relevant to my point in any way.

In the days before Medicare and Medicaid, the poor and elderly were admitted to hospitals at the same rate they are now, and received good care. Before those programs came into existence, every physician understood that he or she had a responsibility towards the less fortunate and free medical care was the norm. Hardly anyone is aware of this today, since it doesn’t fit into the typical, by the script story of government rescuing us from a predatory private sector.

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The above has to be the biggest load of bull**** I've ever seen. It's not surprising there isn't even a citation for it. It's simply untrue. 100 years ago if you had money, you had no healthcare. That's the way it has been for the overwhelming majority of modern medicine's existence. Want a source? All you have to do is ask me the name of the country in question and I'll find 10-20 books on the subject.

Hatuey said:

The above has to be the biggest load of bull**** I've ever seen.

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The Kerr-Mills program covered elder care before Medicare.
Not sure why you'd call it bull when it existed.

Ohh and a citation.

Before 1965, federal assistance to the states for the provision of health care was provided through two grant programs. The first program was established in 1950 and provided federal matching funds for state payments to medical providers on behalf of individuals receiving public assistance payments. In 1960, the Kerr-Mills Act created a new program called "Medical Assistance for the Aged." This means-tested grant program provided federal funds to states that chose to cover the "medically needy" aged who were defined as elderly individuals with incomes above levels needed to qualify for public assistance but in need of assistance for medical expenses.

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http://www.policyalmanac.org/health/medicaid.shtml

tessaesque said:

I've defended you in the past, by why in the holy hell must you make EVERY SINGLE POINT about race? It is neither pertinent nor relevant to my point in any way.

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Anytime international comparisons are noted the implication is always that it is the system of medical care which is the primary determinant of patient outcomes. You posted a link to 'Cancer Survival Rates Vary by Country" - well those survival rates are not just determined by how much medical care and the sophistication of that medical care that was delivered to the patient.

So, this data that I provided actually makes your case stronger because the US has some population groups with higher incidences of heart disease or more aggressive forms of breast cancer and despite this manages to deliver better survival rates compared to other countries with populations which exhibit less aggressive forms of breast cancer or heart disease.

PzKfW IVe said:

The target is obvious:

Make the argument that I should be forced to provide you with goods and services that you, yourself, cannot afford.

While doing so, be sure to address the fact that while you have the right to life, you are not entitled to the means necessary to exercise that right.

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Alright, I will make that argument. Because, see, we live in this thing called a society, and sometimes it's beneficial to everyone for all the members of a society to pitch in for the common good. Because, see, the common good includes you.

atrasicarius said:

Alright, I will make that argument. Because, see, we live in this thing called a society, and sometimes it's beneficial to everyone for all the members of a society to pitch in for the common good. Because, see, the common good includes you.

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people that pitch in do so voluntarily, which I have no problem with.

the problem is, you aren't asking all members of society to pitch in. you are forcing a very small percentage to handle it all because they can.

Hatuey said:

The above has to be the biggest load of bull**** I've ever seen. It's not surprising there isn't even a citation for it. It's simply untrue. 100 years ago if you had money, you had no healthcare. That's the way it has been for the overwhelming majority of modern medicine's existence. Want a source? All you have to do is ask me the name of the country in question and I'll find 10-20 books on the subject.

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the books will likely be authored by Walter Duranty though

ARealConservative said:

people that pitch in do so voluntarily, which I have no problem with.

the problem is, you aren't asking all members of society to pitch in. you are forcing a very small percentage to handle it all because they can.

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That might have something to do with them having most of the money.

Goshin said:

That might have something to do with them having most of the money.

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it might have more to do with making it easy to buy votes when you pit a large percent of the population against a very small percentage.

atrasicarius said:

Alright, I will make that argument. Because, see, we live in this thing called a society, and sometimes it's beneficial to everyone for all the members of a society to pitch in for the common good. Because, see, the common good includes you.

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and I would argue, how does it benefit the common good to allow the weakest members of society to artificially survive? we should take a cue from nature. look at a herd of deer, the weakest and the old and the sick fall prey to predators and keep the herd at a manageable size. when you remove the predators, the herd expands and then all suffer due to lack of food caused by over grazing.

that is exactly what we have done in this country. the resources of this planet of finite, and since most people are either too stupid or too short sighted to see the value of space exploration, and conservation will only go so far. many of the problems we face today are caused by the simple fact that there are just too damn many people.

Goshin said:

No, we shouldn't. We aren't savages, and we aren't that desperate as a society.

Maybe we've forgotten what health care insurance IS: it is insurance. The idea behind insurance is, if something drastic happens the insurance company pays so you don't lose everything and go into debt.

If you need a lifesaving proceedure and have no insurance, you get the proceedure. You may end up in bankruptcy and debt, but at least you're still alive. You can still work, get your finances straightened out, and get on with your life... none of which you could do if you were dead.

We aren't primitive tribesmen living on the edge of starvation. We don't push the old and the weak out into the wilderness to die alone, and we shouldn't let someone die in pain in the waiting room of a hospital just because they have no insurance.

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That sounds good goshin and in principle I agree with you...however, your not taking into account just how much these procedures cost vs what the bottom half of america earns...impossible to pay that is the whole problem...people that cant afford insurance premiums certainly cant afford to pay the whole tab in the end....I dont believe you can claim medical on bankruptcy anymore and make it go away like you used too before the law change...I could be wrong...

Harry Guerrilla said:

You don't understand the argument and it's not really worth my time explaining it all.

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I very well understand the argument harry...but lke you said its not woth the time going back and forth...

ARealConservative said:

people that pitch in do so voluntarily, which I have no problem with.

the problem is, you aren't asking all members of society to pitch in. you are forcing a very small percentage to handle it all because they can.

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Well, hey. If income inequality in this country wasn't so obscene, the tax base would be a lot fairer, too. If a very small percentage takes all the money, well, they're gonna have to pay more taxes, too.

lpast said:

That sounds good goshin and in principle I agree with you...however, your not taking into account just how much these procedures cost vs what the bottom half of america earns...impossible to pay that is the whole problem...people that cant afford insurance premiums certainly cant afford to pay the whole tab in the end....I dont believe you can claim medical on bankruptcy anymore and make it go away like you used too before the law change...I could be wrong...

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By making insurance really insurance, and not a "catch all payment plan", the costs would go down as would premiums, making them more affordable to those who may not today, be able to purchase them. Such a move would also cut the exorbitant costs of hospital stays, procedures and treatments since the inflated costs are being addressed. By allowing people to get insurance from any state and not just within their own would also drive down costs. There are a few measures which would address this, but that's not where we as a country are right now unfortunately.

atrasicarius said:

Well, hey. If income inequality in this country wasn't so obscene, the tax base would be a lot fairer, too. If a very small percentage takes all the money, well, they're gonna have to pay more taxes, too.

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they do pay more taxes. history shows that no matter how much taxes the government gets, they always seem to "need" more.

ARealConservative said:

they do pay more taxes. history shows that no matter how much taxes the government gets, they always seem to "need" more.

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Except that suggesting we raise taxes has been borderline political suicide since Reagan. Don't you hate it when reality disagrees with your position?

atrasicarius said:

Well, hey. If income inequality in this country wasn't so obscene, the tax base would be a lot fairer, too. If a very small percentage takes all the money, well, they're gonna have to pay more taxes, too.

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yeah, that income inequality is a real bitch. a HS dropout working at mickey D's should be making the same $$$ as a neurosurgeon.

OscarB63 said:

yeah, that income inequality is a real bitch. a HS dropout working at mickey D's should be making the same $$$ as a neurosurgeon.

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So, are you aware that that's a straw man, or do you really not understand how terrible of an argument that is?

atrasicarius said:

So, are you aware that that's a straw man, or do you really not understand how terrible of an argument that is?

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give me one example of where two people with the same training, education, etc are paid dramatically different. you sound like you want communism. equal pay regardless of your effort or qualifications.


"income inequality" is one of those catchphrases for people engaged in class warfare baiting.

OscarB63 said:

and I would argue, how does it benefit the common good to allow the weakest members of society to artificially survive? we should take a cue from nature. look at a herd of deer, the weakest and the old and the sick fall prey to predators and keep the herd at a manageable size. when you remove the predators, the herd expands and then all suffer due to lack of food caused by over grazing.

that is exactly what we have done in this country. the resources of this planet of finite, and since most people are either too stupid or too short sighted to see the value of space exploration, and conservation will only go so far. many of the problems we face today are caused by the simple fact that there are just too damn many people.

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Would you be saying this if it were your mother, child, or sibling? It's easy to write the lives of other people off as unimportant when healthy and with good fortune. Personally, I would agree that those who have life styles which increase their risk of health problems should not be supported. unfortunately, that is next to impossible to determine.

As far as UHC is concerned, the government has proven itself inept at managing even the simplest of tasks. I certainly wouldn't want to rely on it to provide healthcare. However, I am still undecided on this issue.

OscarB63 said:

give me one example of where two people with the same training, education, etc are paid dramatically different. you sound like you want communism. equal pay regardless of your effort or qualifications.


"income inequality" is one of those catchphrases for people engaged in class warfare baiting.

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Right, so you really don't understand why that's a horrible argument. I'm not advocating complete income equality. I just take issue with the fact that CEO's are paid 400 times what their workers make. Even better are investors and stock brokers and hedge fund managers. These are people who spend all day playing with other people's money, creating absolutely nothing of value, and making millions of dollars while doing it. You chose neurosurgeon because that's a high value job that actually requires a lot of training. Of course they should be paid more than a kid flipping burgers. The stock broker shouldn't be, though, because the kid flipping burgers creates more value than him, and I don't think burger flipping jobs should even exist. I take issue with the fact that some people buy houses as abstract investments without planning on ever actually living in them while their previous owners are kicked out onto the street. That's what income inequality is about.

evanescence said:

Would you be saying this if it were your mother, child, or sibling? It's easy to write the lives of other people off as unimportant when healthy and with good fortune. Personally, I would agree that those who have life styles which increase their risk of health problems should not be supported. unfortunately, that is next to impossible to determine.

As far as UHC is concerned, the government has proven itself inept at managing even the simplest of tasks. I certainly wouldn't want to rely on it to provide healthcare. However, I am still undecided on this issue.

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I didn't say it was an easy or a kind choice. but, sadly, I fear that unless we do something now, our children will be forced to do something drastic later.

"soylent green is people"

evanescence said:

Would you be saying this if it were your mother, child, or sibling? It's easy to write the lives of other people off as unimportant when healthy and with good fortune. Personally, I would agree that those who have life styles which increase their risk of health problems should not be supported. unfortunately, that is next to impossible to determine.

As far as UHC is concerned, the government has proven itself inept at managing even the simplest of tasks. I certainly wouldn't want to rely on it to provide healthcare. However, I am still undecided on this issue.

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Like I've said before, just because this government is an incompetent, corrupt piece of **** doesn't mean all governments are necessarily incompetent, corrupt pieces of ****.