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Our Defining Choice: Afghanistan or Health Care

“America’s Defining Choice” is a simple one, writes Nicholas Kristof in the NY Times:

What’s the best way to spend $100 billion per year? Health reform or troops for Afghanistan? Simple, because lack of insurance kills far more Americans than the Taliban does.

And Europe has made that decision already a long time ago...

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Zyme on :

Don't know where I read it, but is it true that Obama's new health insurance program (for those that don't have one) will cost American taxpayers up to 1500 billion dollars? Or is this a joke? Seriously, German reunification did cost Western Germans 1300 billion Euros. Pretty much the same amount of money but not for health insurance but for the general overhaul of an entire country!

Pat Patterson on :

More than that. One Senate bill will cost $1 trillion but only cover 16 million Americans. Another bill will cost $1.6 trillion but will cover twice as many as the other bill. The problem is that nearly half of the cost of the bill is simply pork for various congressman. For example some of the money is coming to my state as part of a project to provide fresh water but oddly enough it is also paying for pools, parks and reconstruction of existing infrastructure. And the worst part is that this water will stay in Northern California because none of the money is to be used on the California Acqueduct which provides much of the water for the LA area.

Pat Patterson on :

The age brackets most likely to not have insurance are 20-30, 30-40 and closely followed by 40-50. Yet the absolute leading causes of death in this category are motor vehicle accidents and firearms. How exactly is mandatory health insurance going to lower those types of deaths?

Zyme on :

Maybe more car accident victims can be saved then ;) Seriously, I am just astonished by these numbers regarding costs. I always thought that here in a state dominated health care system everything is by nature overpriced (for the state) due to a lack of competition. How come health service providers in the motherland of capitalism are even more expensive?

Pamela on :

There are two reasons why current health care provider premiums are more expensive than they need to be. 1. Insurance cannot be bought across state lines. Therefore if there are only two providers in a state, there is damn little competition. (Auto insurance CAN be bought across state lines.) 2.Malpractice, aka, TORT reform. Physicians have to buy insurance to cover them in the event they are sued for malpractice. Now that would seem to be a reasonable precaution. Except for one thing. The awards in some of these lawsuits are so exhorbitant the the insurance providers must raise the premiums for ALL physicians to cover the cost. In may areas, a lot of obstetric/gynocology docs simply can't afford the premiums for the obstetric part and simply stop practicing that part and continue only with gynocology. That is certainly true for my doc. Now, if the gov't gets involved as a provider it gets worse. It will provide the lowest cost insurance. Well, lower cost is an incentive and many people will go with the gov't. Which will give it a large pool and a requirement for more money to cover the cost. How much money does the gov't have? Trick question. Zero. The gov't gets money from taxpayers. The more people in the pool, the more tax money required. Concurrently, the private providers lose their pool of insured. This is not hypothetical. It's been tried in 3 states that I'm aware of: Massachusetts, which is already WAY over budget and out of money; Tennessee had a program called TENN CARE which cost so much that they killed it; and Hawaii, where they tried to mandate public coverage only for children. Same thing. Had to kill it because of the required tax burden.

Zyme on :

As interesting as it can be. It seems horribly more difficult to establish state sponsored health care than to maintain one which has been running for a long time.

Pat Patterson on :

But that's why the examples that Pamela provided are so important. These states either modified, limited or dropped these types of programs. Which is why the Democrats are trying to take this power away from the states and concentrate it in an aloof bureaucracy that does not have to deal with local politicians or local citizens. In other words such programs are indeed hard to create, as it should be, but as long as the power resides in the individual states then they can be repealed almost instantly. But once a federal bureaucracy is established this type of healthcare program, even if it is catastrophically a failure will live on because there is now a group of people, quite capable of giving campaign donations, who see their jobs as more important then creating and running a successful program. We still have Dairy Councils from the Depression, the TVA from the same period and one orphan group that still is budgeted from World War I, the Wool Trust. Just in case the US runs out of locally produced wool and has to rely on alien sheep and goats. Next thing you know we won't have any sheep shearers or shepherds because we've outsourced those good American jobs to lower cost countries.

David on :

48 million Americans lack ANY health insurance and Harvard recently released a report that 44,000 die each year due to lack of coverage. Tort reform and selling insurance across state lines would do nothing to change that.

John in Michigan, US on :

Welcome back, David. Care to provide a link, or does Harvard still not understand this funky, new Internet thing?

Pat Patterson on :

Even the Obama adminstration has cited a much lower number that are without health care insurance because nearly half of that figure get jobs within 6 months that have such coverage and almost one quarter of that figure are illegal aliens who by no stretch of the imagination are Americans. There is probably a hard corps figure of around 16 million without insurance for lengthy periods of time. Plus the leading cause of death among the insured are as I mentioned before the result of car accidents and criminal violence. Things that are not going to be ameliorated by either private or public insurance.

David on :

"Even the Obama adminstration has cited a much lower number that are without health care insurance" Here is President Obama at a Town Hall meeting earlier this fall: "I don't have to explain to you that nearly 46 million Americans don't have health insurance coverage today. In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don't get the care they need." This number has been confirmed as accurate by the fact-checking organization Politifact. Glad to see you are still playing fast and loose with the facts, Pat. The number of uninsured comes from the US Census Bureau and has been confirmed by the Obama administration. If anything, the number is an underestimate, since millions have lost their jobs over the past 18 months and their health inusrance along with that. How many of the unemployed are finding jobs with health insurance within six months? Very few in this recession. In terms of the uninsured non-citizens, the US Census estimates that at 9 million.

Pat Patterson on :

You might want to read the entire article next time as Poltifact, rating the statement as mostly true based on certain suppositions actually came up with the figure of 36 million uninsured after removing both the legal and illegal as part of the uninsured. And oddly enough the numbers I came up with are remarkably similar to the caveats that Politifact posted. http://www.politifact.com/truth-o-meter/statements/2009/aug/18/barack-obama/number-those-without-health-insurance-about-46-mil/

Pat Patterson on :

So it's not 48 million but 46 million and the CBO Director Douglas Holtz-Eakin said that the frequent claim of 40+ million Americans lacking insurance is an “incomplete and potentially misleading picture of the uninsured population." Testimony before Congress. Here's what we do know, 10 million are ineligible to received health insurance because they are not in the country legally, 17 million make more than $50K and for whatever reason have not purchased that insurance, 10 million already qualify for Medicare or Medicaid and lastly almost 20 million will reacquire insurance in the next four months. Obviously this adds up to be more than 46 million but many fit into more than one category. If you are still unhappy then write a letter to the CBO for blatantly contradicting Prsident Obama. And the President must not be aware that insurance is different than coverage. One may lack the former but the latter is required to be offered by any hospital. And welcom back David and I am also glad to see that you are still repeating talking points with a thin veneer of righteousness that is so endearing.

Zyme on :

Apropos health care - did any of you already vaccinate against swine flu? I had my date with the needle today ;)

Pat Patterson on :

The vaccinations are being rationed, mostly to people showing symptoms, though many of the older vaccines are still available in a lot of places. The elderly, the very young and some public service occupations. Though just the other day the department store's Santas asked to be moved up the list.

Zyme on :

Isn't it too late to vaccinate people showing symptoms? I hear that it takes a week or two for immunization to take effect - people showing symptoms most likely are already sick and won't need vaccine any more.

Zyme on :

Oh and what about the others? Thought about vaccination or refusing to do so? Come on, tell us your thoughts. After all, we still want to continue our discussions when the pandemic is over. It won't be fun when there is only half of us left :) There is a bunch of differences between European and American vaccine. Surprisingly the US government had more restrictions and consequently has far less supply: http://online.wsj.com/article/SB10001424052748704335904574497324151841690.html But I almost went to my doctor in vain today, too. They simply forgot to put me on the list, as there are 10 people needed for every vaccination (read link above why). From looking at my face upon hearing this, the medical assistant knew she would have to become creative. So she offered me the vaccine for some guy who was late for his appointment. When I left happily, discreet as I am, I preferred not to ask the guy entering about his motives.

Pat Patterson on :

I didn't mean to imply that it was logical but that pretty much covers who gets the vaccine. I believe that so far only 10% of what is needed is available and the rest will be rushed into production for 2012. And the FDA wouldn't approve the better European methods for making vaccine for some unknown reason. Even though the CDC recommended such a change last winter.

John in Michigan, US on :

I have no philosophical objections to the vaccine, but I think that swine flu is (mostly) hype. It is just like normal flu, but more deadly. That still means that the chance of getting it is very low, and the chance of dying, lower still. So I can't be bothered with the vaccine. Nice link to the WSJ story. Did you know they are now the most-read national newspaper in the US? It won't be long before people wake up and realize that the WSJ, not the NY Times, is the US [url=http://en.wikipedia.org/wiki/Newspaper_of_record]Paper of Record[/url] (which has always been an informal title due to the 1st Amendment). It amazes me how people like our David can say "Tort reform...would do nothing to change that." Our toxic legal culture is one of the reasons for the vaccine shortage. But, there's nothing special about vaccines, all sorts of promising medicine is prevented because of junk science. For example, Vioxx.

Zyme on :

I'm no expert on this but as I understood it the hype of the swine flu is not due to its current nature. The massive amount of vaccinations in such a short time occur due to the danger of the virus mutating into something like in 1918/19. It has a similar structure and that is why people born before 1920 are immune against it. The more people that have the virus, the higher the chance of a dangerous mutation that kills humans like foot and mouth disease among live stock. Hence the more people vaccinated, the lesser the chance. Also there are dangers stemming from a mutation that simply affects an extraordinarily high number of people. The doctors I know told me there are lethal health consequences coming with every standard flu (for example affecting the lungs) which are easily treatable in today's health care system - but only as long as hospitals are not overcrowded. You wouldn't want to die because of a disease side effect treatable for decades just because there are too many in line waiting for the same treatment would you? But maybe I am overcautious :)

John in Michigan, US on :

Yes, I've read that too, the danger of it mutating into a super-flu. It is a tantalizing prospect, the idea that we could prevent this from happening instead of merely reacting to it IF it happens. I think it is still a big IF. They've got really fancy computer programs to [url=http://en.wikipedia.org/wiki/Protein_folding]model the 4-dimensional structure of complex proteins[/url], etc. Maybe they can even model an entire virus. But, they still don't know how to model entire human cells, not to mention multi-cellular systems like the human immune system, not to mention population-wide variation and how all those components interact. Plus they would have to model pig, bird, etc. systems at the same level, since any of these could incubate a human super-flu. Normal flu is a new mutation each year, or really, a series of new mutations each year. So all flu has the potential to become a super-flu. Swine flu has some features that make it appear more similar to the 1918/19 flu than a normal flu...but they still have no idea if those similarities are the ones that matter, or if they are just incidental similarities. Still, this massive vaccination program does have some real benefits. I think of it as a sort of elaborate fire drill, to keep the vaccine industry in good shape and give it practice for when the next real super-flu happens. Also it will generate a lot of experimental data, which is priceless.

John in Michigan, US on :

Everyone - check out this article in the respected Atlantic Magazine: [url=http://www.theatlantic.com/doc/200911/brownlee-h1n1]Does the Vaccine Matter?[/url] "Jackson’s findings showed that [i]outside of flu season[/i], the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson’s papers “are beautiful,” says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. “They are classic studies in epidemiology, they are so carefully done.”" This article discusses regular flu vaccine, not specifically swine flu. But, there is every reason to believe that attempts to measure the success rate of the swine flu vaccine will encounter the same type of problem.

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