Oct 15 2012
Mortality and 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. Given that this is a medical blog dedicated to discussing the scientific basis of medicine and not a political or health policy blog, I am not going to go into the reasons for a lot of this. What I am going discuss is a recent eruption of the central problem that led President Obama to make the PPACA one of the central policy initiatives, if not the central policy initiative, of his first term. That problem is the issue of people without health insurance, who number roughly 50 million, with a further estimate that 86.7 million people were uninsured at some point during the two year period from 2007 to 2008, representing about 29% of the total U.S. population under 65.
The question that bubbled to the surface last week in the form of a statement by Republican challenger Mitt Romney, and a tear-inducing op-ed piece published yesterday in the New York Times by Nicholas Kristof entitled A Possibly Fatal Mistake, is what the health impact of not having insurance is for those millions of people. This is a question that can be addressed scientifically and is, despite its politically charged nature, correctly within the purview of science-based medicine. What to do about it, in contrast, is a matter for politics and public policy. So first let’s examine the question.
A clueless statement and an op-ed that puts a face on the problem
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 Friday afternoon phone calls 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 forced by law to eat the costs of caring for the uninsured.
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. In New Jersey, I used to take care of quite a few illegal immigrants. Here in Detroit, it’s the uninsured and the poor, so much so that a large fraction of my practice is made up of the uninsured and Medicaid 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 it. 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 SBM-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 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.
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 start by looking at some of the evidence regarding the outcomes of breast cancer patients who are uninsured compared to those who have health insurance. For example, a study published this year examining the outcomes of 2,157 hospital admissions for women with spinal metastases from breast cancer. Analyses were adjusted for differences in patient age, gender, primary tumor histology, socioeconomic status, hospital bed size, and hospital teaching status. The investigators found that women operated on for spinal metastases from breast cancer tended to do worse and have a higher risk of death if they were uninsured than if they had private insurance. The authors concluded that the poorer outcomes observed among the uninsured were primarily due to the uninsured patients being significantly more likely to have a nonelective hospital admission and present with myelopathy. Although this study had some limitations, namely that it couldn’t account for lesser quality private insurance (for instance, plans with high copays and/or poorer coverage) and variations in Medicaid eligibility by state. Also, the database used only includes in-hospital data and therefore couldn’t examine long-term outcomes.
Since surgery is also my specialty, I thought I’d also point out that there is considerable evidence that being uninsured or underinsured is associated with worse outcomes after surgery. For example, a recent study published in the Annals of Surgery from LePar et al. at the University of Virginia examined outcomes from 893,658 major surgical operations and found that mortality was considerably worse in Medicare, Medicaid, and the uninsured than they were in patients with private insurance. Adjusting for age, gender, income, geographic region, operation, and 30 comorbid conditions eliminated the outcome disparity for Medicare patients, but Medicaid and uninsured payer status still independently conferred the highest adjusted risks of mortality.
In fact, the list of conditions and procedures for which being uninsured is associated with poorer outcomes and higher mortality goes on and on: cardiac valve surgery, surgery for colorectal cancer, breast cancer treatment and outcomes, trauma mortality (including among children), and abdominal aortic aneurysms, to name a few. Moreover, analysis of survey data from patients who were uninsured but then became old enough to be enrolled in Medicare suggests that “acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.” In summary, there is a large and robust body of evidence suggesting that people do, in fact, die because of lack of health insurance.
Not so fast…
Of course, for a question as complex and prone to confounders as whether lack of health insurance is associated with poorer outcomes, including mortality, there are always those who are not convinced by existing observational data. Certainly, lack of health insurance can be a marker, not a cause, for poor health and subsequent poor outcomes, and teasing out the various confounding factors is not a trivial task. Perhaps the most widely cited study questioning this relationship was featured prominently in an oft-cited article in the lay press by Megan McArdle in The Atlantic entitled Myth diagnosis. It’s a study by Richard Kronick published in Health Services Research in 2009 that questions the IOM report from 2002:
These results demonstrate that if two people are otherwise similar at baseline on characteristics controlled for in the model presented in Table 3, but one is insured and the other uninsured, their likelihood of survival over a 2–16-year follow-up period is nearly identical. Further, I show that survival probabilities for the insured and uninsured are similar even among disadvantaged subsets of the population; that there are no differences for long-term uninsured compared with short-term uninsured; that the results are no different when the length of the follow-up period is shortened; and that there are no differences when causes of death are restricted to those causes thought to be amenable to the quality of health care.
Basically, Kronick found no relationships between insurance status and mortality. While this study was large (600,000 subjects) and controlled, it is also an outlier, just as much as the Harvard study is an outlier. Again, that doesn’t mean it was a bad study; outliers can often tell us something, and what Kronick seems to be telling us is that the magnitude of the effect on mortality associated with lack of insurance might not be as large as previously thought. Might. It is, remember, just one study, as large as it might be. McArdle might refer to Kronick’s study as “what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality,” which sounds incredibly impressive, but the simple fact is that no single study can provide the answer, particularly to question as complex as whether having no health insurance status is associated with increased mortality and poor outcomes. Kronick’s study also has a significant problem that was pointed out in this post by Ezra Klein, namely that people in poor health are more likely to seek health insurance, which would tend to obscure any positive relationship between health insurance and health status.
McArdle also makes another argument against such a relationship:
This result is not, perhaps, as shocking as it seems. Health care heals, but it also kills. Someone who lacked insurance over the past few decades might have missed taking their Lipitor, but also their Vioxx or Fen-Phen. According to one estimate, 80,000 people a year are killed just by “nosocomial infections”—infections that arise as a result of medical treatment. The only truly experimental study on health insurance, a randomized study of almost 4,000 subjects done by Rand and concluded in 1982, found that increasing the generosity of people’s health insurance caused them to use more health care, but made almost no difference in their health status.
I hate to say it, but McArdle is drifting rather close to Gary Null territory here, in which she seems to be arguing that whatever benefit having decent health insurance might convey, it’s about the same as the harm that “conventional” medicine does. In other words, her argument seems to be that providing people more access to health care will cause as much harm as benefit, making it a wash whether one is insured or not. Of course, that argument cuts both ways, if you accept estimates of over 100,000 “deaths by medicine” per year in that it would imply that having health insurance confers a benefit in terms of mortality reduction that is much larger than the numbers we have would suggest, making the imperative to improve health care coverage and decrease medical errors a much more reasonable conclusion from such an argument than concluding that striving for universal coverage would not reduce mortality. Be that as it may, more problematic is that like many proponents of dubious medicine and science, McArdle cherry picked the literature, choosing one study that is an outlier and a thirty year old study from the RAND Corporation that showed what she wanted and in essence dismissed the rest. In refuting McArdle, by J. Michael McWilliams, MD, PhD, Assistant Professor of Health Care Policy and Medicine at Harvard Medical School and an associate physician in the Division of General Medicine at Brigham and Women’s Hospital points this out and speculates:
How many lives would universal coverage save each year? A rigorous body of research tells us the answer is many, probably thousands if not tens of thousands. Short of the perfect study, however, we will never know the exact number.
Indeed.
Policy implications
The very term “science-based medicine” was chosen intentionally. Medicine itself is not a science. It can’t be. There are too many other factors that influence treatments, including patient preference, resource allocation, and level of skill of individual practitioners, to name just a few. Our central thesis is that medicine should be based on science and that the best health care is based on science. My purpose in writing this post was not to advocate for any specific solution to the problem of the uninsured, although people who know me know my politics and my position on the matter. Rather, it is to lay out the science studying the question of the relationship between health insurance status and health outcomes. While we do frequently say that correlation does not necessarily equal causation, in some cases the correlation is so tight that it strongly suggests causation. This is one such case. Given that there is no ethical way ever to do a randomized clinical trial in which people are randomly assigned to be insured or uninsured, much as is the case for examining health outcomes between vaccinated and unvaccinated children, we are forced to rely on observational and quasi-experimental data. Those data support the hypothesis that providing health insurance to as many people as possible is associated with better health outcomes and that lack of insurance is associated with poorer health outcomes. That is the science. When someone like Mitt Romney claims that no one ever dies from lack of insurance in the U.S., he is demonstrably wrong.
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.
300 Responses to “Mortality and lack of health insurance”
Wow – an entire blog post to support a VERY narrow point of view, that has a ridiculous number of obvious “co-explanations” (for lack of a better word.) David, I hoped that by no longer following you on Twitter I could avoid your douchey political posts, it looks like I was wrong. SBM should be ashamed to publish such ridiculous crap. Where is your post about the negative aspects of Obamacare?
SH–I just lost all respect for you even though I have defended your “colorful” language in the past. Dr. G went out of his way to make this post apolitical and you’ve responded with no facts and a personal attack that is entirely unwarranted.
The post is not about Obamacare–it is about LACK OF HEALTH INSURANCE AND MORTALITY.
Here’s an anecdote you can chew up and digest:
My granddaughter, aged 23, works full time (no health insurance offered), goes to college part time (pays her own tuition), and has had a nasty case of psoriasis since age 9. Now it’s psoriatic arthritis and she can barely walk. Thanks to OBAMACARE, she can be on her parents’ insurance. Please inform me of the negative aspect of that.
Thank-you Dr. Gorski. Excellent post. I even liked it on FB…in spite of the lack of kitten photos.
I think Obama is trying to defend the status quo. Maybe Romney could do better. There are still millions that are uninsured under Obamacare. Will Romney give coverage to those that fall between the cracks? Will Obama?
As someone from the UK I find the state of healthcare in the US as something of a mystery. The BBC recently did a couple of documentaries called ‘Health before the NHS’ which showed that prior to the formation of the NHS the situation here was similar to that in the US, with rich people able to afford healthcare and poor unable, and suffering poorer health and higher mortality as a result. It seems incredible to me that something that could be so obvious to British politicians almost a hundred years ago still eludes those in the US. Universal healthcare was not set up because we suddenly had a load of ‘bleeding-heart liberals’ in power, it was because politicians realised that an unhealthy workforce was bad for the economy.
My neighbour has recently been treated for breast cancer, something that was painful and stressful for her and her family. I can’t imagine what it must be like for those in the US who have to go through all that with the added stress of wondering how they will afford it. A series like ‘Breaking Bad’ could never “(hopefully) translate to the UK because the fear of paying for healthcare doesn’t exist.
Please can someone explain why there is such a fear of universal healthcare in the US? What is wrong with paying, in taxes, into a collective pot and then having the security to know that if you break your leg, or get cancer, etc, you can get treated without the fear of loosing all your savings? What am I missing?
@Janet,
How about the hundreds of thousands of Americans that can no longer afford health insurance thanks to Obamacare changes like forcing insurance companies to allow “kids” on their policy longer (thus increasing the cost of insurance from private companies for everyone?)
Here’s an anecdote. My parents-in-law can’t afford healh insurance but don’t qualify for Medicaid. The increased cost of care secondary to Obamacare has made it that much more impossible for them to afford insurance. Where’s the positive in that?
Here’s another. Mother calls 911 to have ambulance being her and 1 month old to ER bc baby fell one inch onto carpet without injury, but mother was “worried.” You paid for that ambulance ride and the ER visit. Mother didn’t pay a dime – either out of pocket or in taxes (she never had a job.) Repeat story but substitute nose bleed for non-traumatic fall.
SH – So nothing substantive to say on the actual topic of the article, “Mortality and lack of health insurance”?
@ Ceratius:
A large part of the resistance, I think, is because people are used to health insurance being associated with their job rather than thinking of it as a more general concept. The historical accident of employers trying to get around wage controls during WWII has become The Way Things Are Done.
Another large part is that Americans are on average much less welcoming of centralized government-provided services than Europeans. It’s the whole individualism/self-reliance thing.
In order for us to live in a civilized society, sacrifices must be made. We all get car insurance, we all wear our seat belts, look both ways before crossing the street and obey traffic laws. Our taxes are used for security and infrastructure, education….. and they should be used for health too. It’s not about everyone being socially equal. It’s about equal opportunity.
Regarding your last comment #skeptichealth… they might have called an ambulance, but at least they should be paying insurance. Not everyone reacts equally to falls, big or small. Some people fall from 10 feet and say, “i’m fine”, some fall from 2 feet and want to see a Dr.
But if we all have insurance, the cost is reduced for all. Regarding those who “can’t afford”… then they should sacrifice having an iPhone 4, HDtv or other luxuries and concentrate first on necessities.
Sure, there are people that are going to have problems anyway, but it’s not going to be worse than now, where if you have a heart attack, you might for sure end up with over 400k in debt. How are they going to pay for that? People critizice social security until they start cashing it. Then, suddenly, they can’t live without it because they realize a lot of their savings were blown due to medical bills.
The second problem with healthcare, other than insurance, is the medical/dental students debt. And the Obama administration is rightfully trying to deal with it.
@Ceratius:
Interesting question. I think it is, in many ways, a matter of lack of trust. First, there’s lack of trust in our fellow man. As SkepticalHealth illustrated above, there are many people who fear that universal coverage will lead to people bringing in frivolous cases which have to be absorbed in the costs of everyone else (presumably the “hard-working tax-payers” who are complaining). Personally, I think it’s more likely that we’re going to get increased costs in terms of unnecessary and or false-alarm procedures and diagnostics. Take the arguments made on this blog about prostate and breast cancer screening, routine physicals, and pelvic exams. The figures show that routine screening such as this are not only driving up costs, but also aren’t showing any success in terms of increasing survival rates, and might even be hurting mortality due to false positives resulting in unneeded surgery (and, as I understand it, making these routine diagnostics free for everyone is one of the central tenets of the legislation). The lack of trust in government is in implementation. On one side, we fear the costs being driven up by everyone getting the top medical care and passing the costs on. On the other side, we fear “government death panels” deciding that at age 50, the cold equations mean that we can’t get a heart transplant, those being reserved for people under 30 who are more likely to survive the operation. Looking at other countries who have universal health care, we also hear stories of people waiting months or years on waiting lists for routine procedures or having to wait for hours to get into an emergency ward. Notwithstanding the plural of anecdote not being data, it’s enough to frighten people used to immediate access to doctors. And, frankly, the government track record in providing good service for reasonable cost is pretty dismal, so I don’t know that I hold it against people to fear that. *shrug* I’m sure there’s other factors, but those are the two I see people express the most.
As for my own personal anecdotage, my mother-in-law is missing a large chunk of muscle in her shoulder due to skin cancer that migrated while she was uninsured. Her fear was was that, even if she got emergency medical care, because she had some assets, she believed that the doctors would seize those small assets vice the classical case cited of the uninsured being people who had no money to take. I don’t know if her fears were unfounded. My impression did sync with hers that if you turn up in emergency medical care, they do immediately tend to you, but there’s nothing preventing them from then proceeding to harass you with the follow-up bills much like any bill collector. So, she gambled, and lost her pound of flesh rather literally.
Frankly, I don’t believe it’s going to be possible to implement universal health care without cutting some corners. As medicine has advanced, it’s become progressively more expensive (the Monty Python sketch on “the miracle of birth” involving the multi-million dollar machine that “goes ping” and teams of doctors has become the truth of the matter), and we literally cannot afford to give everyone the best care. I think that eventually, things will stabilize where everyone gets some modicum of care and upper levels will become the province of the rich, much like how richer people in countries with universal health care fly to the United States for procedures not covered by the universal care. And eventually, one day, we’ll make the breakthroughs that will make the upper levels more affordable and it will be something better that’s too expensive to give to everyone. I think, ultimately, that’s the best case scenario.
On a side note, outside of routine physicals and such, is there anyone who’ll actually be getting free health care? My understanding was that the legislation provides subsidies for the annual costs of subscribing, but deductibles, percentages, and “out of pocket” costs are barely touched. So the person falling and getting a nosebleed will still be paying their deductible and some percentage of costs up to a maximum, so there’s still no free ride. My experience is that you get the “free ride” people in workplaces and college campuses with an infirmary on-site.
Romney probably runs around offering overstated claims like this because of the common hillaryesque belief that mothers in labor are being locked out of hospitals and newborn babies are dropping in the street.
We don’t know the actual context because the Dispatch article is just those editors noting the parts of the interview they want to bring up. There is a big difference between saying “this is a good system” vs. “this is the actual situation in contrast to a common claim”, and we don’t know which it was.
Here’s what “Obamacare” does for disabled kids and adults, individuals with pre-existing conditions and adult children who will have medical insurance coverage under their parents’ health care plan…up to the age of 26:
http://specialneedsplanning.net/2012/07/what-obamacare-really-does-for-individuals-with-disabilities/
You don’t have to be a political animal to be following the news on Obamacare. And for those with disabilities, the Supreme
Court’s recent ruling to uphold the bill could certainly impact your life.
For the most part, the bill accomplishes the needs of people who live with disabilities – and a number of organizations such as the National Council on Disability, Easter Seals, the National Council on Independent Living and the United Spinal Association are on board and in favor.
One huge element of President Obama’s Affordable Care Act is that people with pre-existing conditions can no longer be denied insurance coverage – an issue that affects more than 17 million children in the U.S. alone. In the past, the risk of this happening was very real – and it could affect the medical care and even the happiness of an individual or entire family. Take for instance, someone who worked long hours at a job they hated. If that person – or their spouse or child – had been treated for certain conditions within a given period of time, that health concern would be considered a “pre-existing
condition.” So if the employee wanted to find a new job, they might get the job offer – but not be eligible to get health
insurance. So they stay where they are because they can’t afford not to. Under the new law, it would be illegal to deny that coverage.
Obamacare also prohibits policies that put a cap on coverage limits. In previous years, some insurance policies just plain stopped when certain coverage limits were reached. This amount may be determined as an annual amount or over a lifetime,
but when a patient has a disability and needs ongoing treatment, costs can add up in a hurry. So previously, after that limit was reached, the insured was on their own. And the old pre-existing condition caveat made it hard for the person to get a different insurance, many times leaving them with no insurance at all.
And lastly, Obamacare increases the age of young adults on the parent’s policy to 26. This is potentially a huge cost savings for young adults with or without a disability. In addition, depending on the health insurance carrier, an individual with
special needs may be able to stay on that coverage for life. This last statement is not new information, but important to recognize and check out prior to the age of 26 for an individual with disabilities.
Now, insurance plans have to provide decent coverage, too. Sounds simplistic, but it’s important. You want insurance that provides a certain level of care – annual physicals, mental health coverage and rehab services. Yearly check-ups help your doctor to find and keep on top of any health problems. Rehabilitation after an illness or injury gets people moving up and out and back to work sooner. And while people often think they don’t need mental health coverage, all it takes is a serious illness or loss (of anything from a loved one to a job) to turn your world upside down. You might be glad you have it.
The nation’s healthcare debate continues to rage on – with Democrats and Republicans each adding their own spin. And each of them has some very valid points. But one thing is clear – the ruling as upheld by the U.S. Supreme Court will certainly have a positive effect on the lives of many people currently living with a disability.
And while Romney was incorrect to say that it never happens, note that 20,000 is about 1% of annual deaths from heart attacks, strokes, cancer, infections, etc, while 17% of those who die have no insurance. Death due to a lack of insurance, though it sucks, is actually not generally happening even to uninsured people.
The real problem is that there are really nasty things short of death (such as untreated chronic conditions) which are not represented by those numbers (as Gorski mentioned already).
I’m worried about the details of putting co-morbities in the models when those themselves may be effects of lack of insurance, and causes for the worse outcomes. For example say I’m looking at heart-attacks. Those uninsured folks are more likely to not be having their lipids controlled or be lectured about their diets or have gotten angioplasty. That could be the problem rather than something to control for. It’s a tough problem.
@SH: I think you should have a thicker skin. Dr. Gorski is clearly making an effort here to discuss the facts without being overly political, and there is nothing “liberal” or “conservative” about acknowledging that the US healthcare system has a problem with respect to access to care.
SkepticalHealth: If single-payer is the option, completely decoupled from your employer (why are they in this business), then I’m not so fond of the current system by comparison either.
We do have to decide who to tax how much to pay for it. Good news: I know how.
Interestingly, there are a few “studies” or surveys/polls, in which when asked about the specifics of Obamacare separately, they are generally liked and applauded by both liberal and conservative alike; both from a common sense and economic point of view. But when it is referred to in its entirety, it is quite disliked. Like any good chiro, I haven’t read the entire article and have only scanned it. So if this point was made then I apologize.
@SH
“How about the hundreds of thousands of Americans that can no longer afford health insurance thanks to Obamacare changes like forcing insurance companies to allow “kids” on their policy longer (thus increasing the cost of insurance from private companies for everyone?)”
Got any evidence for that?
Just what do you recommend for my granddaughter and your in-laws, by the way? In 2014, your in-laws will be able to get into the new exchanges. Sounds like a reasonable solution to me given that we can’t get people like you to support real reform.
I have a feeling the baby in question fell more than one inch, but in any case, it is better to make sure, is it not? If the ambulance had refused and the baby had a brain bleed, the lawsuits would cost more than the ambulance ride. And what has the mothers’ status got to do with a baby who didn’t ask to be born needing care?
I appreciate this post and find the conclusions valid. Examining the evidence by scientific means didn’t used to be called political or narrow, but we now live in interesting times.
As for SkepticalHealth’s demi-screeds on politics, I find it comforting, as a former manipulator of public opinion, to see the repetition of carefully crafted talking points rather than any useful remarks or original thoughts. Should I want to return to my old profession, I know there will still be jobs waiting.
Twain had it right in his Autobiography: “In religion and politics people’s beliefs and convictions are in almost every case gotten at second-hand, and without examination, from authorities who have not themselves examined the questions at issue but have taken them at second-hand from other non-examiners, whose opinions about them were not worth a brass farthing.”
SH clearly is either trolling and/or has highly partisan leanings. I don’t know what he would have me do. It’s not as though I advocated a single payer system or a government takeover of the health care system (which, whatever its benefits versus costs, “Obamacare” does not do). Also, I did point out that one study widely cited by supporters of either a national health care system that claims that 45,000 people a year die due to lack of health insurance is an outlier that was funded by a partisan group that does advocate a single payer health plan.
Also, did I not point out that what science shows (that lack of health insurance is associated with higher mortality and many other health problems) does not tell us what we should do about the problem. It only tells us that the problem exists and that to lessen it we need to find a way to allow as many people as possible to have health insurance. As I said, how we accomplish that (or if we even want to accomplish that) is up to the political process. Perhaps SH would like to deny it, but he certainly hasn’t presented any concrete evidence of sufficient quantity and quality to call into doubt the current scientific consensus on this issue.
Oh, and, regardless of one’s politics, it’s hard not to conclude that what Romney said about the issue was really ignorant.
Ceratius: I’m with you – it’s simply a mystery to me (born and brought up in the UK, resident in Spain for 30 years) how anyone can regard socialised medicine as anything but the greatest boon ever brought to illness-prone humankind! Waiting lists – ok, not but what you can supplement your National Health Care for a rate of private insurance which would make US eyes water with its cheapness if you want something done in a hurry. Unfortunately creeping neoliberalism is infecting these superb Health care systems, inflicting upon them the effects of a recession coupled with capitalist values. This is to be lamented – if these systems are dismantled, it will be extremely difficult to bring them back up to scratch.
The problem with Obamacare seems that it has come too late in the day: even still, surely a step in the right direction!
@Those from the UK: The entire American system is founded on the premise that a powerful central government is not to be trusted, and we erected one only with the greatest of trepidations. From the beginning, the government has had constitutional fences set about it, and there are some thing still it may not do. (This is nonsensical to a Brit, where any act of Parliament is by definition valid under their constitution.) While most Americans have become more or less comfortable with a central government far more powerful than that envisioned by the Framers, its intrusion into new areas of American life is still regarded with an enormous amount of mistrust by a very large segment of the population.
If this goes the way of very large programs in the past, it is first met with denial, then resistance, then compromise, and finally acceptance.
If I may step into political territory for just a moment, I don’t believe Romney is in earnest when he talks about repealing Obamacare. We might recall that his institution of a similar system for the state of Massachusetts was an issue during the primaries: he must know that such a system in fact results in better care and at more affordable cost all around. I think that if he wins, he’ll make a show of an attempt to repeal it, which he’ll allow to devolve into a series of tweaks and improvements, followed by an announcement that he did all the Democrats of Congress would allow, and that it’s best now to just drop the matter and move on in the interests of certainty about the future of healthcare.-
I feel like I’m having a conversation with a bunch of naive morons.
I mean seriously, of course some of the ideas in Obamacare sound good, but all they do is increase the operational cost of health insurance companies, which of course gets passed on to the customer (look at the average health insurance premiums over last 5 years), which makes it more difficult to afford, which means fewer people pay for healthcare. In fact, I’d argue that people who have never worked a day in their life have better access to healthcare than many families that have two jobs but don’t qualify for Medicaid/Medicare. I know that the example I gave of an idiotic non-working mother using an ambulance to take her baby to the ER for no reason is a huge waste of tax payer money that she will never have to pay a dime for (and she’s never worked a day in her life or paid a dime in income tax), and that my father in law drove himself to a charity hospital with his thumb hanging off after he severed it with a tablesaw because he could never afford the ambulance ride because he doesn’t qualify for Medicaid.
Obviously there is not a single simple solution. Not even close. I appreciate whomever foreigner wrote in this thread or another about the vast delays in their healthcare system. I don’t have the answer.
Re: David’s post. You have to actually consider the population you are studying. Sure, I believe that the poorest population probably has the worst outcomes after a surgical procedure. How many of us have had patients that have repeat infections, repeat DKA, repeat MI, repeat practically everything simply because they refuse to be compliant with medication, or because they refuse to take a bath? The mere argument that the poor, or that those on Medicaid, do worse after a procedure or anything else because they have reduced access to healthcare is incredibly naive and short sighted. In fact it makes me question just how much “medicine” someone is practicing who would suggest such a ridiculous position. (David, do you actually do medicine? Or are you all research?) It’s the exact argument that David would argue against under any other circumstance. His argument carries the same weight as any positive homeopathic study – sure, it may correlate, but it doesn’t mean causation.
Anyways. I’ll keep on treating diabetic people on Medicaid who are given free healthcare and free medications when they come into the hospital with DKA because they can’t be bothered to take their medications or to eat a reasonable diet. And I’ll keep treating the MI of the person who “doesn’t have access to healthcare” because he was too busy using cocaine to take his heart meds.
@SkepticalHealth,
You have been warned, yet you still continue to use insulting language.
David wrote as nonpolitical a post as is humanly possible and you chose to misinterpret it as political opinion, called it “ridiculous crap” without responding substantively to the content of the post, and now you are calling other commenters “naive morons.”
After you were warned, you behaved well for a while, but now you are backsliding. You are very close to being banned.
So are you now just in it for the money? You express a moralizing financial sense and delight in pronouncing on the worth of others based on their relative bank balances. You’ve also made it clear you sure don’t mind treating “diabetic people” on generous executive health plans “who are given free healthcare and free medications” courtesy of other people’s sweat “when they come into the hospital with DKA because they can’t be bothered to take their medications or to eat a reasonable diet” free of veal, foie gras and martinis.
And I suppose you’ll happily “keep treating the MI of the person who” has access to full private insurance” and takes advantage of that to keep “busy using cocaine” with a paid-for Viagra chaser and forgetting “to take his heart meds” while looking down at you as yet another annoying lackey that keeps him alive.
You have expressed a clear preference for treating people who have money of their own, preferably of the kind that is imaginatively called “self-made,” so that you can feel much better lecturing about the Dickensian surplus population clogging up the system and bothering paying patients.
How did a doctor become so embittered and find that one way to deal with it all is to show up on this blog and act like a jerk?
SH – what are you on about? Welfare to Work laws we’ve had since 1996 limit welfare payments. Recipient are required to work after two years of receiving assistance and there is a five year lifetime maximum on benefits. How are ALL these people who have never worked a day in their life eating and finding shelter? Or are you talking about people who are on disability, since age 18?
And how do you know when ambulances are paid for by an individual? How do you know the entire work history of an individual who visits the ER, much less that of a pediatric patient’s parent. These anecdotes sound more like a narrative formed by your ideology than real observations.
We all know that some people recieve medical care that they subsequently don’t pay for AND the costs are then passed on to the public in various ways. Some of those people may currently be jobless, but we know some of those people are working poor and middle class without insurance as well as some with insurance. Common sense suggests that some of those people are going to be pretty despicable, just like some rich people are pretty despicable and some doctors are pretty despicable. I’m hardly going to make major healthcare decisions based on anecdotes of despicable doctors*, so why should I form my opinions of how the nation organizes healthcare on anecdotes of despicable patients…from a person on the Internet who seems increasingly unhinged.
*disregard this asterisk.
As I’ve said before, I cannot understand the attitude towards patients that SH has expressed on this blog.
Why not see it as a challenge managing these difficult patients. Or just be happy that you’ve made some small difference in their lives. It must be just easy treating people who do exactly what the doctor commands.
Maybe there is something wrong with the medical school selection process.
Lytrigian – If Romney is not in earnest about repealing ObamaCare then why is he saying he will? I think it’s because that is the only way that he will garner the political support that he needs to win the election. He may have an incredibly difficult time maintaining that support if he doesn’t make progress on the Republican platform. I think people view presidents to much as individual decision makers, they are not. They are heavily influenced by their party, donors and in Republicans, FoxNews (who influences the base).
I think, If Romney doesn’t repeal ObamaCare he is going to take a huge amount of negative pressure from the right and the tea party. There will be also the risk of lack of enthusiasm from the right in mid term elections (that Obama faced from the left during the last mid term). I personally doubt that he would be willing to take the kind of political hit it would require to maintain ObamaCare for something he doesn’t seem to support.
Of course that just my IMO, I don’t have a crystal ball or anything.
Apparently SH thinks that the researchers who did these studies are so dumb that they didn’t try to control for confounders. Oh, wait. They all did. One can argue over whether they controlled for enough confounders or whether they used the appropriate methodology to control for the confounders that they did control for, but to imply that these studies don’t control for obvious confounders, such as socioeconomic status, is just wrong.
As for whether I do medicine or not, I’m off to the OR in a few minutes. One wonders whether SH actually read this post, rather than, having seen the word “Obamacare” not surrounded by invective leaping to the conclusion without reading further that I’m a hopeless crunchy liberal who wants to Impose A Tyrannical Government Takeover of Health Care on the hapless Galtian heroes like himself. If he had bothered to read, he’d know that I’ve spent pretty much my entire career practicing in cancer centers that have a large percentage of Medicaid and uninsured patients. Currently I practice in the middle of Detroit. I’ll also add that before that a large portion of my training was spent at a county hospital. So, yes, I know about the problems of taking care of the uninsured and underinsured from personal experience. I’m familiar with patients who are poor and have substance abuse problems. I’ve taken care of them for years.
Finally, if a correlation is strong enough, it can strongly imply causation. For example, do you accept that smoking causes lung cancer in humans? There’s never been a randomized trial to prove it; the data are all from epidemiological studies.
BillyJoe – I just think that SH is a perfectly good doctor who made the easy mistake of setting up his practice in the 5th ring of Dante’s Inferno…the rent was cheap, you know, and it had a view of the water.
I don’t really care that much about what SH says about me, particularly since his rants have been so completely data-free and anecdotal. I have a pretty thick skin in online discussions, having developed my skeptical chops on Usenet sparring with Holocaust deniers, quacks, and pseudoscientists who made SH’s current insults seem quaint and tame by comparison. He’d have to start saying I’m a pedophile even to approach that level of vileness. However, I do not like seeing him abuse and insult our other commenters. Our moderation policies are pretty loose here, but once again he’s gone beyond the pale.
It is also depressing to see a physician who expresses such obvious contempt for his own patients. In any case, SH has been warned a second time. Three strikes, and he’s out.
@MTR –
The only reason that you don’t know the answer to these questions is because you do not know the first thing about an ER visit. Half of these questions are answered by the patient as part of a reasonable H&P (“What do you do for a living?”) and the other is a well known fact. Seriously, do some reading before asking.
@David -
At least you admit it.
@David & Harriet:
I don’t care that the only “power” you have is to ban me from a website. I’m sure if I can’t read the next article that David posts telling us that cancer is cured with magical radioactive spoons it will be a tragedy. Additionally, I’ll be more than happy to no longer read a website that unapologetically publishes political posts that are as flimsy and ridiculous as the one you (David) posted. Seriously – keep this garbage off your otherwise decent website.
And adios
Skepties just frustrated ya’ll.
The world of the ghetto is a strange place and for those not in it, or working around it, a very foreign place indeed. Oh, everyone has their stories of the ridiculus things they’ve seen in related circumstance, but unless dealing with it, you really have no clue.
That’s all ole Skeptical is saying, really. Do you really want him outa here, going to just some yippy, skippy, happy, pappy meaningless discussion?
This is a big time topic; very, very relevant to today’s America. Its a growing problem, the things Skeptical has touched on. It is the very thing that Churches in their phoney, ivory towers of self righteousness run from when they build their cathedrals to themselves, proclaiming to help the poor and the indigent….yes, in the nicest neighborhoods. Such rot.
Its a dirty place in the ghetto. Drugs, mental illness, just utter grossness abounds. What can required health insurance do for that? What will it do for that? Is it fair? Is it right for doctors to be frustrated by the naive notions of passersby? ( I wish I could spell)
Don’t go Shane!
The only reason that you don’t know the answer to these questions is because you do not know the first thing about an ER visit. Half of these questions are answered by the patient as part of a reasonable H&P (“What do you do for a living?”) and the other is a well known fact. Seriously, do some reading before asking.
I have two children and I’ve never been to the ER? Incorrect. No I’ve been to the ER five times for myself or the kids and I’ve never filled out a full employment history. The typical question is “occupation” I sincerely doubt that many people are putting “I’ve never had a job in my life” in that slot.
As to “well known facts”? Like the well known “fact” that vaccines are full of toxins and doctors are all just pharma shills? Your anecdote is directly contracted by the well known fact of the welfare to work laws. Which you probably don’t know about, because their presence contradicts the narrative you have built.
SH is exhibiting symptoms of burnout. He is a hospitalist. That means he is a glorified resident. As residents, I am sure we can all remember the patients that he is talking about. What kept me sane, was knowing that in private practice I would not have to see those patients. He has no choice. That is his job. Good luck, buddy. From an asshole internist.
Dr. Gorski, I’m glad you mentioned SH’s contempt for his patients. I was going to, but thought it might be going too far. This incident makes me a little sad because I have corresponded with SH through his now defunct blog and found him to be very different that what has turned up here the last couple of months. I know approximately where he practices and it must be challenging, but sadly, he seems to be an ideologue first and a doctor second, yet accuses the rest of us of politicizing the discussion.
If it’s any consolation
I agree with Skeptical!
My personal ‘healthcare’ is vitamins vs. vaccine, less carcinogens and more vitamins to curve cancer rates. I choose to have catastrophic because I don’t run to the doctor’s for every sniffle. But, now my premiums went up 5 times since Obamacare passed, and I’m being forced to pay for others and for something I don’t even want or believe in for myself. The whole idea is immoral bordering fascist state. It’s at a point perhaps to seriously consider leaving, sorry to say if it’s not repealed. I love America…or what it was meant to be. This socialist system is failing in Greece..failing in other countries, no matter how rose colored it’s presented no country is able to sustain it for long without forced intervention and control of how much who gets what. Those on the left, would YOU like GWB deciding what healthcare you get? No? Then you understand why those on the right wouldn’t want BO to decide what healthcare we get. And 2400 pages is deciding what healthcare we get. You’re giving your life over to whoever is in control. This isn’t freedom any longer, it’s tyranny if it’s allowed to continue.
Actually Janet, I think SH is implying ignorance of that which he speaks rather than politicization.
It seems that both doctors and teachers, when frustrated aren’t allowed to vent a bit and let some of that frustration be heard by others who might have similar experiences and also bring to light very real problems in both healthcare and education. They get labeled as jaded, or in this case, accused of having contempt for patients.
Education is truly messed up by such reactions to teachers concerns and I suspect that many problems in healthcare will be perpetuated by the very same response.
The frustrations of doctors and teachers alike need to be heard and considered, not taken personally by those who are really not the target of the frustrations. Education in America, especially middle school and high school education is now defunked and pretty much beyond repair because of it. I suspect healthcare is well on its way to such defunkment.
How about changing your name to Sisyphus, SH?
Actually, I find it a huge consolation that RH agrees with SH.
weing – Is this typical of the burn-out you see with hospitalists? My mom worked at Community Mental Health and Crisis Center in a tough area in Flint as a counselor, while raising five kids. I never heard her talk about any of the folks she worked with the way SH does. Which is not to say everyone who works in tough situations needs to be a saint, but I don’t think burn-out that results in these kinds of attitudes is inevitable.
It just makes me wonder what sort of oversight there is of hospitalists or other staff that have high pressure positions.
He says as he flounces away, clutching his pearls so very tightly.
Give me a break. You haven’t actually—oh, you know—demonstrated that my post is “flimsy and ridiculous.” You’ve simply asserted that it is without making a single substantive criticism or citing a single bit of evidence to counter its content and evidence. All you’ve done is to make unsupported assertions, heap abuse and insults on other commenters, and whine. You’ll have to do better than that if you expect me to take you seriously anymore.
Speaking of “seriously,” though: Seriously, dude. What the hell happened? You used to be pretty reasonable around here, but you’ve turned into either a troll or truly obnoxious character. Something’s happened.
Well I’m just a registered nurse and retired from a large County public health department and SH might not appreciate my experiences working in public health clinics.
I worked, and I still reside in a County, which has diverse populations and our seven satellite clinics were sited in some dicey areas. We cared for people who were uninsured, underinsured, on Medicaid and who were undocumented immigrants. A small number of our patients were drug addicts and some were HIV positive. I felt then and still feel that we provided a medical home for these patients. Many of the patients came to us for aftercare after they had been treated in our County hospital. No one was ever turned away.
Going back to Dr. Gorski’s studies that included people who were uninsured; isn’t it a good thing, that our County hospital and County public health clinics provided preventive health care and ongoing health care for pregnant women, young babies and older people, who were uninsured? Isn’t it far better to provide immunizations and to treat emerging health problems, in their early stages, instead of hospitalizing people for advanced cancers, diabetes, and cardiac problems?
Scott, provided us with a small history of health care insurance in the United States…
“A large part of the resistance, I think, is because people are used to health insurance being associated with their job rather than thinking of it as a more general concept. The historical accident of employers trying to get around wage controls during WWII has become The Way Things Are Done.”
To add to his history; the United States was at a different time then. It was mainly the trade unions that provided health care as part of the benefits package during WW II and post war. Health care insurance was cheap then, because our medical technology was in a (relatively) primitive state. We didn’t have medicines to control hypertension; FDR received the very best care and his blood pressure was in stroke territory for years, before he died from a CVA. The medical insurance companies didn’t make huge profits, didn’t pay bonuses to their executives and were not publicly traded on stock exchanges, where their stockholders expected dividends:
http://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association
“Blue Cross is a name used by an association of health insurance plans throughout the United States. Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice-president of Baylor University’s health care facilities in Dallas, Texas.[5] The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally.[5] The American Hospital Association (AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960 the AHA commission was superseded by the Blue Cross Association. Affiliation with the AHA was severed in 1972.
The Blue Shield concept was developed at the beginning of the 20th century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.[6] The first official Blue Shield Plan was founded in California in 1939. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans.
In 1982 Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association.[7]
Prior to the Tax Reform Act of 1986, organizations administering Blue Cross Blue Shield were tax exempt under 501(c)(4) as social welfare plans. However, the Tax Reform Act of 1986 revoked that exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation but entitled to “special tax benefits”[8] under IRC 833.[9] In 1994, the Blue Cross Blue Shield Association changed to allow its licensees to be for-profit corporations.[4] Some plans[specify] are still considered not-for-profit at the state level.”
Here’s Wellpoint, which is just one of many the Blue Cross/Blue Shield affiliates that are now “for-profit” corporations.
http://en.wikipedia.org/wiki/WellPoint
In defense of my peer group who are Medicare recipients. We are not all *GOGS* (Greedy Old Geezers). The majority of intelligent, informed older people realize that our Medicare Part A, is being paid for by Payroll taxes paid by most employees, employers, and people who are self-employed, and through the Medicare Trust Fund and Income Taxes. Before we retired, we funded the Medicare payroll taxes from our salaries. We are not the seniors on Medicare who held up signs “Keep Government Out Of My Health Care”. We are not the GOGS whose Medicare coverage is assured, who will tolerate the undermining of Medicare coverage for those under age 55.
We are not the GOGS who b*tch and moan when our Part B month premiums are raised or when we pay income taxes on 85 % of our Social Security checks. Tax all of our Social Security checks, raise the premiums for part B, raise the income tax rates to balance the federal budget…we will be happy to kick in more money to balance the budget and so that we don’t mortgage our childrens’ futures.
(Sorry, Dr. Gorski…for introducing some politics into this discussion)
lillady..just wondering..to ‘balance the budget’ you do know 4 trillion $ is already mortgaged to your children’s future the last 4 years alone to ‘balance’? And, that’s not even beginning to pay for social healthcare. Can your children’s future be mortgaged any more?
@Dr. Gorski – I quite liked your article.
@rustichealth – Those on the left, would YOU like GWB deciding what healthcare you get?
I’d much rather have bureaucrats from the government in charge of healthcare than bureaucrats answering to plutocrats, which is the system we have now. Regarding your ridiculous assertions of an incoming ‘facist state’, has it occurred to you to wonder about some of the countries that actually have a single payer system?
England. Japan. Thailand. Australia. South Korea. Brazil. Pretty much all of first world Europe.
All of these places have strong democractic processes in place, and yet none of them have decided to replace their system with one that models America’s system. Why do you think this is? Are they all ‘facists’ in Japan? Is Australia a socialist heaven? Does everyone except the far right wing on the US have it wrong, and for decades the populations of all of these other countries just haven’t decided to vote in a change of their system?
no matter how rose colored it’s presented no country is able to sustain it for long without forced intervention and control of how much who gets what.
There are thirty goddamned million Americans with no health insurance, and Dr. Gorski pointed out with great elegance that this is a risk factor for dying. Do you think any of these people are feeling like their healthcare is ‘forced non-intervention’? It isn’t the government that is controlling ‘how much who gets what’, it is our system; one viewed as universally cruel if not inhumane in the rest of the world; especially for a country so rich in resources.
It’s at a point perhaps to seriously consider leaving, sorry to say if it’s not repealed.
Here’s a thought experiment for you: to where?. Please, please enlighten us to which country you will retreat to that has a healthcare system that more closely models the for profit model of pre-obamacare US that you hold so dear?
@skepticalheatlh: see above. You won’t be missed.
- pD
“seriously consider leaving”
Perhaps RusticHealth would be happier living in Gambia. He would not be taxed there for the health care of others, and even its President discourages pharmaceuticals and offers his own natural cures. Also less pollution, less processed foods, less of all the things Rusty wants to avoid.
http://www.sciencebasedmedicine.org/index.php/more-hiv-nonsense-in-africa/
Ah look, it’s Rustic, who keeps healthy by never consuming chemicals. Skeppy’s in good company!
OK, time to burn some of these straw-Brits who spend three weeks in the Accident and Emergency (A&E) dept. with a severed hand, or two years waiting to have cancer diagnosed.
It’s utter bollocks.
Guess what? Americans don’t have a patent on triage. Obviously someone going to A&E at a very busy time, with a bruised knee or a cat scratch, is going to wait longer than someone with a suspected MI or serious injury. However, the maximum wait is capped now at four hours. Sure, if it’s a busy day AND three planes crash into a local housing estate, you might have to wait a little longer, but do not tell me that there’s no wait in American ERs, that’s a flat-out lie.
We also have nurse-led minor injuries clinics, as well as GP-staffed urgent care centres. They can both deal with injuries, fevers, infections, illnesses worsening etc. The waits are typically very short, and some UC’s let you do phone triage before going there, so that if you do need to go you can see a doctor within minutes of arriving.
I recently went to my local UC with abdominal pain and inability to urinate, assuming it was my usual kidney infection. Within an hour of arriving there I’d been assessed, taken by ambulance to the nearest acute hospital, and booked into a ward. Stayed there for two weeks thanks to a bowel obstruction, and at no time did I. have to worry about money.
I was taken home by ambulance, I receive regular district nurse care and my GP has visited on a few occasions. No cost.
My father-in-law died recently. He was experiencing shortness of breath. My partner called an ambulance, it took him to the local A&E where they assessed him immediately, and admitted him. After one night on the ward his doctors were concerned, and admitted him into ITU. He stayed there for three weeks, with two-to-one case around the clock. They tried everything, but he died. He was cared for with dignity and respect the entire time he was there. We did not have to fret about getting approval for procedures or treatments.
It was his heart that ultimately failed him. You see, there was no NHS when he was a child. He got rheumatic fever, and his parents couldn’t afford a doctor. He sustained cardiac damage as a result of the illness. But, he lived a long and productive life thanks to socialised medicine.
>>>@Those from the UK: The entire American system is founded on the premise that a powerful central government is not to be trusted, and we erected one only with the greatest of trepidations.
Not so fast…. That was the premise for the Articles of Confederation. Nearly all power to the states very little power and authority to the central government and it was a colossal failure.
Our constitution was drafted as a balance between the power of state governments and a central federal government, and through amendments and laws passed over the years, the balance has shifted somewhat to the federal government, but not as much as the right wing imagines.
ES
passionless..with all the ‘work’ put into HCR..it still leaves out 40 million people! and, who does it benefit? those who either don’t want HC..like young people who self decided understandably they don’t need it..why would they? I didn’t or wouldn’t want it at that age..but we’re paying for them now! even those who choose not to have it..like myself. Why should you pay for my healthcare? buy my vitamins? my organic food? you gonna pay for that for me too? The only people 2 years of big brains in gov came up with are those with uncovered illness, who don’t want to go bankrupt! great!! we’re paying for them to keep their bank books! Anyone else? We already have medicaid for those who really Can’t afford it. What else will you all ‘mortgage’ over to gov bureaucrats to think for you…they’ve already bankrupted the country as it’s going.
You’re really more ignorant about the issue than I thought if you really believe this is enough.
>>>But, now my premiums went up 5 times since Obamacare passed
My premiums have gone up every year for as long as I’ve had insurance (20+ years). I have not noticed any Obamacare bump.
>>> I’m being forced to pay for others and for something I don’t even want or believe in for myself.
You were before Obamacare. Uninsured people who go to emergency rooms are treated at the hospital’s expense and that cost is passed on to the rest of us. A good part of your premiums are already paying for service provided others who can’t afford or simply choose not to by insurance.
The other issue about costs that no one has mentioned is the inverse relationship insurance has with price/supply/demand.
For just about any other product sold when demand increases and supply remains steady prices go up. For insurance, because of the very nature of insurance, when demand goes up, more people buy but prices go down because the risks are shared.
As more people participate in the system some costs may rise but, overall, the price for insurance should drop and the aggregate spending for health care will have less upward pressure when more people are covered and don’t rely on ERs for primary medical care.
>>>The whole idea is immoral bordering fascist state.
This whole idea is perfectly consistent with the goal: “Promote the general welfare”
>>>This socialist system is failing in Greece..failing in other countries
The crisis in Greece and other countries is due to the free enterprise global banking system.
There are also more socialized countries that are doing very well, thank you.
>>>And 2400 pages is deciding what healthcare we get.
Too many words? Or not enough? How many pages would you prefer. (I think a single page would suffice: “Single payer Medicare for all”)
ES
I’m still trying to figure out how a national health care plan that was written and enacted by elected representatives and signed into law by an elected president (who ran on a national health care plan platform) and largely approved by a reasonably conservative Supreme Court can be considered fascist.
Did I miss the night of the long knifes?
Not everyone who needs healthcare qualifies for Medicaid, nor can they afford insurance. Anecdotal, but I can name countless acquaintances off the top of my head that I have encountered in both my family, friends, and patients I’ve seen.
Harriet..as long as I can grow my own organic food, and buy vitamins..I’m okay. : ) What I find funny is..whenever you come against big over-bearing government, the alternative is living in squalor or anarchy? America wasn’t begun on ‘big overbearing government’..it liberated itself from it actually. We had government, but it was limited..States decided for themselves what they wanted…that’s as it was and should continue to be. And, I have a question ..why are so many unions and other towns, and companies ‘exempt’ from Obamacare..?
http://www.freerepublic.com/focus/f-chat/2900475/posts
(Damn, Dr. G beat me to it)
[...] Mortality and lack of health insurance Science-Based Medicine [...]
Right, now to new/chronic illness care and waiting times.
New symptoms reported to a GP that warrant the attention of a specialist are referred on undeR either the two week rule or the six week rule. TWR is for potential cancerous, neurological, cardiac or pulmonary disease. Patients are often seen much sooner. I’ve personally had TWR requests made on my behalf that have resulted in a call from the clinic asking me to attend the next day.
Under SWR you typically. receive a letter saying “Your GP has requested a referral to [specialty].
Please go online, and using the details provided (address, userID, password) log into the Choose and Book system. There you can choose which hospital you wish to be treated in, and the most convenient appointment slot.
You can also call us on [number] or use our minicom (TTS for d/Deaf or HoH users)”
The waiting time for surgery depends what it is. Obviously something emergent or critical is going to take precedence over a cosmetic procedure or a minor hernia repair.
As someone with disabilities and chronic illnesses that require ongoing care, I’ve seen the NHS inside out. I even worked for them for a few years. It pisses me off something chronic when people spew secondhand nonsense about waiting days to get treatment for a stroke, or death panels, or whatever the current neocon or libertarian “expose” is. It’s sheer idiocy to do that, and not expect to be rebutted.
In countries that have the concept of a social contract, where everyone is seen as deserving healthcare, education and a roof over their heads, we’ll always see socialised medicine as a good thing. Nihilistic individualist regimes? Nope. Never gonna get it. You’ll have doctors raging about non-compliance to medication regimens that cost thousands of dollars, while I pay a maximum of £104 a year. You’ll have people ignoring symptoms that could be dealt with cheaply and easily, and instead, turning up to the ER with stage IV cancers and organ failure.
Oh and Skeppy, one last thing re: the financial crisis. One, the moronic American practice of sub-prime mortgages caused global chaos. Two, the US isn’t exactly sittin’ pretty bucko. Teachers and nurses living in their cars with. their kids, getting food from food banks and soup kitchens. Wow, such prosperity and wealth, and yet… no socialism involved. So that puts a bit of a hole in your smug statement about socialism destroying nations.
Dr. Gorski..I believe it’s a much easier problem simply expanding medicaid, for those who can’t afford it, perhaps pay according to what they can afford in premiums..then to dictate and force everyone else to pay for something they don’t want. How difficult can that be.
Christ. Do you live under the sea, or in a volcano lair? It’s just, I live across the Atlantic and I know that’s ridiculous.
You know what’s happening right now with people who can’t afford treatment in the US, but don’t qualify for aid? They’re going to India, Mexico and Colombia. Some Indian hospitals have entire wards devoted to US medical tourists.
Americans spend. billions every year, flying to India, Turkey, South America etc. for surgery and treatment that is too expensive at home.
mousethatroars..lol “You have to Pass it to Read it!”..Pelosi..heh..wow what does that say?
Americans spend. billions every year, flying to India, Turkey, South America etc. for surgery and treatment that is too expensive at home.
elburto..problem solved..free people choose to do what they wish with their money.
Or if RH actually thinks the statement is even true. Try getting Medicaid as a single male.
Correction: Pelosi: “We have to pass the bill so that you can find out what is in it” lol…what a comfort that is
“trusted” bureaucrats in control…
http://www.unitedliberty.org/articles/5233-pelosi-we-have-to-pass-the-bill-so-that-you-can-find-out-what-is-in-it
Just an observation: David’s article said there is evidence that insurance saves lives. There has been no disagreement with that premise. All the commenters agree that insurance is a good thing, but they have turned the thread into a political discussion about how best to provide that insurance: exactly what David tried to avoid. Let’s try to stick to science and leave political opinions at the door. There are plenty of other, more appropriate places for those discussions.
@ rustic health:
I’m willing to *bet* that you don’t have enough money to pay for hospital care for a major medical emergency. Should we stop treatment and kick you to the curb, once you run through your assets?
See how long your assets last, if you require care in a long-term facility.
http://www.completelongtermcare.com/states/
I’m also willing to *bet* that you have already, or will be, planning to divest yourself of assets and ownership of your home, so that your heirs have an inheritance and you qualify for Medicaid-funded care. (Medicaid has five year “look-back” authority to check for assets in your name).
I have a real “problem” with people who have personal wealth that they divest themselves of, to “qualify” for Medicaid care. These are the same people who have the ability to purchase, and refuse to pay for, Long Term Care Insurance.
@Chris Repetsky:
Not everyone who needs healthcare qualifies for Medicaid, nor can they afford insurance
How is this any different than before Obamacare though? It seems like Obamacare is at least trying to address this.
From Kaiser: [http://www.kaiserhealthnews.org/Stories/2012/March/22/consumer-guide-health-law.aspx?p=1]
What if I make too much money for Medicaid but still can’t afford to buy insurance?
You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.
These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current poverty guidelines).
Narad..medicaid can very easily be expanded..as above.
And, none of this covers illegals, which is the major problem in ER isn’t it? Exactly who does it benefit? very very few…yet will cost more, and control all..(except those who were exempt!)
@HarrietHall – I’ll respect the editors wishes if you all don’t want political comments, but to be honest it’s not so easy to find a forum that provides such a broad spectrum of intelligent political attitudes. My objections to SH’s comments are not that they are political, but that they are abusive and lacking in content.
I actually enjoy hearing the informed political opinions of other readers. There are other commentors here, whose politics are quite opposed to my liberal leanings, who make some excellent observations.
I enjoy hearing the accounts from other parts of the world as well.
If a bunch of people who are into critical thinking can’t question hyperbole and discuss constructive political solutions to an agreed problem, then who can? We’re doooomed.
lillady..I have a problem paying for anyone except myself and my family. Everyone else should have a problem paying for me too. If you have a medical bill..you pay… on time.. That’s what I do..what my parents did. I have catastrophic, but, that’s my business..I shouldn’t have to ‘fess’ up to you what I’m covered or not covered for. But, there..see? want control? Now pay for my vitamins and organic food, since that’s my ‘healthcare’..oh..I don’t see anything in the brainiacs hc bill to cover real health actually..imo
Careful. You do realize that Medicaid is a government program and expanding it could result in our coming closer to a single payer plan, don’t you?
Okay, back on topic. Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?
What about the *silent killers* (elevated blood glucose levels, hypertension and hyperlipidemia) that go undiagnosed and untreated due to lack of insurance? Do we as a society want people to go into major organ failure or lose their eyesight due to undiagnosed and untreated glaucoma, because they lack insurance?
I have familial hypercholesterolemia, and because I had medical insurance my condition was monitored…but untreatable. I was enrolled in one of the early Lipitor trials by my private physician. When the trial was unblinded, my cholesterol level was 180 mg/dl…down from 400 mg/dl. What would my health status be today, if I didn’t have insurance coverage?
@Harriet
Although I was trying not to be too political in my post (little swipe at Mitt Romney aside, which I considered justified given that I was about to present evidence to show him to be wrong in this instance), I also realized as I wrote this that it’s impossible to avoid politics completely discussing this particular topic and that the issue would almost certainly be politicized to some degree in the comments. And it was. Given the subject matter, it was almost inevitable, although admittedly I didn’t expect it to happen so fast and so obnoxiously in the very first comment, with SkepticalHealth leaping in with a political rant attacking me. That being said, I do not think we at SBM should shy away from easily politicized issues or inherently political issues. The caveat, of course, is that we SBM bloggers should in our posts stick with positions that are science-based, which is what I tried to do. This is the Science-Based Medicine blog, after all. If that weren’t the case, I might have injected my ideas regarding what should be done about the problem of the uninsured. If I decide to repost this particular post over at my not-so-super-secret other blog, you can be sure that there will be…modifications. I don’t follow the same rules with respect to avoiding being too political over there as I do here at SBM.
Be that as it may, even here I tend to take a somewhat more freewheeling view of the comments, and if our commenters want to get a bit political I don’t necessarily see anything inherently wrong with that, as long as it doesn’t get out of hand. This isn’t Daily Kos, Balloon Juice, or Hot Air (popular political blogs), after all. However, in the spirit of Science-Based Medicine, I would hope that commenters can back up their positions with evidence and…science!
At which point they’d also still have a two-year wait before Medicare kicks in under SSI, just by the by.
RusticHealthy – You need to read up on ObamaCare. If you choose not to buy insurance you will pay a fine (or tax). This offsets the systemic costs of people who decide to gamble and lose. You are not forced to take part in the healthcare system if you don’t wish it.
http://www.factcheck.org/2012/06/how-much-is-the-obamacare-tax/
I believe we all benefit from having a healthcare infastructure. I don’t think that Amish people get to pay lower taxes because they don’t use the freeways. Nobody decided to give me a tax discount when we invaded Iraq, just because I thought it was a bad idea. I don’t think that people who decide not to partake in healthcare should get to opt out of paying for the system either.
You all know they can change the $ amounts anyone pays ..anytime they have an inclination to do so right? This isn’t the end..this is the beginning of the problems that come. In the same way they took such “good care” of their ‘stewardship’ of our money in social security? ha, medicare? ha, and most other federal budgetary spending, HA, the same ‘care’ they will have in how much we will be paying for the “healthcare” (not real healthcare to me) they will etch out and allow us to have, and how much we pay for it. What I fear, and see, is, it will be far too late before most people wake up to the fact.
lillady..asthma is helped by vitamins..C, omegas..in my own experience having got off of 2 inhalers and 2 meds including steroids :/…most childhood diseases are vitamin deficiency…causing low immunity.
@ rustic health:
“Americans spend. billions every year, flying to India, Turkey, South America etc. for surgery and treatment that is too expensive at home.”
That’s a crock. The Americans who fly to foreign countries for *surgery* and *treatments* are going to those foreign countries for cheaper cosmetic procedures, that are not covered by private or publicly-funded health care insurance.
“lillady..I have a problem paying for anyone except myself and my family. Everyone else should have a problem paying for me too. If you have a medical bill..you pay… on time..that’s what I do..what my parents did. I have catastrophic, but, that’s my business..I shouldn’t have to ‘fess’ up to you what I’m covered or not covered for.”
So you do have catastrophic medical insurance, eh? (Just in case your home-grown organic foods and vitamins don’t protect you). I’m not asking you to “fess up”, but I just “bet” that you wouldn’t refuse Social Security Disability checks and Medicare, should you become permanently disabled. I just “bet” that your parents did not refuse Medicare when they were qualified at age 65.
“But, there..see? want control? Now pay for my vitamins and organic food, since that’s my ‘healthcare’..oh..I don’t see anything in the brainiacs hc bill to cover real health actually..imo”
I’ll pay for your vitamins and organic food, when you pony up money to pay for my prescribed OTC calcium/vitamin D tablets and pony up money for my groceries.
mousethatroars..”If you choose not to buy insurance you will pay a fine (or tax). This offsets the systemic costs of people who decide to gamble and lose. You are not forced to take part in the healthcare system if you don’t wish it.”
why the list of those ‘exempt’ from it then?
Dr. Gorski..what should be done about uninsured illegals..would like to know what your idea is.
Rustichealthy wrote “…I have a problem paying for anyone except myself and my family. Everyone else should have a problem paying for me too….”
So from a psychological and moral point of view, you are a selfish person and believe it would be helpful for everyone else to be just as selfish. That is certainly interesting.
Science is pretty clear on one thing when it comes to species survival: cooperation is as integral as competition. If we don’t consider other people worth anything or in need of a general social contract to ensure everyone has the basics needed for a healthy life, then what is the point of -any- kind of hospital, clinic or program to provide medical care to anyone? Why are you here on this forum instead of building a sturdy wall around your property?
@ Narad:
“Do we as a society want people to go into major organ failure or lose their eyesight due to undiagnosed and untreated glaucoma, because they lack insurance?”
“At which point they’d also still have a two-year wait before Medicare kicks in under SSI, just by the by.”
The exception to that two year waiting period for Medicare is for patients who have ESRD (End Stage Renal Disease).
http://en.wikipedia.org/wiki/End_Stage_Renal_Disease_Program
Quill…We as a society do help the poor. I don’t believe anyone has a problem with that. I’m talking about those who are able to think and do for themselves. I believe in charity giving. Most conservatives do. We give of our own time and money out of free will. Now the gov will be in charge of it all..because no one will have anything left to give to anyone when they’re through with us..as evident with their unlimited spending and ‘giving’ to their crony voters.
passionlessDrone:
Maybe I didn’t come across as such, but I support Obamacare! My statement about Medicaid was to Rustic, who claimed that Medicaid was available to all those needing healthcare who cannot afford it.
weing,
“What kept me sane, was knowing that in private practice I would not have to see those patients.”
Again, I don’t understand this. Why did you go into medicine in the first place? Was your original purpose to set yourself up in such a way that you only have to see clean, well-dressed, well-off, compliant, middle class patients who do exactly what you require of them and who know exactly when they need to see you and won’t bother you when they don’t?
I suppose you are lucky that there are so many patients for every doctor that you can pick those you like and piss off those you don’t.
You are also lucky I was not on the medical school selection panel, because I have absolutely no respect for this attitude. Fortunately there are counter examples here such as David Gorski, Harriet Hall, and Steven Novella, otherwise I would have lost respect for your profession.
rustichealthy, out of my own free will I clicked on your name and went to your site, clicking on one of the many links at random. Found this statement from you:
Of course that is your choice to do so and if it makes you happy, then huzzah! But why on earth do you bother being here with all these non-anecdotal types who value science over one person’s personal experiences? You are passionate but if you hope to persuade you are not making a very good case for why your opinions should trump experimental, verifiable data.
Interesting that you would like to both include yourself in and offload this concept to suit whatever you find to be most self-servingly convenient at the time. How did you feel about the ARRA subsidy for COBRA payments?
I think they’re ‘taxing’ charities now! So the money we do give will be taxed and who will be suffering? those whom the money was supposed to be going too!..wow…Giving can only be a voluntary action. And, what’s taken, and spent in gov pol hands, is not ‘voluntary’, nor is it giving, it’s legal thievery putting it nicely. The ‘trust’ you all have, is unfounded. What’s evident once again is irresponsible unlimited spending..then whining that the people should be ‘happy givers’ (because that’s what Congress has the right to do right? Tax) and are not ‘giving’ enough, so more taxing..then more spending..then more whining, then more taxing. This is the vicious cycle we are in now, and all getting away with how “we, your trusted politicians know what to do with your money better than you do”..and it seems most of you here fall for it despite the failing stewardship of ‘programs’ they (pols) installed, made us pay for, now going bankrupt!
Sorry…I just can’t resist posting this link:
http://www.youtube.com/watch?v=HhHNH9B4TWE
Quill..when I “experimented” on myself, and found vitamins do work..and actually, when others tried them and they did work for them also, then I believe, there’s something wrong with the ‘science’ claimed by conventional medicine that they don’t work…I’m here to share my own hypothesis and hope some might listen. However, I can only take so much in here admittedly
OK, if you want politics, I’ll share my opinion. Obamacare is too little, too late, but is better than no Obamacare. In the first presidential debate Romney said he wanted to repeal it but he had no other plan to offer. He said he would get people on both sides of the aisle together to talk and see what they could come up with. I thought we already tried that, and that’s what gave us Obamacare. I’d be quite willing to pay substantially more taxes to support any universal or single-payer system; but every system that has ever been tried has had defects. Any system, single-payer or otherwise, is only as good as the people who are responsible and their ability to recognize and correct defects in the system.
@lilady: Thanks for the reminder! I assumed those few minutes of that debate were secretly sponsored by The Board of the Soylent Corporation.
Exactly so and this is where this post comes in, where science becomes the only tool to find those defects and propose effective solutions. If there was a single payer system it is reasonable to assume that much of the money, time and debate that goes into arguing about who will pay for things would shift to what to pay for, what is the better treatment and what are the better outcomes.
Then again, there could just be even more yelling about everything.
@Quill, regarding your 4:09PM comment. I think it has been established that .rustichealthy doesn’t believe in magic. On the other hand, she does seem to believe in magical thinking.
>>> In the first presidential debate Romney said he wanted to repeal it but he had no other plan to offer.
Yeah, Romney says a lot of things.
Here’s the deal, Obamacare was passed by both houses of Congress and is the law of the land. A president cannot repeal a law. In order to repeal Obamacare he would have to get bet a repeal bill passed by both houses, and Democratic Senators can use the filibuster and other tactics to prevent a repeal, even if the Republicans get a majority.
There are things a President could do to water down Obamacare, but not repeal.
ES
@François Luong: I’m not sure that has been established. If you consider the definition of magic to be “the power of apparently influencing the course of events by using mysterious or supernatural forces” the rustichealthy’s site is full of just such things and even though there is a version of the Miranda Quack Warning there as well, it seems odd she would post so many things without believing in them.
Especially since she claims she can fix asthma with vitamins. If that’s not magic, I don’t know what is!
RusticHealthy – So you think we should only have voluntary charity contributions for a social safety net? Have you thought about what would have happened to this nation if the programs that you deride hadn’t been started. I can give you one idea. My father rode trains out west to find a job when he was 12, because the family didn’t have enough money to feed everyone. His brother suffered a permanently crippling ankle injury when he was a child, that wasn’t treated by a doctor, because they had no money for it. Where was the charity? My Mother’s family had only navy beans to eat for an entire winter when she was a child. She always talked about how they were lucky, because they had ‘something’ to eat unlike others. Does it look like charity was making sure that children weren’t malnourished?
I gotta tell you, my parents and the many other working and out of work poor of the great depression weren’t going to just sit around hoping some rich benefactor would give them a hand out. I can’t think of one industrialized nation that got through the great depression with some stability without establishing a social safety network. Can you point me to one?
mouse..my parents went through the GD also, along with 8 children on my mother’s side, and 6 on my father’s side…they didn’t have any safety net either. They worked nickel and dime and they all actually pulled themselves out. It wasn’t an exception either. In any case..this is the problem we have today. No one knows when enough is enough. We have social welfare, for those unable to work, for babies, children whose fathers left, or unable to work, we have social security that people paid for..we have a few decent programs. That’s not what I’m referring to in any case. I’m talking about where does it stop? Now we have to pay for those who don’t want to lose their bank accounts if they are sick, or for young people who more than likely don’t want it or need it. When is enough enough? What justifies another Trillion dollar hc program, when we have medicaid already for the poor. We’re tired of it. Enough is enough.
@BillyJoe,
Read about Sisyphus and you’ll see what I mean. Thankfully, not all patients are like that. But there are those that you just discharged 3 days ago, had them set up with outpatient services and now they are in the ER with alcoholic pancreatitis again. Believe it or not, I have seen some residents drop out of medicine altogether after experiences like these. And I think you misunderstood the reason I don’t see patients like that. It is because they don’t come into the office. They are no shows. They show up in ERs where SH has to deal with them.
This is an interesting fact, 80% of the dollars in government ‘programs’ go to administrative cost..20% goes to the people who actually benefit from it. In private charity..80% goes to the people who actually need it, and 20% for administrative cost. Funny huh?
I know a fellow who ditched a specialty in geriatrics and retrained out of crushing discouragement with the gig. He chose the eminently tractable field of psychiatry.
Correction: 70% government administrative cost 30% to the people…
http://libertariananswers.com/is-private-charity-more-efficient-than-government-welfare/
Well, I am obviously late to the party… and what an interesting party it is! Normally I don’t bother catching up on an article I missed and the ninety-nine! comments within 24 hours that ensued. This, however, is a topic I am interested in and the comments were (for the most part) worth reading.
I won’t jump in with a huge discussion of the politics (my thoughts are more or less in line with Dr. Halls on the topic of PPACA specifically and BJ’s in general) or the trollery (a sadly good riddance to SH, and rustic is… well, rustic).
However, many of the comments seemed apropos of a discussion that I had just this afternoon with a couple of colleagues – namely the kind of patients a hospitalist tends to see.
I spent 8 weeks on a single hospitalist service and by the end was essentially admitting and managing patients entirely on my own with oversight from my superiors (essentially acting as a sub-I). We had a lot of bounce backs. As the only tertiary care center in a 95 mile radius with some very serious backwoods and podunk places in that radius I saw a lot of non-compliance, repeat alcohol/drug admissions, babysitting a gentleman in DT’s because he had no place to go and no money to continue outpatient xanax treatment (and the hospital decided 5 extra days of hospital stay was preferable to pay for instead of a shelter and $20 bucks for some benzos), etc etc etc etc etc.
So today my colleagues were talking about how much they loved medicine and were interested in an internal med residency, but whinging about just how much they hated all the bounce backs, the non-compliant patients, the babysitting jobs, the waste, and the lack of resources for psychiatric and other social support. Hell, I have a 5 year old kid as a patient who needs a liver transplant within the next 6-12 months, but can’t get listed because his social situation is so poor, his mother so destitute, and absolutely no support net. This child will most likely die because his family – and he – was born into an utterly desolate situation with no means of public support. They asked me, incredulously, didn’t all “those patients” grind on me? Make me wonder if that field was the right choice? Without a second thought I said no. Why would it? These are the people we are spending a very decent chunk of our lives learning how to help.
Shunning these patients and making everyone pony up or die – as rustic and the repubs in lilady’s link would like – will not solve this problem. It will continue to bleed us dry slowly until we either fix the entire system radically or truly grow that heart of stone and actually create a schism of the haves and have-nots and watch entire swaths of people die before our eyes and marvel at how “those people” have a life expectancy decades less than ours. The sad thing in all of this is that most of the proponents of this selfish system don’t realize what side of that schism they will actually be on, or else they would not be advocating it.
In Australia, the Aboriginals have a life expectancy 17 years less than the average and vastly higher incidences of basically everything, most notably high blood pressure, cardiovascular disease, kidney disease, diabetes, and trauma. Rather than writing them off, the Aussie government has their med students train specifically on the societal, systemic, and sociocultural issues that lead to these poor outcomes and how to overcome them. They have a single payer public system with a private system on top of that for those that can afford it. Shockingly enough, despite this, they still have just as good (if not better) outcomes than we do, slightly better life expectancy, spend (roughly) half as much adjusted dollars on healthcare, don’t have atrocious waits for medical care, pay their primary care doctors roughly 20% more than their US counterparts make (though admittedly specialists make roughly 20% less, though still quite a bit to live a comfortable life), pay their interns and residents at least 40-50% more than American interns and residents (and they can work overtime for extra money if they want/need), and have a dollar that is stronger than the US with an economy that is vastly more secure than ours. And some have wondered why being licensed to practice medicine in Australia is something I would even remotely like to have as a bonus in my back pocket. Oh yeah, and the domestic med students? The worst case I have ever seen is someone finishing with around $40k in debt for their education. Most only need about $20-30k in loans and they can have that completely erased if they do their intern years in underserved areas. But most pay it down during med school because minimu wage there is $18AUD/hour and part time work actually affords you a decent pay.
I’ll add that the TGA – which provides all the meds for Aussies for free or cheap – demands evidence that a drug is effective, safe, and that the marginal cost is worth it before approving it. People can still buy whatever they want with private insurance subsidies or out of pocket, but if the peoples’ money is paying for it, they demand it is really worth it. And they use the collective buying power and demand for evidence and cost effectiveness to leverage pharmaceutical companies for good prices on bulk quantities.
So clearly, and without doubt, the American system is vastly superior.
No system is quite perfect, but certainly the hobbled on public benefits stuck on to a private for-profit system like Frankenstein’s monster is farthest from it.
I’ll close by commenting that not all bounce backs are “those people” either. I did have one sweet old lady bounce back a number of times because her condition was simply that hard to manage. She was my patient through changes in the team and I got to know her best. Eventually I was the one that placed a dialysis catheter in her jugular vien for palliative dialysis and had the conversation with the family about end of life and signing a DNR. When we were finally able to get her home for her last few days – literally her only dying wish – her family thanked me for everything I had done and I hugged them and cried a little, feeling good that we had managed to do the best we could and the right thing.
I want to practice medicine to help everyone. Some patients do grind on you, in the same way your kids grind on you because they don’t listen and think they know better. But we don’t fault them for their lack of knowledge and experience and we shouldn’t our patients who really are like children when it comes to understanding health care. We try and help and educate them. And we live for the moments when we have our greatest successes because it makes weeks of grinding worthwhile in the flash of a smile or the hug of a grateful patient.
nybgrus…” Hell, I have a 5 year old kid as a patient who needs a liver transplant within the next 6-12 months, but can’t get listed because his social situation is so poor, his mother so destitute, and absolutely no support net. This child will most likely die because his family – and he – was born into an utterly desolate situation with no means of public support.”
In America we have medicaid..for low income unable to afford healthcare for children already, that’s not what we’re talking about in Obamacare..see my post above…..
(((We have social welfare, for those unable to work, for babies, children whose fathers left, or unable to work, we have social security that people paid for..we have a few decent programs. That’s not what I’m referring to in any case. I’m talking about where does it stop? Now we have to pay for those who don’t want to lose their bank accounts if they are sick, or for young people who more than likely don’t want it or need it. When is enough enough? What justifies another Trillion dollar hc program, when we have medicaid already for the poor. We’re tired of it. Enough is enough.)))
.
@nybgrus
I was having a “meh” day, and your post just brightened it considerably.
That’s the exact motivations I have for choosing this field, and when I start practice, that’s the kind of doctor I want to be.
Thanks for such an insightful and thought provoking comment.
and nybgrus..we have a co ed going to D.C. testifying how she needs $3000 of contraceptives to get through law school and for us to pay for them…see how needy people are in America?
http://hotair.com/archives/2012/02/28/georgetown-co-ed-please-pay-for-us-to-have-sex-were-going-broke-buying-birth-control/
DugganSC commented way up thread,speculating on why Americans were so loath to accept universal healthcare by saying,in part, “…or having to wait for hours to get into an emergency ward. ”
Let me submit my own anecdote here on that specific point:
About 8 years ago,just after my wife went through extensive treatment for cervical cancer,she developed a cellulitis infection on her upper thigh,extending to her groin and abdomen. She was treated with powerful broad spectrum antibiotics,and told that if the infection appeared to spread,to go to the hospital ER immediately.
Of course,about 24 hours later,that is exactly what happened,at 9PM on a Saturday night (you docs out there know where this is going,right?).
I got her quickly to the Baylor Medical Center ER in Dallas,where she was triaged,and we spent the next 6 hours,with her in agony from pain,and exhaustion,waiting to be next in line to be treated,and here is the kicker,we DID have what is considered to be Cadillac heath insurance via my job at AT&T!
So the bottom line is how is that a superior system,for either a person like her (very well covered),or the poor schmucks that were clogging up the ER that lousy evening with everything from a bad cough to a barroom laceration?
If people think that just because they have excellent insurance,that they can waltz in to an emergency room,and go to the head of the line…they are fooling themselves.
I remember a patient who was brought to the ER because he had a seizure in a public place. He still had the bottle of anti-seizure pills in his pocket, unopened, from his visit to the ER the night before for a seizure. Why do you think he hadn’t taken them? Was he a bad person who was just out to make the doctor’s life difficult? Could his noncompliance be based on something beyond his control? Low intelligence? Education? Misunderstanding? Memory lapse? Psychological disorder? Cultural factors? Alcohol? He wasn’t my patient, and I don’t know the followup, but I wonder if anyone really tried to find out why he hadn’t taken his pills or to understand his thinking processes.
I remember another patient everyone hated. He was angry and abusive. It turned out he was suffering from organic brain syndrome and his anger was a desperate coping mechanism. He was doing the best he could.
I remember a child who was brought into the ER for a headache that had already resolved. I thought the parents were abusing the system (just because care was free in the military) until I questioned the mother and found out she was genuinely concerned because the child had recently had a head injury and she thought the headache could be a sign of a brain bleed.
I remember a newspaper story about a homeless man who was arrested a ridiculous number of times for drunkenness and cost the public a ridiculous amount of money, but who was eventually helped to stop drinking, to find a place to live, and to turn his life around.
I may be a Pollyanna, but i like to think most people are doing the best they can. Sometimes their best just isn’t good enough. Sure, some people simply can’t be helped no matter how hard we try. But shouldn’t we at least try to understand them and help them?
Yes. Many times yes!
Because Passionless Drone has posted brilliantly on “Obamacare”, (and because I swore not to *go there*), I am offering up my experiences as the parent of a multiply-handicapped child.
My son was a *frequent flyer* at area hospitals for seizure control, FUOs, and for IV hydration. A few of the resident ER docs treated him like a “GOMER” (Get Outta My Emergency Room), hesitant to admit him…and fearful that I would abandon him. I quickly and succinctly disabused those doctors about his condition and my devotion to his care. There would be no miraculous *cure* and he would be back, frequently, for life-sustaining treatment.
He was, for all of his twenty-eight years of life, a *drain* on the health care system…even though we had private health care insurance. He would never be a *productive member of society*, but he was a human being who fought to stay alive and deserving of good health care. Perhaps that is the reason why I thoroughly enjoyed working as a public health nurse, to care for patients who are dependent on our publicly-supported health care system.
@nybgrus: As a non-doctor, I will agree with Chris Repetsky. It’s heartening to see the dedication of doctors like you.
Wow, so many really impressive and heartfelt comments. I feel lucky to have had the opportunity to see a little bit into all of your thoughts and lives*. Thanks!
*Although I’m a bit bummed out that I don’t live in Australia now.
As colorful as this thread is, I actually have a technical question that I was hoping Dr. Gorski could answer. The Harvard paper supported by Physicians for a National Health Program concluded that 45,000 people a year die of lack of insurance, while the IOM study from 2002 concluded that the number is more like 18,000. However, the Harvard paper also claims that is used many of the same statistically methods as the IOM paper. (It is mentioned in the link). If that is the case, why is their figure more than double the IOM one? What does the Harvard study consider that other report leaves out, and can we say that they used an improved methodology, or one that merely validated their political position? Anyone know -
“I have a problem paying for anyone except myself and my family. Everyone else should have a problem paying for me too.”
I can’t argue that there isn’t an element of fairness in your statement rustic. We have a similar idea of matching input and return in the Australian health system, except instead of ‘I give nothing and expect nothing,’ we opt for ‘we all [well... most of us] give, and we all receive.’ It’s not a perfect system, we may still have to pay for certain things, such as imaging studies for some conditions, and we may have to wait for some procedures (although this can be minimised by paying a little extra for private cover), but it’s nice to know that the contents of my wallet will have little to do with my healthcare if something awful happens. I’m happy to have ~30% of my wage go to tax if a decent part of that is going towards securing the wellbeing of myself, my family and my community.
Also, I’m starting a medical degree in a couple of months and I’m very relieved that the ‘wallet biopsy’ won’t be featuring in my day-to-day.
@nybgrus – you’re right, the Aussie government is very kind to university students, they knock the total cost of a four year graduate medical degree from ~$200,000 down to roughly ~$40,000, although the undergraduate course is at least a year longer, so that may result in a higher total. The loan scheme is also quite nice, the interest rate is inflation-only, and the default option is to pay it as a small percentage of our income once we start earning >~$50k/year. It’s not all rosy though – housing is hugely overpriced here, especially in the big cities, which can be a big problem for students.
My parents still love to rub in the fact that university was entirely free back when they went through, but having compared my debt situation with that of an American law graduate, I can’t bring myself to be upset about how things stand at the moment.
Sandra Fluke? Seriously? You’re attacking Sandra Fluke on a huge straw man argument that basically implies she’s a slut? Pathetic:
http://www.huffingtonpost.com/sandra-fluke/sandra-fluke-joe-walsh_b_1876782.html
http://thinkprogress.org/health/2012/09/06/804301/conservative-commentators-bash-fluke/
Dr. G..my point is how far does it go?..enough is enough…I don’t have a bank account myself, I’m not wanting to to pay extra in premiums to “save” someone else’s bank account, or someone’s sex, or for 25 year olds who should be supporting themselves by then..sorry..I think that’s beyond…enough is enough.
@nybgrus,
Australia is nice. I was debating going there about 15 years ago. Too bad my kids didn’t want to. Now, I think, it’s too late. Even with my skills, I may be considered too old for an immigrant visa. I don’t think you have the illegal immigration issue that we have here in the US. Correct me if I’m wrong. Does Australia still bar HIV + immigrants?
((My friend was not alone. Hart Research Associates found that 55% of young women ages 18-34 report having had difficulty affording the contraception they need to treat medical conditions or to prevent unintended pregnancies. That’s no surprise when you realize that for some women contraception can cost as much as $960 per year ($1,210 with the doctor’s appointment), according to the Center for American Progress)).
For medicinal purposes, no I’m not familiar with how contraceptives will work for it, and we all pay for doctor visits don’t we…in any case that would be an exception to the rule, and could easily be done through doctor and insurance company I’m sure, not to make it a blanket Demand by all for “unintended pregnancies”… and, going to a catholic university, expecting them to go against their own belief and policy for her (who chose to go there) or anyone else is ‘attacking’ the freedom of one’s religious belief..actually.
RusticHealthy – (sigh) the Sandra Fluke argument?
@ rustic health: Haven’t you read the links that Dr. Gorski provided? Sandra Fluke was discussing her friend who lost an ovary because she was denied birth control pills, to treat PCOS (Polycystic Ovary Syndrome)
For goodness sake, before you post here, why didn’t you “Google” “Polycystic Ovary Syndrome-Treatment”. There are plenty of web pages, that are reader-friendly about treating PCOS with birth control pills.
The ACOG (American College of Obstetricians and Gynecologists), has “Treatment Guidelines-PCOS”, here:
http://guidelines.gov/content.aspx?id=15200#Section420
Management/Treatment
Anovulation and Amenorrhea
Combination oral contraceptives
Progestin, including medroxyprogesterone acetate
Insulin-sensitizing agents, including metformin and thiazolidinediones*
lillady..(( Haven’t you read the links that Dr. Gorski provided? Sandra Fluke was discussing her friend who lost an ovary because she was denied birth control pills, to treat PCOS (Polycystic Ovary Syndrome)
For goodness sake, before you post here, why didn’t you “Google” “Polycystic Ovary Syndrome-Treatment”. There are plenty of web pages, that are reader-friendly about treating PCOS with birth control pills.
The ACOG (American College of Obstetricians and Gynecologists), has “Treatment Guidelines-PCOS”, here:))
I said I didn’t know, but there could be ‘exceptions to the rule’…that could or should be worked out with her doctor..that’s not the norm…Fluke also added “unintended pregnancies”..birth control..for all women, not only medicinal purposes..and that’s against catholic belief..forcing them to cover it in all instances is against their religion and that’s against religious freedom of a catholic university.
Fluke can always go to another university..so could any other coed..or they can buy their own contraceptives…and I suppose the guy should help out with the big expense too
@Rustic, you genuinely have no idea what you are talking about. And to insinuate that a 5 year old child might die because myself and his doctors couldn’t figure out to refer the person to Medicaid is downright insulting.
@weing: I don’t know actually if they bar entry, but they certainly do require a check. I had to demonstrate HIV status prior to getting my student visa. I just don’t know exactly what would have happened if it had come back positive.
Also, I am American, currently live in America, and (at least for now) plan on practicing in America. Except for one rotation next year I am done with my studies in Australia. But yes, it is indeed much harder to be an illegal immigrant in Australia for myriad reasons.
nybgrus…I misunderstood. I thought you were in Australia…Not sure why a 5 year old is not covered.
http://www.ncdhhs.gov/dma/medicaid/families.htm#infants
that’s sad..see that should be fixed…but, not all the other things..like my paying for someone to keep their bankbook, or for 25 year olds who should be supporting themselves..or anything else someone comes up with claiming they need for us to pay for…enough is enough is my point.
@weing – Immigration health requirements are discussed here: http://www.immi.gov.au/media/fact-sheets/22health.htm
According to the website: ‘Only TB is mentioned in migration legislation as precluding the grant of a visa, but the applicant is given the opportunity to undergo treatment in most cases. Other health conditions are assessed on the potential cost and impact on the Australian community resulting from the possible use of health and community services.’
Illegal immigration is one of the big political issues in Australia. Being an island nation, the only real option for arriving in secret is via sea. It’s a risky method, especially given the safety standards in the people trafficking industry, but unfortunately it’s still popular. It often doesn’t end well.
@weing:
Australia is an interesting case regarding long-term stays and HIV. You may find this site useful:
http://www.hivtravel.org/Default.aspx?PageId=143&CountryCode=AU
In the United States, we have tuberculosis protocols in place for legal immigrants. As far as I know very similar TB protocols are in place in every country.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6130a2.htm
Rustic, as I said, you really don’t have any idea what you are talking about. It is not an issue about getting the money or means for the liver transplant itself. Getting a new liver doesn’t instantly mean you are all hunky dory for the rest of your life. It is an extremely complex illness to manage and this boy will not survive the aftermath of the surgery in his current sociocultural living situation. It was an example of the most basic and fundamental ways in which systems level issues – completely outside the direct control of individuals mired in them – create a very real second class citizen with very, very little recourse for good long term outcomes. The argument you are making would make them third class, people like yourself (and potentially me) as second class, and leave a very small 1st class you can actually afford good longitudinal care.
Stop embarassing yourself. Please. It is one thing to try and prattle on about how your vitamins and organic foods saved your life. It is quite another to think you can even remotely adequately comment on complex socio-medical topics and studies which you link in your comments (but clearly have nearly zero capacity to read beyond the title and a few sentences of the abstract). I see this boy every day and it pains me to realize that there is literally nothing that can be done for him. I’ll find out tomorrow what the outcome of the ethics committee, family, and child protective services meeting actually was.
This attitude of “mine and f*ck you” is patently archaic and stupid. You should want to divest yourself in the improvement of others with the social contract that others will do the same. If you at least argued that you don’t want to help others because nobody wants to help you then that would at least be a starter. But to argue that in principle everyone should fend for themselves is just downright stupid. We succeeded as a species because of cooperation and civilization, not because everyone tried to play king of the hill. The intelligent discussion is “how do we get society at large to buy into the social contract in a mutually beneficial way” not “that damned slut is making me pay for her contraception so screw her and everyone else!”
Jeez. Have some humanity along with your organic vegetables and mega doses of vitamin C.
As you’ve made this incredibly foolish claim more than once, I’ll give you a hint: No, it’s not. It is the choice of the Church to enter into the secular realm of employment and insurance, and they’re free to leave it.
nybgrus..maybe I’m not making myself clear..I’m really not sure but, I have no problem helping those who can’t help themselves..like the little boy and his illness, and his socioeconomic situation. I have no problem ..I understand there are things we should and could help in. (I’d question where 4 trillion $ went that didn’t help him went) but, never the less…I can see you’re emotional of course about it..being personally involved, but, once again, I’m not talking about such a situation. I do have to say, after so many brains in d.c. got together for 2 years to put through such a hc bill that doesn’t address it, I think it should indicate to you and everyone else where the problem lies.
What I’m referring to is the ‘entitlement’ mentality, and over things the people can even pay for themselves..like saving someone’s bank account ..my paying more for my insurance (5 times more).. myself not having a savings account..nor a possibility in the future to have one as I pay more and more for other’s contraceptives, bankaccounts and 25 year olds that won’t get out and support themselves. I hope I can still afford my Vit. C, and organic food when you all get through.
Translating in a language that hopefully (I have high expectations) RusticHealthy will understand. nybgrus is arguing for basic human dignity, which is what every civilization should strive for. RusticHealthy, on the other hand, is arguing to the Hobbesian natural state, where everyone is a savage beast.
And before you start accusing us of being socialists, RusticHealthy, please note that the first state-sponsored health insurance program was started in Germany in 1891 by … Otto Von Bismarck, who, last time I checked, was far from a leftist. The French Sécurité Sociale (which doesn’t have anything to do with the US Social Security) was founded by Charles De Gaulle in 1945. Again, not a socialist. The NHS … Okay, you can have that one. It was started by a Labour government. But you know where the Canadian health insurance program started? In Saskatchewan. Not really a leftist province either.
@ Narad: New York Case, where Catholic Charities-Albany tried to get an exemption to Federal and State laws to provide contraceptive coverage enrolled in their group prescription plan…they lost. A similar case was heard in California, the Church lost the case:
http://lawandreligion.com/sites/lawandreligion.com/files/CatholicCharities.pdf
@Narad: Don’t forget that Georgetown has also made the (now) secular decision to enter education (with all the federal funding this entails).
I know.. why don’t we all pool everything together, and we all get exactly the same amount..to be perfectly fair because I’ll be damned if you’re entitled to more than I have..now I can call you greedy..nybrus..I’m going to guess you probably make 10 times more than I do..and I don’t think that’s fair..and if anyone makes a dollar more, well..they just have to give it up…is that the idea? Let’s see what that produces. Wait..wasn’t that tried before? and then everyone was equal..equally desolate that is. Oh, there were a few, in gov, that ran the system..they somehow were entitled to a little more..of course. It’s easy to call others ‘greedy’ isn’t it..when they don’t want to give you all that you want and demand. That’s a great tactic…that settles everything…you’re a selfish ‘greedy’ bastard nybgrus for making more than I do..I can’t even afford a decent car right now, now I have to tell you my economic situation, just to prove to you how I’m not greedy, just that I like freedom and I’d rather do without with freedom to decide for myself what I do with the little I have. Have you all gone mad? Do you even think of what you think you consider this ‘ideal’ b.s. sharing will entail?
Francois..’accusing’ you..would infer that you’re not, but that I’m falsely ‘accusing’ you..but you are..so I’m not ‘accusing’ you, I would be stating a fact. Why? are you denying it? It’s what you are.
You haven’t considered the results of it, what will happen more and more, as it grows, but, it’s what you are, (or you think you are), until you one day find yourself in ball and chains owing everyone else ..atleast what those in the government lording it over you say you owe..(for the others good of course)..so you give whatever you have to them..those in control (you’d be greedy not to)..to divy out..(pocketing first what their ‘needs’ may be first of course) (you’d be greedy to question it)..but you’ll trust them of course to do what is ‘right’…while in your ball and chains… then tell me if you want to be a socialist or not then.
April, 2012 The faculty of Georgetown University took Paul Ryan to task…
http://thecaucus.blogs.nytimes.com/2012/04/24/georgetown-faculty-latest-to-chide-ryan/
Representative Paul D. Ryan, the Republican chairman of the House Budget Committee, has been excoriated by some Roman Catholic leaders ever since he claimed this month that his budget plan, which slashes antipoverty programs, was inspired by the moral teachings of his Catholic faith.
The latest criticism comes in a letter released Tuesday and signed by nearly 90 faculty members and priests at Georgetown, the Jesuit university in Washington, in advance of Mr. Ryan’s visit there on Thursday. Mr. Ryan is to deliver the prestigious Whittington Lecture, named for an associate dean who was killed on the airplane that crashed into the Pentagon on Sept. 11, 2001.
The letter says, “We would be remiss in our duty to you and our students if we did not challenge your continuing misuse of Catholic teaching to defend a budget plan that decimates food programs for struggling families, radically weakens protections for the elderly and sick, and gives more tax breaks to the wealthiest few.”
“Your budget appears to reflect the values of your favorite philosopher, Ayn Rand, rather than the Gospel of Jesus Christ,” says the letter, which the faculty members sent to Mr. Ryan along with a copy of the Vatican’s Compendium of the Social Doctrine of the Church — “to help deepen your understanding of Catholic social teaching.”
Paul Ryan, has also stated he wants to eliminate the Title X Family Planning Program, which has never funded abortions, since the enacting legislation for the program was during Richard Nixon’s administration, 1970. After all, coitus interruptus (The Sin of Onan), is in the bible.
I wish I could dig it up but just don’t have time at the moment. I will try and find it later today at some point if I can.
However, firstly, any purely sectarian organization is exempt from the mandate. I don’t think they should be, as all the exemptions granted to sectarian organizations are based on the principle that they are completely removed from the secular sphere (i.e. no politicizing) but clearly continually and forcefully inject themselves into it. I think we should also repeal tax exemptions for sectarian organizations that don’t meet 501(c)3 criteria. But I digress. They are exempt.
Additionally, each individual is exempt from both the mandate and the fine if they express sectarian objections. Once again, I don’t think they should be, unless they also sign a contract stating that they will not consume medical services until after payment has been rendered (i.e. they are still members of society with access to medical care, but opt out of the social contract involved). But, they are exempt.
And lastly, organizations headed by sectarian groups but whose primary activity and employee constituency are not sectarian are not exempt. In a recent court case (which is what I was trying to find but couldn’t), it was ruled that this lack of exemption stands. The plaintiff (sectarian group) claimed that it was an unfair religious burden that they subsidize something they are morally opposed to (contraception). The judge deemed that such subsidization was not a substantial burden on their religious freedom since they pay their employees money and money can (and is) used to purchase contraception. Thus, they are still subsidizing the individual use of contraception and denying the entirety of a mandated health cover for that one issue becomes an unfair burden on the otherwise secular employees. The point is that we all – directly or not – ultimately subsidize something we don’t particularly like in society because we are a diverse and secular country. Some people may not like cars and driving, but their taxes still subsidize roads. I don’t like war, but my taxes subsidize wars. Jane Doe ay not like animal testing, but her taxes subsidize the NIH. And such is the social contract we have to act in the greater good of the whole of society – not specific subsets of it. If we did that, it would be anarchy.
lilady – ouch! Gotta love those Jesuits – although I disagree with the Georgetown policy on contraception, that is a damn good set down on social policy.
nybgrus “The judge deemed that such subsidization was not a substantial burden on their religious freedom since they pay their employees money and money can (and is) used to purchase contraception.”
This has been so obvious all along, it just kills me how seldom it comes up. Glad a judge figured it out.
Also – So you’re back in the States now, jetsetter? During one of the recent comments dust-ups I took the liberty of checking out your school (cause I’m a stalker). My dad lived in that region for a number of years. They are sorely in need of medical people. Thanks so much for your service there.
The Georgetown faculty do not know the difference between giving, and taking, apparently. Or what the bible actually means by it. Between one’s true heartfelt voluntary own choosing of giving, and the individual freedom to choose who/what they want to personally give to; to government bureaucrats taking (taxing) $ and handing them out for votes. That’s all this mounts to. Some pols divying $ to the most likely people/place that will get them Votes…and nothing more. And, of course the attitude of You Owe Me helps to have in order to get them in your hands, whether it be for your bank account …or sex life…or failed business (or ‘educational’ grants to university). What this mounts to is a nicely acceptable way of theft and highway robbery, and a total infringement on freedom…it’s not giving..it’s Taxing and pandering..I wonder how many of my $$ will go in Georgetown U hands to spend on their nice new desks and big faculty salaries. So, is the catholic ‘doctrine’ governing us now? I wonder.
And, just to clarify..there’s a difference between tax breaks, (what R’s propose) and bail outs (bailouts would be taxing others (like me) to give to a business/corporation/crony so their ‘bottom line’ is not altered)… tax cuts is allowing any and all businesses/people..rich/poor/middleclass (without bias or prejudice) to keep their own dollars , to decide what they do with what they’ve earned…i.e. Freedom. And, come to think of it..I’d like to see how much those faculty members give of their own to families struggling. Prove to us all how much they’re suffering and giving out of their own pockets, now that they’ve brought it up.
Just an idea nybgrus..why don’t you hit those GU faculty for the $ to help out that little boy?
The preamble of our constitution gives these tasks to our government. “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
That is the point, we accept the constrains and responsibilities of being part of the People of the United States so they we may share in Justice, Tranquility, Defense, General Welfare and Liberty.
The constitutution specifically allows for taxation (WITH representation, which we have) to fulfill those tasks.
Disagreement in how we go about fulfilling those tasks is credible in my mind. But disagreement with the basic tenants of our constitution does suggest that a move to another country with a different constitution or no constitution may be in order.
mouse..and if we the people so decide to have less taxation..as we did 2000..then you should all have been happy with that too..because that’s what we the people decided. I guess we’ll see what we the people decide this election..and yes a move might be necessary, unfortunately..but that goes both ways too.
@rustichealthy: Oh the poor citizens of Norway, Sweden, Finland, Denmark, Japan, Canada, France, Germany, Argentina, Brazil, Switzerland, the United Kingdom, the Netherlands, Belgium, Luxembourg, Iceland, … all under that totalitarian boot of their socialist government. Oh, the evil socialist Angela Merkel, oh the evil socialist Otto Von Bismarck, oh the evil socialist Charles De Gaulle, the evil socialist David Cameron, the evil socialist Stephen Harper, oh evil socialist me, oh the evil socialist François Hollande, oh the evil socialist Julia Gillard. Oh, wait, the last two are actually Socialist and Labor respectively. But quite frankly, you’ve just proven your ignorance here, rustichealthy. Get out of the country a little bit, RH, it will do you some good. And it will also show you how narrow your point of view is.
@nybgrus:
You’re probably thinking of the Hobby Lobby case. As I understand it, they’re not so much against the contraceptives as the abortifacients that got included in the list. I can kind of see their point. If a law got passed requiring businesses to provide non-lethal self-defense weaponry to women and included handguns on that non-lethal list, I suspect people would complain there too.
@ rustic health:
I’m giving you points for the longest run-on sentence, that I seen in a very long time.
(I’m still the undisputed *queen* of the run-on sentence…nice try, though).
“And, just to clarify..there’s a difference between tax breaks, (what R’s propose) and bail outs (bailouts would be taxing others (like me) to give to a business/corporation/crony so their ‘bottom line’ is not altered)… tax cuts is allowing any and all businesses/people..rich/poor/middleclass (without bias or prejudice) to keep their own dollars , to decide what they do with what they’ve earned…i.e. Freedom.”
Romney also proposes to keep the capital gains tax rate at 15 %…down from the former capital gains tax rate at 35 %, before the Bush Tax Cuts were implemented in 2010. Those tax breaks were due to *sunset* in 2010. Why didn’t they RH? All of Romney’s income is derived from capital gains taxed at 15 %.
BTW, where are all Romney’s prior years Income Tax Filings? I want to see if he is part of the “47 % of Americans who don’t pay any Income Tax”).
“mouse..and if we the people so decide to have less taxation..as we did 2000..then you should all have been happy with that too..because that’s what we the people decided. I guess we’ll see what we the people decide this election..and yes a move might be necessary, unfortunately..but that goes both ways too.”
Are you stating RH, that if Romney wins you will move out of the USA? Promise?
RH – “and if we the people so decide to have less taxation..as we did 2000..then you should all have been happy with that too..because that’s what we the people decided. I guess we’ll see what we the people decide this election..and yes a move might be necessary, unfortunately..but that goes both ways too”
That is the whole point. It doesn’t go both ways, because I support and understand Democracy.
If I am not happy with the decisions made my our democratically elected representatives, I don’t move, I vote and I speak.
You can do the same, but all these claims that you are making that you only have the responsibility to take care of yourself…that is just not consitent with the responsibilites of living in a democratic nation.
DugganSC – “I can kind of see their point. If a law got passed requiring businesses to provide non-lethal self-defense weaponry to women and included handguns on that non-lethal list, I suspect people would complain there too.”
Businesses pay their employees a salary. Should a business be given the power to prevent an employee from purchasing a legal firearm with that salary? If not, why should an employee be prevented from using their company benefits, which are an agreed upon substitute for salary to obtain legal/standard of care medications?
Why does it matter whether the employee’s salary or benefits are being used to abstain the legal thing you don’t like?
obtain, not abstain….that’s another contraception argument.
@mouse:
Yes, I’ve been stateside all year and except for 2 months next year will continue to be. As for”stalking”me, no worries. It should be reasonably easy for anyone to have figured out what program I am in by now. Hopefully it is a little harderto figure out really who I am, but I have nothing to hide anyways. And thank you for the kind words.
Also, I was going to say exactly what you just did in response to the hobby lobby case (yes, that was the one). It doesn’t make one whit of a difference if you are opposed to one small part of the mandate or one really small part of the mandate. The underlying principle is exactly the same and it is still not an unjust burden of religious freedoms. I mean, what if the Jehovah’s witnesses wanted to object because they didn’t want to indirectly support blood transfusions?
nybrgus “Hopefully it is a little harderto figure out really who I am”
Oh well, I haven’t figured out really who I am. I hardly have time to figure out who someone else is.
mouse..we’re a Republic..”for as long as we can keep it”..I think that was Benjamin Franklin..but, there is a difference..in a straight democracy..the majority rules.
In a Republic, there Are rules of law such as the Constitution, ..despite what the majority says or ‘votes’ for. I always remember this scenario… Democracy is 2 wolves and a lamb voting on what’s for supper, (not good for the lamb)..and a Republic is one well-armed Lamb.
There are certain inalienable ‘rights’, that can’t be taken away..the right to bear arms, for instance. Or, the right to free speech. Let’s say..the ‘majority’ believes they should ban arms ..well you can’t do that..that’s why we’re a Republic as much as the left tries and keeps trying to do. The Constitution was made for Individual rights..not what the Majority happens to vote for or against.
I believe our forefathers were geniuses..that or, extremely committed to freedom individuals..knowing the nature of the ‘beast’ i.e. big Federal government, and the hardship they endured and the blood they shed, knowing how important freedom of the Individual was..and not the majority. We’re a Republic.
Regarding “Congress shall Tax” it was originally a limited Federal government…meant to protect us in defense, and a few other federal duties perhaps… and I believe they used tarriffs then. It wasn’t to micromanage everyone’s income in the whole country..as it’s doing now. It was never meant to take from one and give to another, they may have taxed the rich more..to cover defense , but not to redistribute wealth. In fact, there was no federal taxation until the 20th century I believe..except for wartime which had to do with defense…nothing more from the Federal level. All taxes were decided at the state and local level..where it’s much more manageable and close to the people it affected.
Anyway..what we have is a huge beyond manageable mess. 4 Trillion dollars..printed out in four years alone..to redistribute to cronies and buy votes. None of it helped that little boy though.
Francois..or Stalin, Lennon, or Hitler..let’s not forget them
And Nazi stood for a National Socialist party..he and Stalin pretended to be friends on the same page until one of them decided to not be. And, one thing..I think it’s Norway..it’s the size of half of NYC in population #s..half of them are probably related! 
it’s a bit different then a huge micromanaging Fed government over 330 million in America. We have 50 States..that’s what we have states for..Not to be micromanaged by a monster Federal Gov. costing more and more each day..beyond control. Your countries are limited in their spending because they don’t have printing machines our Fed gov has contribed along with the banksters. 
@mousethatroared / nybgrus:
I suppose that, in the end, it kind of gets into the question as to whether it matters whether it’s a personal choice or something happening to someone else. As I understand it, the owner of Hobby Lobby isn’t opposed to his employees using contraceptives (which only affects themselves, same as the Jehovah’s Witness example) but was concerned when it included medications that directly affected another person. It’s kind of like the difference between giving money to a person to buy cigarettes and giving it to them so they can shoot their wife. *sheepish smile* Maybe… as I recently commented to a friend, I’m as good at analogies as I am at describing something which is entirely non-bowling-ball shaped. The basic argument is that the law stated that they were doing A, which was approved, and somewhere along the lines, someone added B as well.
@tmac57 (way up there):
FWIW, I had a similar situation, albeit in a strangely reverse fashion. Several years back, I developed a severe nosebleed that wouldn’t stop for the space of a few hours. After waking up choking on my own blood one too many times, I drove down to the emergency room (the only thing open at 3 AM) whereupon, after only about a half hour (me obviously being a low-risk case), I got admitted in, ahead of several people who’d just got in and had obviously just gotten out of a traffic accident (one guy still had bits of gravel embedded in his chest). I guess that hospital really took “first come, first served” seriously… Ultimately, though, I was commenting on the perception and belief involved between private and public care. People here have heard horror stories about overseas and most of them have had speedy treatments in the E.R.
lilady…how much did Obama give out of his Own pocket to the poor?
lol big taxing kind of people don’t do that do they..I remember Clintons claiming $25,000 in deduction to underwear they donated..that was amusing. And, I remember Gore, the change your lightbulbs and cut your electricity guy..had an electric bill upwards of $2000 a month! I love how that goes. Just an fyi..Canada cut their capital gains tax finally to 17%..half of what ours is, and their economy started leaps and bounds. You lower taxes on business and you see how they open up to expanding and hiring..something that just didn’t happen the last 4 years of squandering trillions to cronies did it? Romney has the right idea.
@mouse: lol, fair enough.
@duggansc: That still does not fundamentally change the calculus of the issue at hand. The choice is legal, the cover is under the jurisdiction of medical expertise, not employer expertise. No matter how many steps or refinements you take the outcome is still the same. If a Hobby Lobby employee used money from his employment to kill his wife, should Hobby Lobby then enact a system wherein they do not pay their employees money but instead have them mail bills to corporate to pay their cost of living?
Once again, we cannot prevent people from making bad choices (at least not most the time). But when your claim is an undue infringement upon your beliefs – religious or otherwise – the law requires demonstration of substantial burden for that claim to be valid. As long as the cover in the mandate covers legal medical procedures (which obviously it must) then any objection to any part of it will simply not meet that test.
DugganSC – I don’t understand. What other person does the medication directly affect?
And, the general ‘welfare’ didn’t mean a welfare state, and ‘blessings of Liberty’ doesn’t mean taking anyone’s money or property…even if I decide I need or deserve it..(as I do
I believe he is referring to the hypothesized conceptus, but correct me if I am wrong
rustic healthy:
“lilady…how much did Obama give out of his Own pocket to the poor?”
http://blogs.wsj.com/washwire/2012/09/22/romneys-taxes-a-window-into-charitable-giving/
Mormons tithe to the LDS church 10 % of their income. So, why should should I support the Mormon church…when Romney’s 10 % tithes further reduce the income tax he pays?
http://openchannel.nbcnews.com/_news/2012/08/13/13262285-mormon-church-earns-7-billion-a-year-from-tithing-analysis-indicates?lite
Do you need any help packing your belongings for shipment to a foreign country, when Romney gets his butt whupped on November 6th?
lilady..we’ll see..but I have to tell you…not too many people I know see it as you do. They like deciding what to do with their money, and their property, and their businesses, and they have no problem with someone else having the same freedom..whether you approve or not..that’s freedom. Of course, if you’re a taker, and benefit from taking ..maybe in grants, free handouts, union raises more than what the people who work and pay for them now get…then I suppose you’ll vote for more. Unfortunately, not even considering the ramifications of it all. I don’t intend to change your minds…there are givers and there are takers. The confounding part is..the takers in this country are walking around as IF they’re givers..because they believe in taking and accusing others of not being givers!..so they can have the ‘right’ to take! Kind of something you expect in a mental ward.
@rustichealthy: Funny, I remember talking to Canadians (I work a lot with Canada) and none of them were very happy with the capital gains cut, considering it lead to degradation of infrastructure. And those are people from the mainstream Canadian political spectrum. And this is lamented in the Globe and Mail and other Canadian newspapers. Remember those demonstrations in Québec, Toronto and Vancouver? Yes, all in opposition of Stephen Harper’s policies. Again, you make a completely ignorant statement.
I wondered how long it would be before rustic healthy added yet another unnecessary proof to Godwin’s Law. The more rh writes the greater becomes my wonder at how much ignorance one can contain without bursting one’s clothes.
Francois..Well some are simply conditioned very well I suppose..or they have political loss, like the whining and grumbling 6 years of an incredible economy in America during Bush years!!..the whining was unstoppable from the left!…Jobs everywhere, UE down to 4%, growth, more revenues went to Feds because of tax Cuts..it was really amazing! Then the Left took control of both houses..and things spiraled from there..increased spending..bailouts…UE…policies destroying American economy..just 2 more years and Americans woke up and got the House back.. what were they protesting btw? exactly? didn’t get the freebees they wanted? you’ll have to explain that..but, not now..I’m going to wrap this up lol it’s neverending the whining of socialists..sorry
see you all later.
@Quill: I had totally missed her reference to Stalin, Hitler and Lennon. Wait, what? John Lennon? What does John Lennon have anything to do with this? I also like her overt racism toward Norwegians and the fact that she completely ignores the existence of this little thing that just got the Nobel Peace Prize, the European Union (I’m not going to discuss the merits of that Peace Prize). Or that she ignores the fact that Germany, the Netherlands, Canada and Belgium are, like the United States, a federation of states. Or that Japan has 128 million inhabitants and still manages to offer state-sponsored health insurance. As for the Nationalsozialistische Deutsche Arbeiterpartei, thanks, RH! Having lived and studied in Germany, I thought I had a very good grasp on its history, but never ever would I have thought that a name stood for everything an entity stands for. Now, thanks to you, oh dear rustichealthy, I will have to rethink the connection between Ayn Rand and the US Objectivist poets of the 1930s like Oppen, Zukofsky, Niedecker, Bunting and Rakosi. Now, thanks to you, oh dear rustichealthy, I will have to rethink the Republican Party as the true inheritors of the legacy of Plato’s Republic, the Roman res publica, the Republic of Venice, and the French Republic! Gee whiz, the things people learn thanks to you, oh dear rustichealthy.
Lilady – the funny thing about RH is, she can leave, but as an U. S. citizen, she still has to pay U.S. taxes and it’s illegal to give up your citizenship to avoid taxes. Also you need a passport to enter most countries and often a Visa as well, therefore you need some sort of citizenship. Not really sure what her plan is.
FL – you are confusing me, but then I still get bemused by the fact that Teddy Roosevelt was a Republican and where does the Banana Republic come in?
I’m pretty sure there’s a Life of Brian bit in there somewhere.
pretax so suspect that John Lennon would have been happy to have offended RH.
@mouse: Banana Republic, Republicans, Irish Republicans, the Republic of California, même combat !
(For more context, see RH’s post at 4:20PM. I wonder if that timestamp is indicative of anything)
I would like to comment that I wish I had François Luong’s breadth, let alone depth, of knowledge when it comes to literature and philosophy. In my circles I am often amongst the more well read and while I admit you may turn out to be a poseur, I think it more likely that I would be well out of my depth in a conversation with you on such matters. Which makes me wish all the more to share an appropriate libation* and have said conversation. One of my most fun conversations of recent memory was over multiple Scotch’s whilst learning about the architecture of Le Corbusier from an Irish architect in Australia.
*I recently discovered a wonderful such libation at a local restaurant. They call it “A Little Indescretion.” I bought what I needed and recreated the drink at home the very next night.
First you must take caraway seeds and boil them in simple syrup until it reduces by about half. Then you take 2 parts bourbon, 1/2 part each of lemon juice and the caraway syrup (sans seeds), and a splash or two of rose water, with a little lemon zest. Shake thoroughly, strain, and serve up.
@ Nybgrus: I remember get thoroughly trashed on Kummel Schnaps in Germany ~ 40 years ago:
http://www.danish-schnapps-recipes.com/caraway.html
And queue right wing talking point used only by those who are mind-numbingly ignorant of basic history and politics. Fortunately, I am not. I’m actually fairly conversant about WWII history and the rise and fall of the Nazi regime, as it’s one of my interests and I’ve long been involved in combatting online Holocaust denial. In any case, one of the more amusing refutations of the whole “Nazi-ism is socialism” meme was published in, of all places, Cracked, which proclaims, quite correctly, that Nazi-ism is not:
I know, I know, it’s a sarcastic deconstruction, but the blurb above about what Nazi-ism is not has the advantage of being true. Nazi-ism is much more akin to fascism thansocialism; Nazis fought socialist parties before they took power in Germany and destroyed them after they took power. Ditto Communists, whom Nazis viewed as their mortal enemies, so much so that this enmity drove Hitler to do something as stupid as invading the Soviet Union and opening up a two-front war that Germany couldn’t possibly win in the long run.
In any case, Nazi-ism rests on the concept that the strong have the right to dominate and exploit the weak, of nationalism such that only members of the “volk” are entitled to the benefits of the state, and encouraged private property and enterprise in the state interest, most famously the arms manufacturers, which became in essence extensions of the Nazi state. Historian Ian Kershaw, whom I’ve read fairly extensively, points out that the Nazis were one of many nationalist and fascist parties vying for the leadership of Germany’s anti-Communist movement in Weimar Germany. The Nazis viewed communism as dangerous to the well-being of nations because of its ideology demanding the dissolving of private property, its support of class conflict, its aggression against the middle class, its hostility to small businessmen, and its atheism. Kershaw points out that Nazi-ism rejected class conflict-based socialism and economic egalitarianism, favoring instead a stratified economy with social classes based on merit and talent, retaining private property, and the creation of national solidarity that transcends class distinction.
Here’s a nice quote from Hitler from 1930: “Our adopted term ‘Socialist’ has nothing to do with Marxian Socialism. Marxism is anti-property; true Socialism is not.” In 1942, Hitler was quoted as saying: “I absolutely insist on protecting private property … we must encourage private initiative”. Later, Hitler came to regret the party having included the word “socialism” in it.
Which is being able to not be able have a bank account and blowing what cash there is on supplements?
^ “Which is not being able to have”
@nybgrus: I studied English lit and philosophy at university, then more of the former in grad school, so I guess it should be expected that I have a fairly extensive knowledge of American modernist and postmodernist poetry. But don’t sell yourself short, if we were to have a drink, I’m sure we’d have an interesting conversation on histology, biophysics or anatomy, areas you have an extensive knowledge of.
And thanks to Dr. Gorski. I’m afraid it will fall on rustichealthy’s deaf ears. She’s already labeled us all socialists, despite our various political affiliations.
Where I want to sit at a Drinking Skeptically meetup… right next to François Luong and Nybgrus, plus Narad.
nybrgus – I was partly uncertain if DugganSC was talking about an actual legal person, such as the employer, who feelings are affected or if we were talking about the “conceptus”, which set of cells was being designated a person. I’ve heard people designate eggs or sperm a person, or fertilized eggs before implantation, post implantation, etc. I have heard some people argu against all birth control pills on the grounds that they can act as arbortificient.
Narad…that would be my business..or would I have to spend it on what you tell me to spend it also? maybe the way Fluke spends hers is more appropriate.
Narad reminded me of another quite stupid trope that RH busted out on us – the money aspect. There was a time when some physicians made it out with extremely low debt and went into extremely high paying specialties. That is simply no longer the case. A friend of mine has been an ER attending (i.e. finished residency and started making “the big bucks”) for over 10 years. He still has $75,000 in med school loans to pay off. When I graduate I will have close to $300k in loans to pay back between undergrad and med. Those loans are accumulating interest as we speak. 6 months after I graduate the interest will re-capitalize on the principle and I will be expected to begin paying the new total back. However, since the average intern salary is around $47k per annum, I will have absolutely no way of affording my loan repayment. So, just like every other intern in the country, I will ask for a hardship deferal for the 3 years of my residency. Then, after that I will go on to another 3 years of fellowship, where I still won’t be able to afford my loan. So 6 more years of interest will be recapitalized on the previously recapitalized principle. Then I will get the job that pays me the big bucks and finally be able to start paying off my loan. To the tune of well over $3,000 per month for ten years. But I am making an amazing salary right? Some 30 times more than rustic? Well, not quite. Most doctors will be lvery ucky to make 15 times the national average salary, while the majority will make between 5-10 times. Well, that’s still a lot, isn’t it? Yeah, it is not an insignificant amount. And I have been known to quite crassly remind colleagues that they have pretty much the only degree that effectively guarantees you such a salary. However, we do have vastly more liability, lost out on a minimum of 8 years of any sort of salary, and work copious overtime without more money. Oh yeah, and that loan worth 3 times the average house to pay off.
So when you figure that other college grads (because my numbers above were based on the average US salary, not the average US college graduate salary) were making more than will for my 6 years of post grad training and have a few hundred thousand less in loans and don’t have the same liability I will…. let’s just say that the “gets paid a lot of money” argument is a pretty darned weak one.
To some back of the envelope stuff that means that if I had just gone to work using my undergrad degree instead of going to medical school to “make the big bucks” by the time I finish fellowship, I will have made a total of roughly $500k more than I otherwise will and be roughly $350k less in debt. So just at the word go, I start out my attending life $850k worse off for having chosen this path (and those are conservative numbers. It would be very reasonable to round up to $1m). Some people have spouses that can help out, but most don’t, and many even have other med students as spouses further compounding the debt. Thankfully my fiance does not have med school debt, but she does have grad school debt, and as cool as it is rocket science doesn’t actually pay all that much (plus she is applying for he PhD at CalTech).
This is not to say that physicians, in general, don’t live very comfortable lives and have a lot more security than most people. We certainly do and as I said I rebuke colleagues who lose sight of this. But we most certainly are not all fat cats rolling in the easy money. I knew one hospitalist who couldn’t afford to get the laser eye surgery he wanted so much because between his low salary (that group was on the low end, paying about 20% less than a typical hospitalist group in my area), his student loans, his wife’s student loans, and their desire to have a house and family (how dare he?) he was living month to month, let alone building a savings account.
Sorry for the rant, but on top of all of it, I hate the rhetoric that doctors tend to be these excessively rich people. Some most certainly are, and still can be today, but the vast majority are far from it.
@ François Luong:
Indeed, this is why we become experts at different fields. And why I love hanging out with people who have different expertises. Histology and anatomy were my least favorite topics (kind of like saying chips ahoy is my least favorite cookie) but physiology and molecular biology we can certainly talk about
@Chris:
I have high hopes to make it to TAM! next year. Perhaps if you and François Luong are there we can make it happen
@mouse:
I agree, it was indeed obscure. However, based on previous discussion involving DugganSC on the topic (abortion) I do believe that is what (s)he was referring to.
Won’t you all love the watchful eye of socialism when it takes full root, making sure you spend every penny you get on approved items only? let’s see..drugs are good, contraceptives (of course), mercury filled lightbulbs…chemical filled foods,..what a life:)
FL – Sorry, I did get and genuinely appreciate your previous post on RH, it’s just to hear her “logic” voiced by a rational person is even more confusing than hearing it from her.
RusticHealthy – Yes, our individual rights are protected by the constitution. That was my point. Every time you proclaim that ‘all this taxation’ is just a slippery slope to some form of communism, you are completely denying how that is prevented by the Constitution. Our slope is not so slippery, it has an elected legislature, president and supreme court (not to mention all the state component who also play a part).
Come on, do you really not recognize that saying a constitutional democracy that taxes people to expand healthcare coverage is on a road to Stalinism is “Sky is Falling” hyperbole at it’s worst?
As to your version of recent economic history. Well, I would try to point out some areas where you are mistaken. “But reality has a well-known liberal bias”, So I doubt you would listen. Really, get out of your echo chamber and read some real economic analysis, read the Economist. Be a Republican or an “Independant” or whatever, but be informed(!) try to make your decisions based on reality! Even Pres. Bush or Gov Romney don’t believe your version of history (well, at least I hope Romney doesn’t believe it, because that’d be REALLY scary).
nybgrus – I’m a big fan of mysterious drink concoctions. I’m bookmarking so I can try your recipe.
David Gorski teaches me more about Nazism than I learned k-12 in one blog comment incorporating a quote from Cracked. That’s just one of the reasons I love this blog.
nybgrus..so you don’t like explaining where all your money goes do you…why not? …No one should have to explain to anyone how they spend their money, because ? it’s Their money ..right? ..no one should be determining how much one makes..or take from those who make more… But, that’s what socialists do, because..it’s not fair someone has more money than someone else…as Mitt Romney ..but wait..it’s OK that Obama is a multimillionaire..or the Clintons, or the Gores, funny how that is.
nybgrus..and paying for others ‘welfare’ in free education for life, salaries and benefits, contraceptives and sex change operations will help too..you have so much to look forward to! I’m sure you will be really happy to ‘give’! when you’re out..
and Francois..socialists..You know who you Are! (I think)
mouse..yes..and once again, when we elect a majority of Less taxing, Less welfare state representatives, then I hope …well never mind, I gave up ‘hoping’ the left would ever stop whining for more.
ok..I’ll go now, going shopping…what can I buy..is there a socialist approved list out?
because, I don’t want to spend my $ on vitamins and organic food..so I can pay for your chemical drugs and bank accounts. 
Rustic – I obviously have no issue taking about such things. I wish more people knew the reality of the “affluence” of doctors. And not that it will matter to you, but social MEDICINE is not necessarilypart and parcel with SOCIALISM. Australia is not a socialist country, but they have social medicine. I’d write more but it’s a certain waste of time to do so.
nybgrus,bet that door to door vitamin salesman job is lookin’ pretty sweet to you now
Wow….RH’s comments should be a road side attraction. “Biggest Strawman Ever Constructed!”
^ And out of totally 100% natural, chemical-free organic straw, too!
@nybgrus: What’s TAM!? (My conferences are MLA and AWP) Whatever they are, yes, it’d be nice for this drink to happen. And if your fiance gets that fellowship at CalTech, you’ll only be a couple of hours from me (I’m in SF).
@nybgrus:
I may have succumbed to my tendency towards bad analogies. My intent was to indicate the difference between a personal belief that only applies to oneself and one which applies to others. The Catholic viewpoint on contraceptives is that it’s bad for the individual, but they only believe that the individual is responsible, so they don’t try to force that belief on others. Think of it as like being vegan. Most vegans do it as a personal choice rather than trying to force the rest of the world to cease to consumer animal flesh (although there’s always a lunatic fringe). Their stance on abortifacients is that it’s no longer a matter of the individual themselves. Compare it to being against animal abuse. For the most part, people don’t just shake their heads and say, “Well, I don’t believe in putting kittens in microwave ovens, but it’s their choice.”
Ultimately, though, this is a debate for a different forum. My original intent was to clarify that Hobby Lobby was likely the case you were speaking of where someone was protesting the law by refusing to comply with it.
@tmac57: Ha! I’d sell Rhodiola rosea since I actually did research on it and it is showing promise in anti-aging pharmacology (very, very bench science promise but that is like gold in these markets!)
@Quill: That makes it a very high quality and good for you straw man. Eat up!
@François Luong: TAM! is The Amazing Meeting every summer in Las Vegas. SBM has had a booth there the past two years (I believe… at least this year for sure). I will (hopefully) be doing my elective in San Diego next year at right around that time which is why I think I can make it. I am currently trying to make a bid for and decide whether to do a second elective in SF or LA. Ultimately I would like to go back to SoCal (as would the fiance), hence her looking into further graduate work in aerospace out there (plus it has been a dream of hers to attend CalTech).
@DugganSC: I won’t belabor the point since it is indeed a different conversation, but the notion that Catholics don’t care what others think for themselves is absolutely blinkered. They care very much and demand others believe like they do as much as possible. That point aside, your clarification still doesn’t change the issue at heart.
Whether the dispensation – whatever form – from the Catholic employer is used on the person themselves or someone else (regardless of how you define “someone”) really doesn’t change the argument at all. I can buy a gun and shoot myself or shoot someone else. Either way, the money the employer gave me afforded me the gun. No matter how many degrees of separation it is still a fundamentally flawed argument against a legal choice that the employer has absolutely zero right to weigh in on.
um, poor wording. Shooting someone with a gun is not the legal choice, but the Plan B* and abortions are. So, quite frankly, if we can justify people purchasing guns we should grant even more justification for medical services sucha s these.
*and on top of that, Plan B is not an abortefacient.
@nybgrus,
Correction: SBM does not have a booth at TAM. We have held Workshops there every year since 2010 and have done panel presentations on the main program each of those years, most recently here: http://www.youtube.com/watch?v=z-AUHCf7eHQ&feature=youtu.be Sure hope you can make it!
The analogy of putting kittens in a microwave is kinda offensive. Sorry DugganSC – I know you are not usually inflammatory, so I will assume you just feel really emotional about this issue. But a woman faces a higher risk of financial instability, illness and even death due to pregnancy and delivery than she does using birth control or terminating an unintended pregnancy. At the very minimum one should be able to respect the risks that a woman faces in pregnancy and delivery.
I am aggravated by a nation that rejects default organ donations but thinks they should be able to control a woman’s body to save a zygote.
It is of course your business if you think the best thing to do with your money is to stick it in a mattress or, apparently, invest it in deliverable contracts in the full-stop market. However, you ought not to be surprised when your stream-of-consciousness pronouncements on macroeconomics then fail to generate much in the way of value in the marketplace of ideas.
@Dr. Hall: I sit corrected then. I knew SBM was there, but was unclear with the exact nomenclature involved. And yes, I would love to make it, as would a very good friend of mine from Chicago Medical School. It would be an honor to meet you and the rest of the SBM authorship and whomever from the commentariat that shows up.
Just wanted to add one thing
The Nazis, even if they were not the exact same brand of big centralized government and ‘majority rule’, of socialism, or communism, they were still a Big Centralized Goverment and..’majority rule’…(the ‘majority’ did vote in Hitler afterall). That’s the problem we (on the right, who’ve actually been accused of being Nazis?) have with Any big centralized government, that our forefathers tried to prevent, and why we’re not a straight democracy, we’re a Republic. And, once again, were meant to have the power to individual States and not to D.C. as our Big Centralized Government ruling us all. That’s being changed more and more in the last 50 years or so..and, more so in the last 4..alarmingly so. I think it was called ‘fundamental transformation’ isn’t that what Obama ran on? And now..’let’s finish the job we started’..And that would mean what exactly? what exactly is ‘fundamental transformation’ anyway? hmmmm
Actually, I believe FDR began it in a big way, LB Johnson advanced it with “the Great Society”..and it has continued to be advanced since…perhaps both sides (being wrong) but, nevertheless, it has. I didn’t consider Bush a true conservative actually… but there it is….and it’s mostly (true) conservatives and libertarians that are trying to reign it back. And, I know the raving will now be..how we don’t care for the poor, or for the free education for all, and sex change ops, or for someone’s bank book $, or for any and all things the left determines they need others to pay for…but, enough…is …enough.
When called out on her B.S. that Nazis were “socialists,” note how RH retreats back to the silly and meaningless trope of, “Well, maybe Nazis weren’t ‘socialists,’ but they had a big centralized government; so it’s the same thing.” And, no, that’s not a straw man; that’s the implication of RH’s silly argument.
Oh, and the majority didn’t vote for Hitler, at least not before he came to power in January 1933, after which the Nazis rigged future elections. In July 1932, the Nazis only got 37% of the vote, with the Social Democrats getting 22% and the Communists getting 14%. This was a huge gain, enough to make the Nazi Party the largest single party in the Reichstag, but not enough for a working majority because none of the other parties would form a coalition with the Nazis. Because there was no working majority (leading President Hindenberg to rule at times by emergency decree), another election was held in November 1932, and the Nazi share of the vote actually fell to 33%, with a corresponding increase for the Communist Party and the conservative German National People’s Party. The governing chaos resulting from this situation was what led to the jockeying and negotiations that ultimately ended up with Hindenberg forming a government in which Hitler was Chancellor almost three months later.
Once Hitler got into power, it didn’t take him long to start crushing all opposition, and the rest, unfortunately, is history.
The founding fathers actually did want a strong central government. There is very little question about that. However, the only way that they could actually have any government was to create a document that appeased the individual states and ensured individual rights deemed important by the people (aka the Bill of Rights, the first 10 amendmends to the constitution passed as a simultaneous referendum) which were significantly influenced by the peoples’ experiences during British rule and the revolutionary war.
If you notice, rustic, the constitution is set up such that States can make whatever laws they want – so long as they do not conflict with Federal law. Federal law always trumps state laws no matter what. Which is why the medical marijuana laws in California are actually illegal and why Bush kept sending in DEA and other federal officials to bust medical marijuana users. It was a political ploy by the California advocates however, because they kept setting up the DEA to bust in on little old grannies smoking a joint for their cancer giving very bad PR to the fed. It was Obama that finally decided enough bad PR is enough, and simply look the other way. That said, if you look at the actual laws governing the prescription of marijuana by a physician, it follows the same guidelines as prescription of any other drug except that it is explicitly stated that while the California Medical Board and state/local police would not inquire into such prescriptions (unless they violated the general principles of responsible prescription) the Feds could come in and make trouble for you and there is nothing the state can do about it.
So explain to me how you reconcile a constitution set up in an iron-clad way to ensure that federal decress always trump state decrees (regardless of which decree came first!) with your notion that the founding fathers did not want a strong and big centralized government?
And furthermore, you demonstrate quite nicely exactly why many of us here are proponents of certain legislation in that majority rule does not mean the trampling of minority rights… yet seem to think that only applies to the minority rights you and your ideology agree with.
@Dr. Gorski:
Thanks for that info… I had always thought that Hitler had won control through a very standard and legitimate popular vote and then started running amok. I wish I had the time to go back to the archives of your alter ego and read up on that….
Well..fine Dr. Gorski…whatever the #s..37% is more than 22%..anyway..if the socialists and communists got together they’d have another Big Government rule..either/or..All Three are Big Government rule…or at least One centralized rule ..and yes Hitler was a dictator..or turned to be when he had the opportunity..that’s how it happens..Stalin became Dictator and murdered millions of Russians too..people don’t vote in evil dictators usually… (at least I hope not), but that’s what happens… and the only safeguard is a Republic, and a Limited one at that.
Nybrus..there Is a question about whether our forefathers wanted a strong federalized government. That’s pretty strange to claim…according to whom? they simply “appeased” the population? wow…and you’re OK with that?
Well, atleast, a few of them thankfully didn’t..Thomas Jefferson being one. Well, he’s probably my favorite..who actually seemed to remember what they fought against…..Benjamin Franklin seemed to be another “Its a Republic, for as long as you can keep it”…I don’t care what some “allowed” or “appeased” or what you say you know in their minds what they meant they allowed or appeased..whatever happened..or should have happened, there is a terrible danger of Big Centralized government, overruling and trampling on everyone’s individual rights..Right now, my individual right is being trampled on by forcing me to pay for someone else’s health care..health care I don’t even care or choose for myself!..see? what about MY individual rights there? That’s the damned problem here. This centralized now healthcare run from the Feds is now forcing me to pay for something I don’t want ..for myself for one..or actually, for anyone else. Chemical toxic medicine is not my idea of health! I know I know, you believe you know better than I do for myself..I’m almost TOTALLY sure in your mind you think right now..that’s what ‘dictator’ type socialists seem to have a inclination to do. That’s how this all ties in.
RH – “The Nazis, even if they were not the exact same brand of big centralized government and ‘majority rule’, of socialism, or communism, they were still a Big Centralized Goverment and..’majority rule’…(the ‘majority’ did vote in Hitler afterall). That’s the problem we (on the right, who’ve actually been accused of being Nazis?)”
Learn history – I already made one crack about Night of the Long Knives, that you were obviously not curious enough to look-up.
and, the federal decree of the Constitution, supposedly federal law, was meant to guard against states Not stepping on the individuals rights..I believe, once upon a time, we had.
Also – the idea of public education in the U.S. was started by the founding father’s who made it clear that literate citizens are needed to build a strong democracy. Freedom of the press is pointless, if only the elite can read.
“”If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be.” Thomas Jefferson
mousethatroared:
I am amazed at how little history is known by the “health freedom” folks. There is one elsewhere who essentially wants the FDA abolished, and that there be no regulations (all the time claiming FDA approved drugs kill 100000 people per year), and then claims that the Elixir Sulfanilamide Tragedy only killed about six (it was over a hundred).
The Night of Long Knives was just part of the way the Nazis got rid of their opposition. I recently read about it in Erik Larson’s In the Garden of the Beasts, which is about the American ambassador and his family during that time.
nybgrus and anyone else – As DG points out, there were problem’s with the democratic structure in Germany that lead to Hitler being able to take control. I don’t have as good a grasp of those issues as I would like, since my main German history was learned in a college German films class*. But I know enough to observe that the saying “those who ignore history are doomed to repeat it.” Is more than a warning about individual ethics and predijuce. One needs to look at how government structures and decisions failed, to prevent similar catastrophes. This is the reason that the groundless accusations of communism and fascism (Where labels are empty synonyms for “bad”) from either the left or right, drive me batty. They only get in the way of a nuanced understanding of what mechanisms failed that will help us identify actual problems in governments today.
DG posts are great for that, and amazingly brief (considering the source ) but I am also left wanting more.
*Our Professor lived in Germany as a child, immigrated to the U.S. after Hitler established control and then served as a translator for the U.S. military in Postwar Germany and liked to lecture on films within the context of history and culture, so it was an extremely good class for learning history, but still…
(Not that RH will visit this site), but here it is:
http://www.jewishvirtuallibrary.org/jsource/Holocaust/hitler.html
A few years ago, when my husband and his German colleague were guest lecturers at Donau University, Krems, Austria, we rented a car and drove to Prague. Prague is one of the most beautiful cities in Europe. We and our German friends spent an entire day “touring” sites within the Jewish Ghetto. Here we saw the many synagogues that were part of Jewish life before the Nazis invaded Czechoslovakia, 1939. More than 250,000 Jews in Czechoslavakia perished in concentration camps during World War II.
http://www.jewishvirtuallibrary.org/jsource/vjw/Prague.html
When I was growing up in Brooklyn, New York, many my friends’ parents and grandparents had “identifying” numbers tattooed on their forearms. They were the “lucky” Jews, who survived the work camps and concentration camps. The “unlucky” Jews (6,000,000 of them), were those that were systematically exterminated by the Nazi regime and their collaborators.
nybrgus “If you notice, rustic, the constitution is set up such that States can make whatever laws they want – so long as they do not conflict with Federal law. Federal law always trumps state laws no matter what.”
Well, just to be clear, unless those federal laws are deemed an unconstitutional infringement upon state rights. Checks and balances.
Darn editing, my little crack about David Gorski’s short posts was supposed to have a
indicating gentle ribbing. Doesn’t read right without the wink.
mousethatroared, there is a reason that there are whole university courses devoted to Europe and WWII, along with a whole section of literature in both libraries and bookstores. There are lots of issues that can be studied, including the fractious nature of many governments on that continent. My daughter was thinking of taking a Europe in WWII class, but opted for history of the Americas before 1800 because it may actually be less complicated.
If you ever get to Europe, be sure to visit a museum about that era. We visited one in Amsterdam and the one in Copenhagen. There was a definite lesson in how different they were from each other. (we were visiting relatives in both countries, including one who had spent time in a German camp as a child)
lillady..I’m sorry, but do I give any impression whatsoever? that I’m anti Jewish? I’m a christian, and the One I believe in was Jewish actually!
so, I’m not sure where or why this constant implication, accusation, insinuation, that anyone not a leftist is antisemite and I RESENT IT…yet another socialist tactic to label anyone not socialist to be racist or antisemite or ‘greedy’ or hatefilled…seriously you all need to grow up.
and, lilady, don’t dismiss Stalin’s exterminating millions too..let’s not leave that out.. or are you OK with that?
mouse, honestly, I question the FDA’s need also..they’re passing meds untested, unproven, anyway!..as demonstrated with the constant horrendous results and lawsuits that follow. They’ve allowed gmos/ges in our foods without our knowledge or testing/proof that they’re ‘harmless’…we’re on our own apparently anyway.
@Chris – I’ve been to Europe, a couple times, but you know artists in Europe…we spend most of our available time gawking at art…There is a lifetime to study even before the Twentieth Century. One thing I know about Nazis and art, they hated most of the good stuff.
If I get a chance to got to Europe again, I will have to be more well-rounded. Thanks for the links.
So, now having been shown that, contrary to her historically and politically ignorant blather, Nazi-ism is not socialism and that, contrary to her historically ignorant right wing talking points, the Nazis never got a majority of the vote before they took power, RH retreats to even more historically ignorant speculations about the socialists and Communists getting together. Amusing. That’s why I love being so knowledgeable about World War II, Nazi-ism, and the Holocaust; it amuses me to point out just how dumb arguments of the sort that RH likes to make are.
Seriously, RH. You need to read some history. Some real history. Jonah Goldberg doesn’t count.
>>>>Which is why the medical marijuana laws in California are actually illegal and why Bush kept sending in DEA and other federal officials to bust medical marijuana users.
Just to clarify, the medical marijuana laws are not illegal. California has chosen to not make possession of small amounts of marijuana a crime and to not make using marijuana for medical purposes a crime.
The state has regulations and if you follows those regulations you are not violating state laws, but may be in violation of Federal law. That does not make the state law “illegal.” The states are not required to make possession and use a crime.
It just happens that there are federal laws that make using marijuana a crime, but it’s not up to the states to enforce federal law.
ES
ES:
And that may be tested in at least one state in next month’s elections.
@Chris, mouse, and Dr. Gorski: A systematic problem in the Weimar Republic might have led to the rise of the NSDAP all the way to 1933, yes. But let’s not forget the terrible economic situation Germany was in after 1918, between the astronomical reparations demanded by the Treaty of Versailles and the German currency being terribly deflated. I remember one of my history professor telling us a bottle of Coke costing 5 billion marks in 1932. This was a situation that was already bad, but made even worse with the start of the Great Depression. In such times of despair, it’s not a surprise to see people flock to those who offer a nicer and simpler narrative. You can see a similar movement today, with the rise of the Golden Dawn in Greece, the score Marine Le Pen received in the first round of the French presidential election this year, and the Tea Party in the United States.
It’s this notion of nicer narrative and this economical aspect that make me wonder about the popular success (and the predatory nature) of CAMs. On one hand, you have a narrative that strives toward truthfulness, even if it might be painful (using a very extreme example: You have cancer. We have this treatment, but we have to cut you open, and it only has a success rate of 75%. It might also give you an extra X number of years). On the other hand, you have the nicer and simpler narrative (you have cancer? No worries, we will heal you with my reiki touch of awesomeness and those needles. We’ll add moxibustion for good measure as well. Oh, you still died? Well, that’s because you didn’t believe hard enough). And this “alternative treatment” only costs you a fraction of what a medical treatment would cost.
Personal anecdote: An ex-girlfriend took me to a naturopath a couple of years ago, to have a skin condition checked. I went, because I was curious and because I had no clue what a naturopath was. The naturopath only asked me questions about my diet and had a 5-minute look at the skin of my forearm. She told me I had a fungal infection and sold me a bottle of calendula and a brush. Total cost: Less than $100, without insurance (my HMO didn’t cover “alternative care” at the time), and she offered me a sliding scale. My actual skin condition? Just a very sensitive skin that gets very dry after a shower if I forget to apply lotion. It also happens to my father and my brother.
RH – It was Chris that mentioned the FDA – I’m the one that’s keeps harping on history and the Constitution. Lilady brought up the Holocaust links because we were talking about learning from the WWII history, I don’t see ANY implication that you are a nazi, only that you are sadly lacking in knowledge of the era.
@ rustic health:
““The Nazis, even if they were not the exact same brand of big centralized government and ‘majority rule’, of socialism, or communism, they were still a Big Centralized Goverment and..’majority rule’…(the ‘majority’ did vote in Hitler afterall). That’s the problem we (on the right, who’ve actually been accused of being Nazis?)”
I did NOT accuse you of being antisemitic; the first link I provided is an accurately-detailed, historically-correct documentation of Hitler’s rise to power in Germany. The monster Hitler was not elected by the “majority” as you seem to believe.
The second link I provided, describes what I experienced during my visit to the Jewish Ghetto in Prague.
BTW, I’m a Christian…and a Liberal…and I deeply resent the hijacking of my religion by the far-to-the-right wing of the Republican party, who are against universal health care.
WWJD? (What Would Jesus Do?) He would be in favor of universal health care.
“And Jesus went about all Galilee, teaching in their synagogues, and preaching the gospel of the kingdom, and healing all manner of sickness and all manner of disease among the people.” (King James Bible, Matthew 4:23)
I forgot my point to tie my comment to this post: without any insurance and proper regulation, quacks will be more accessible than doctors.
Francois..I have a comment on my site “Nip it in the Bud”…and one reference is the very very dry chapped hands I used to get…but since taking vitamins regularly and going organic it no longer occurs..here’s a link on it..Vit. A, C E and B complex deficiency perhaps…http://www.ehow.com/facts_4779968_home-remedies-dry-cracked-skin.html
and you can try coconut oil if you like. just an fyi
mouse I looked it up..Night of the Long Knives..I’m not saying they were compatible..obviously Hitler had other ideas and wanted it all…but they’re both still big dictating gov crushing the individual’s rights…that’s my point
And I only mentioned the FDA in regards to not knowing history. And true to form RH is responding with the uneducated knee jerk platitudes.
Mr. Luong, when I was in high school I spotted an English translation of Mein Kampf in the library. I checked it out and caused wide eyed wonder and guffaws of laughter as I read passages from it in the lunch room. The history of WWII in Europe does not start in the 1930s, it starts with the power struggles and political changes in the mid-19th century.
@Chris: You’re right, I’m omitting a lot of things in my comment, such as the issues of Pan-Germanism, colonialism and antisemitism, among other things. I limited my scope to 1918, the German Fall from Empire, to 1933 to have a look at the economic factors that might have lead a significant proportion of Germans (and Austrians) to turn to the far right. I’ve also omitted the case of Italy, which came out a victor of WWI, and where Mussolini came to power in 1922 (granted, through a coup).
Here are articles about two *home-grown* antisemites…both of them Christian:
http://en.wikipedia.org/wiki/Dearborn_Independent
Henry Ford was a pacifist who opposed World War I, and he believed that Jews were responsible for starting wars in order to profit from them: “International financiers are behind all war. They are what is called the international Jew: German Jews, French Jews, English Jews, American Jews. I believe that in all those countries except our own the Jewish financier is supreme . . . here the Jew is a threat”. Ford also believed Jews, in their role as financiers, did not contribute anything of value to society.[1]
In 1915, during World War I, Ford blamed Jews for instigating the war, saying “I know who caused the war: German-Jewish bankers.” Later, in 1925, Ford said “What I oppose most is the international Jewish money power that is met in every war. That is what I oppose – a power that has no country and that can order the young men of all countries out to death’”.
And, the Ford-owned Dearborn Independent published the “The Protocols of the Elders of Zion”:
The newspaper published The Protocols of the Elders of Zion, which was discredited by The Times of London as a forgery during theIndependent’s publishing run. The American Jewish Historical Society described the ideas presented in the magazine as “anti-immigrant, anti-labor, anti-liquor, and anti-Semitic.” In February 1921, the New York World published an interview with Ford, in which he said: “The only statement I care to make about the Protocols is that they fit in with what is going on.” During this period, Ford emerged as “a respected spokesman for right-wing extremism and religious prejudice,” reaching around 700,000 readers through his newspaper.[7
http://en.wikipedia.org/wiki/Charles_Coughlin
After the 1936 election, Coughlin increasingly expressed sympathy for the fascist governments of Hitler and Mussolini as an antidote to Communism.[27] He claimed that Jewish bankers were behind the Russian Revolution,[28] and that Russian Bolshevism was a disproportionately Jewish phenomenon.[29] On November 27, 1938, he said that “there can be no doubt that the Russian Revolution… was launched and fomented by distinctively Jewish influence.”[30]
He promoted his controversial beliefs by means of his radio broadcasts and his weekly rotogravure magazine, Social Justice, which began publication in March, 1936.[31] During the last half of 1938, Social Justice reprinted in weekly installments the fraudulent, anti-semitic text The Protocols of the Elders of Zion.[32] Charles Tull states, “Originally published in Russia in 1905, the Protocols purports to be an account of a Jewish conspiracy to seize control of the world”.
Seriously RH, get a grip, get a life, stay away from your right-wing websites…and starting reading some history books.
@RH: Not interested in remedies for dry skin. It doesn’t even affect my quality of life. I only used this personal anecdote to illustrate how an economic factor, that is to say how cheap CAM providers compared to doctors when insurance is not taken into consideration.
so Lillady…I suppose BO is one too
right? according to you 
and lilady..what were you insinuating with this?..
(Not that RH will visit this site), but here it is:
http://www.jewishvirtuallibrary.org/jsource/Holocaust/hitler.html
Please cut bull..I’m from NY too..and I don’t take too much of it from anyone..but, I especially have a problem with LW BS
lillady..WWJD? He would tell us to give of our own free will..not a Gov Dictatorship. Libs have hijacked actually christianity in this false self-delusion, that you’re giving when you vote for a Gov to take other’s money from them, and redistribute it…but, not of your own giving in fact. You’re Delusional.
@mouse & estockly:
Perhaps my language is not as precise as need be in legal terminology since that is certainly far from my field expertise. And yes, there are indeed checks and balances and both an implicit and explicit expectation for the federal government and state government to work together rather than against each other whenever possible. Additionally, there is a very complicated (well beyond my superficial understanding) set of rules which define the way in which federal case law can or cannot become binding precedent.
However, the Supremacy Clause (Article VI, Clause 2) of the Constitution states that in all matters the federal law shall be the supreme law of the land and bind all citizens – regardless of state laws.
If a state law is more restrictive than a federal law, then the state law takes precedence within the state and if a federal court (due to jurisdictional issues) tries a case wherein a relevant state law is more restrictive then the court is bound to apply the state law as if it were a court within the state. However, the reverse is not true. If a law in a state is less restrictive than a federal law the restriction of the federal law take precedence and are the basis of trial.
In cases where the state and federal law are in direct opposition then the federal law will always trump the state law. This can actually be used to strike down a state law if it is brought to court. For example in Cooper v Aaron (1958) Arkansas tried to nullify desegregation (thus nullifying Brown v Board of Education) by passing a state law based on the theory of states rights. It was struck down by the SCOTUS continuing the precedent that federal law controlled and could not be otherwise changed by state law. In Edgar v Mite Corp (1982), the SCOTUS said explicitly “A state statute is void to the extent that it actually conflicts with a valid Federal statute” which is defined as situations where compliance with both state and federal law is impossible or “…state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress…”
It has even been established that federal and international treaties will always be supreme to any state concerns, even when the state claims that the action on the part of the federal government would abrogate states rights as guaranteed by the 10th Amendment (Missouri v Holland (1920)).
There have has even been SCOTUS case law that the mere intent to act in a certain area by Congress triggers the Supremacy Clause and can nullify state law (California v ARC America Corp (1989)). Even more recent SCOTUS ruling further expounds upon federal supremacy by determining that a state law can be determined unconstitutional even if there is no relevant contradictory federal law but the “state law is an obstacle to the accomplishment and execution of Congress’s full purposes and objectives” (Crosby v National Foreign Trade Council (2000)).
So, my legal understanding is extremely superficial and the likes of Jan Bellamy could certainly set me straight on this, but from my readings and understanding when it comes down to it States Rights is purely a function of the convenience of the federal government. States are allowed to do what they wish but only so far as it does not raise the ire of the fed – even to the point where there need not be a federal law in order to obviate a state right, but merely the “intent” of Congress. And States rights can be abrogated knowingly and intentionally as long as it serves the interest of Congress.
So perhaps in a techincal sense “illegal” is not the correct term, but the California law is definitely in direct contradiction with the federal law and is thus nullified and unconstitutional. The fact that the state is not enforcing it and that the fed is no longer enforcing it and not enjoining the state to enforce it (which it can, if it so desired) is merely a matter of political convenience but does not bear on the legality of the law, whether it can actually stand, or the theoretical requirements of the state to nullify its own law and enforce the federal law. And yes, if Washington and Oregon pass the decriminalization laws they also will be “illegal” and be immediately technically nullified and the fed can either enforce the law itself or enjoin the state to do so.
So even checks and balances isn’t quite the case, since Congress/the Fed can – at any time – abrogate any state law by defining it as necessary for the intent of congress. And all these precedents have been upheld since nearly the inception of the country. It was in Ware v Hylton that the fed struck down a state law using the Supremacy Clause… all the way back in 1796. As such, I still contend that our government – and the founding fathers – is one intended to be a strong centralized power with states rights thrown in as an appeasement for the sake of united the first 13 colonies (since we have precedent to ignore the 10th Amendment at the convenience of the federal government).
Also, in California marijuana possession itself is not decriminalized. You still must have a valid prescription for it. It is the same as any other controlled substance – a person with a script for vicodin can possess it but a person without said script is in violation of federal narcotics laws.
(I did not include the copious links to reference all the case law since it would hold up in moderation and I figured anyone interested could just google the cases)
“So, my legal understanding is extremely superficial and the likes of Jan Bellamy could certainly set me straight on this, but from my readings and understanding when it comes down to it States Rights is purely a function of the convenience of the federal government. States are allowed to do what they wish but only so far as it does not raise the ire of the fed – even to the point where there need not be a federal law in order to obviate a state right, but merely the “intent” of Congress. And States rights can be abrogated knowingly and intentionally as long as it serves the interest of Congress.”
Well, I wish we had a lawyer it then. because I’m remembering the recent Supreme Court case where the states were opposing Obama Care. It was only narrowly upheld when the court observed that the fine was actually a tax, which was within the fed’s power. It’s my understanding that just as individuals have rights under the Constitution, so do states and the Supreme Court can strke down laws that it decides are inconstitutional, regardless of the demand of congress.
RH – you missed my point of Night of the Long Knives. It was not that the Nazi Regime and the German Communists didn’t get along. It was that the ruling political party sent out death squads and executed 85+ political opponents, terrifying the members of the courts and other political offices into supporting the regime.
You keep talking about being oppressed and having your rights trampled. For an oppressed party, the right’s political leaders are surprisingly alive, at large in the community, in possession of huge campaign budgets and healthy media outlets.
I guess they don’t make oppression like they used to…unless you’re Syrian.
You are not being oppressed. You disagree with the current laws, you have a right to speak about that, you have a right to disagree at the ballot box. That is not oppression. That is a fair representative government.
If you truly had a commitment to, something like lowering the deficit, you would educate yourself. Seek to find the most efficient ways to lower the deficit, use your speech to win people over to your ideas and vote for representatives that supported those ideas.
Instead, because you have no idea about the real issues or real solutions, you throw around groundless accusations of socialism, fascism and oppression, which only someone who already agrees with you and takes a similar shallow approach would believe. In addition, you vote based on those groundless claims of oppression, socialism, fascism without any real idea of which representatives would best accomplish your goals.
Your unwillingness to challenge yourself mentally is crippling you in the war of ideas. Don’t you think you can do better?
FL – Excellent points about the population response to economic depression!
Lilady – I meant to thank you for the links earlier…ask for information and you shall recieve!
Also, many of us in Michigan would prefer to leave Henry Ford’s daker side unexamined. He did a lot of brilliant things and his approach to worker pay was very economically insightful, but his antisemitism, very sad.
Just goes to show you, never trust someone because they are brilliant or make alot of good decisions. Question whether they have good logic and evidence for their position.
Okay, I’m done with my Sunday morning sermon, now. Where’s the donuts?
mouse.. I agree I have to vote (so far) in order for change. Unfortunately, now that the very ambiguous 2400 page!! HCR Law is already passed by one majority party and prez, (not reading it themselves before the fact:) it will be difficult to change, but I’m hoping it happens. I still resent being accused of being greedy and racist and evil, because I don’t want to meet someone else’s Demands… believing in my own, and everyone else’s freedom to do with what They so choose with Their money and property. I get that, (not being rich myself)…I respect Freedom more. Especially the b.s. of WWJD?, as if .. somehow some think they’re doing by Them demanding and Taking other’s money and freedom through government laws for Their own gain and so choosing. I’m amazed how many people in this country can’t see that…but, it’s an easy tactic to play on…with the “you owe me” crowd. I thought lilady was insinuating I was antisemetic too..with her ‘holocaust’ link as if I were denying it. Then she brings up how 2 other so called ‘christians’ were antisemetic..so therefore what? see..anyway..I’m tired of this now..too..I’m making Sunday pancakes..with organic ingredients of course..where I rather spend my $ on my personal ‘healthcare’ in healthy non toxic foods..that I now have to defend
RH…Is this you? (From your website that you referred to “Nip It In the Bud”)
http://www.nipitinthebudusa.org/about.html
RH – I agree I have to vote (so far) – There you go again…
No lillady..my nic has my site..sorry…http://gethealthybehappy.yolasite.com/ and in the ‘Comment/New Findings:) there’s a comment titled “Nip it in the Bud”.. http://gethealthybehappy.yolasite.com/comments-and-new-findings/nip-it-in-the-bud- among other comments
Oh I made a mistake…by not clicking on rustic health’s name.
Look what I found…
http://gethealthybehappy.yolasite.com/comments-and-new-findings/barking-up-the-wrong-tree
Time for me to post this again. Woof, woof, grrrrrr….
http://www.youtube.com/watch?v=lvw-9XEyPKk
I just bet that RH home-schools her kids as well, so why isn’t she aware of 20th century history?
@mouse:
Yes, the fed also has limits as to what it can do. There are certain laws that are not explicitly or traditionally something the fed does and all laws must be constitutional. In the case of the PPACA (my understanding at least) is that the states raised a challenge because… well, it doesn’t matter why – they can and that is their right. However, the fed and the SCOTUS then review it and can decide if it is, in fact, unconstitutional and if not then can decide under which legal standing or precedent the law can remain. The SCOTUS in this case decided that the preferred way to uphold the constitutionality of the law was to call it a tax and leave it at that. However, once again from my understanding, the SCOTUS could have just as easily said “Congress has decided that national health policy is in the best interest of the government, the people, and the desires of Congress” and the law would have stood on the Supremacy clause alone.
Of course people and states can always challenge a law – they may say that it is unconstitutional, or not within the purview of Congressional legislative capacity, or anything else really. But that doesn’t change the Supremacy Clause nor the case law precedent that the fed always has the right to the last word, no matter what. For some things they just get challenged and need to find ways to uphold what they want to do.
Okay – nybgrus, I think I’ve got you better the second (or is it the third) time around. I see what you mean, but I’ll have to do some reading before I whole-heatedly agree.
lilady..I did teach my kids this…
You’re Not Giving by Taking Other People’s Money. That’s Not Giving …
it seems to be something “WWJD” lefty’s haven’t as yet learned and that’s what I’m here to teach as well!
@RH: Funny that you should be harping about this country being a Republic. Here is something that you didn’t teach your kids, the notion of public good, which is where the word “republic” takes its etymology in the first place (“res publica,” the public thing). Making sure people have access to health care AND are not bankrupted by it has nothing to do with socialism, it’s basic republicanism, something that even Richard Nixon understood with the Comprehensive Health Insurance Act. Now, are you going to call Nixon a socialist too?
FL – Nixon went to China, so clearly he’s a Communist.
Actually, I don’t know what to call ‘moderates’ on the right…not as bad as left..but, not conservatives either..like Bush also.
In any case..the lesson stands…repeat after me…I’m Not Giving by Taking Other People’s Money. That’s Not Giving
and..sorry again, but, I don’t have a bank account..should I be able to demand you to give me one..or only if I had one, got sick, and so you then pay for me to keep mine…but, only if I have one..and if I get sick…otherwise..tough luck…funny how particular lw laws are…Obamacare is the Law of the land..except 100′s of unions and towns and companies are Exempt!..the illogical lunacy of the left knows no bounds it seems.
FL yes ..the public good..except for the crony voters exempted themselves from Giving to the Public Good..hmmmm: ) and..I believe Congress is exempt from ‘giving to the public good’! let’s not forget them.
Folks, this is the science illiterate who gets her education about preventive health from Livestong.com and Mercola.
This same science illiterate is enthralled with bee pollen, “alkaline balanced diets” and blackstrap molasses.
Ditto, for “natural cures” for herpes, natural cures for pertussis (Vitamin C!) following the advice of Dr. Suzanne Humpries…who in turn…is following Hilary Butler’s Vitamin C cure for pertussis. Rather than prescribed antibiotics…the science illiterate has “natural cures”.
Ditto for “natural cures” for cancer; she’s a fan-girl of Burzynski and Gerson.
“lilady..I did teach my kids this…
You’re Not Giving by Taking Other People’s Money. That’s Not Giving …
it seems to be something “WWJD” lefty’s haven’t as yet learned and that’s what I’m here to teach as well!”
Charity never faileth: but whether there be prophecies, they shall fail; whether there be tongues, they shall cease; whether there be knowledge, it shall vanish away.
For we know in part, and we prophesy in part.
But when that which is perfect is come, then that which is in part shall be done away.
When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things.
For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.
And now abideth faith, hope, charity, these three; but the greatest of these is charity.
-St. Paul, Letter to the Corinthians, I Corinthians 13:8-13, St. James Bible
@lilady,
“Folks, this is the science illiterate who gets her education about preventive health from Livestong.com and Mercola.”
Much as I dislike to, I have to point out that this is an ad hominem argument. Just because she knows squat about medicine, does not mean that what she argues is just as stupid. It may very well be, but not for this reason.
@RH: “the crony voters [who] exempted themselves from Giving to the Public Good“? Do you mean the infamous 47% who pay no income taxes? Like those on Social Security, an entitlement they paid into for 50 years of arduous work, which in most cases is not even enough to ensure a proper retirement? Or those in the military, who are giving their lives in the service of their country? Like Dr. Hall, whom you have accused of being a socialist, and yet served for years in the US Air Force? Well, RH, how dare you invoke the notion of “public good” when you are insulting those who are making sacrifices in the service of others? Like nybgrus when he was a resident, who despite an extremely low pay, would work 48-hour shift to make the lives of others better and yet, despite the grueling and thankless job, has not given up to cynicism and still believes in basic human decency? Because basic human decency is what is at stake here, and you have demonstrated none. You are acting like an embarrassed millionaire. I therefore refuse to call you or anyone in the Republican Party a “conservative”, because to do so would tie you to the honorable tradition of Thomas Hobbes, Edmund Burke, Otto Von Bismarck, and Charles De Gaulle. You people are barbarians who have no interest in the fabric of society, but in sucking its marrow dry. For what matters, I am not an American citizen. I am still, after 12 years, a French citizen. But I still pay my taxes to the Federal Government and the State of California. This is not my country, but I would gladly pay more taxes if this means you people get a decent healthcare system. Because I believe a society should be judged by how it treats its weakest members, and you, RH, have shown nothing but contempt for those.
“Stands”? It’s meaningless. Do you, as a matter of self-consistency, also abstain from voting, which is an inherently coercive act?
Perhaps you would like to try restating this in English. Nobody particularly cares about your personal financial incompetence, which would seem to be severe in that conducting transactions with money orders seems to be demanded, i.e., paying to use your own funds.
Hardly ad hominen, weing…just follow from the top of the thread RH’s comments about “medicine”.
“My personal ‘healthcare’ is vitamins vs. vaccine, less carcinogens and more vitamins to curve cancer rates.”
“lillady..asthma is helped by vitamins..C, omegas..in my own experience having got off of 2 inhalers and 2 meds including steroids :/…most childhood diseases are vitamin deficiency…causing low immunity.”
“For medicinal purposes, no I’m not familiar with how contraceptives will work for it, and we all pay for doctor visits don’t we…in any case that would be an exception to the rule, and could easily be done through doctor and insurance company I’m sure, not to make it a blanket Demand by all for “unintended pregnancies”… and, going to a catholic university, expecting them to go against their own belief and policy for her (who chose to go there) or anyone else is ‘attacking’ the freedom of one’s religious belief..actually.”
“Won’t you all love the watchful eye of socialism when it takes full root, making sure you spend every penny you get on approved items only? let’s see..drugs are good, contraceptives (of course), mercury filled lightbulbs…chemical filled foods,..what a life:)”
“ok..I’ll go now, going shopping…what can I buy..is there a socialist approved list out?
because, I don’t want to spend my $ on vitamins and organic food..so I can pay for your chemical drugs and bank accounts. 
“mouse, honestly, I question the FDA’s need also..they’re passing meds untested, unproven, anyway!..as demonstrated with the constant horrendous results and lawsuits that follow. They’ve allowed gmos/ges in our foods without our knowledge or testing/proof that they’re ‘harmless’…we’re on our own apparently anyway.”
I think you will find that RH interjected “politics” into this thread with her ad hominem attacks about posters here accusing us of being Nazis, Socialists and Liberals. I provided her with links to a historical correct website (The Jewish Virtual Library), to check out how Adolph Hitler came to power…he did not have the majority in the Reichstag.
She then accused me of labeling her as antisemitic and then provided us with this “Confession of Faith”
“lillady..I’m sorry, but do I give any impression whatsoever? that I’m anti Jewish? I’m a christian, and the One I believe in was Jewish actually!
so, I’m not sure where or why this constant implication, accusation, insinuation, that anyone not a leftist is antisemite and I RESENT IT…yet another socialist tactic to label anyone not socialist to be racist or antisemite or ‘greedy’ or hatefilled…seriously you all need to grow up.”
No weing…I think you are directing your comments about launching an ad hominen argument to the wrong poster.
@lilady,
I honestly cannot follow her arguments. If you understand them, then more power to you.
I’ve been following her arguments weing and her type of “medicine”…based on her spectacular science illiteracy.
She’s as ignorant as they come…about medicine, about American and world history. She’s also clueless about politics…so obvious, because she confuses repeatedly fascism, communism, socialism and Liberalism.
Here’s Federal income Tax Rates in the United States for the past century and its effect on the economy. Except for the past few years, we have had a “Progressive Income Tax Rate” and there is a reason for labeling Non-Progressive Income Tax Rates as “Regressive”.
http://www.businessinsider.com/history-of-tax-rates-2012-5?op=1
Thanks for the link. I will check it out. My expertise is medicine. I look upon all political and economic solutions with great suspicion. The ACA is a work in progress. There is no way Romney could get rid of it if he wins. I don’t think either party has a solution to our problems as there is no utopia. Hopefully, we will muddle through again.
Francois..no..I mean..all of these unions, towns, companies…
http://www.freerepublic.com/focus/f-chat/2900475/posts
I recently had a conversation with someone of the more conservative bent whose opinions I respect but don’t often agree with (although we both have a soft spot for giant multinationals). He named some people on various forms of public assistance whom he knew had relatives who could afford to help them out. He asked me ‘Do you want your tax dollars to pay for them to mooch off of the system? Their relatives are gaming the system by not helping them out.’ I said ‘Sure. I don’t mind if my tax dollars go to them, even if they are mooching off the system.’ Why? Several reasons, and this all applies to healthcare too. Firstly, there are always going to be freeloaders. You’ll never weed them all out without weeding out people who “deserve” the assistance too. I asked this friend what rule could possibly be applied to the welfare system such that these particular people could be denied service but a similar case, say where someone had been disowned by their wealthy family, would be accepted?
To me, the risk that my tax dollars might pay for a few moochers is worth it because there are people I know who’ve used public assistance who needed the safety net. I would want it to be there , and I think anyone who can admit that they don’t have control over everything in their life would like to have it there.
And on those lines, rustic, when you do something dumb and get injured (and we all do something dumb every once in a while.) to the point where vitamins just won’t pay the stupid tax, and the jar of quarters that you’ve been stashing under your bed because you’re too paranoid to have a bank account runs out, I would be happy to have my tax dollars go towards keeping you alive and reasonably comfortable. I will even pay for the jello that they give you at this hospital. I don’t know or even particularly like you, but in order to reap the benefits of an advanced society which gives me a chance to do the most I can with my life, I have to give something back.
PS. Did you just claim to know more about Christianity than the Jesuits? LOL.
PSS. Render unto Caesar…
“Because I believe a society should be judged by how it treats its weakest members, and you, RH, have shown nothing but contempt for those.”
The irony is that she is one of those weakest members.
Billy, us ‘weakest members’ are even More Weak since the Big Spending of LWr’s in D. C. in last 4 years.
And, just a ‘reminder’ ..it was a LW Majority Congresswoman Speaker who said..it was “Unpatriotic” to vote against Bailing Out Rich Corporation Cronies! Remember?? lol please spare me
((Just because she knows squat about medicine, does not mean that what she argues is just as stupid.)) thanks for that weing
RH – Rewriting history again. The AWESOME economy is what we call a bubble. The debt didn’t start building when Pres. Obama came into office.
mouse..no it didn’t..it started more so when the LW took majority 2007/8 and doubled spending..from 1.6 Trillion the last budget of a RW majority ..to 3 Trillion..and 3 Trillion each year since..in addition another 4 Trillion in 4 years of Obama.
And..what you call a ‘bubble’ is what we call an Awesome Economy!..housing burst, but, that was a bunch of Bad banking policies..oh yes..brought on by ..Fannie and Freddie?… but, even that didn’t have to burst the economy..certainly not keep it spiraling since..and still, why didn’t 4 Trillion $ added spending turn it around? and still didn’t help the middleclass Or the poor! A whole Lot of “Misspending” there.. and these are the brainiacs of brainiacs right? that we so ‘trust’ stewardship with and so ‘greedy’ not to trust our money with.
The Awesome economy was based on credit. Housing burst, Banks wouldn’t loan money. Businesses go under without money. Even the conservative economists would wince at your misrepresentation of the situation. You’re also neglecting to mention TWO wars that might have something to do with the debt that Bush and the Congress accumulated.
RH -Iif you have a good argument for your beliefs, why would you have to misrepresent the facts?
By the way – The Automotive bail-out helped this middle-class person AND probably over a million other people in this country. It’s likely that it helped you. Because those kind of job loses and the resulting lost tax revenue and additional pension revenue would have had wide ranging consequences to the whole country.
@MTR,
That’s it. Hit her with facts. All we can do is examine the data. I still don’t understand why they won’t bring back Glass-Steagall.
2 wars..that is true..but that’s one ‘expense’ the Federal gov is supposed to be there for. Not bailing out corporate buds, or buying votes.
weing “I still don’t understand why they won’t bring back Glass-Steagall.”
Me either.
@weing: “That’s it. Hit her with facts.” Sadly, she’s just going to ignore them. Or misread them. Or call them socialist.
“Our” money? L-rd knows that when I’m looking for macroeconomic analysis, the first place I turn is to someone with no assets.
well..why don’t you ‘share’ some of yours with me Narad
right Lil? Give and it shall be given to you?
@FL – Ancient Painter Wisdom – One does not straighten a painting due to the believe that the painting will learn to be straighter. One straightens for the brief satisfaction of seeing a level painting.
I suggest we all ignore RH, now…maybe she’ll just “go away”.
Does anyone want to go over all the various socialist programs we have in the country, and how they are the reason RH is in business? Socialism isn’t bad, and majority of the programs in the US are socialist. I always find it humorous how it’s condemned yet they rely on them for many many things…oh and how they like to use it interchangeably with communism.
@weing and mouse
” I still don’t understand why they won’t bring back Glass-Steagall.”
Three reasons:
1. It makes perfect sense and is therefore impossible given the current political climate;
2. Banks make far more in investment banking than in commercial banking;
3. Banking has an extraordinarily powerful lobbying presence; essentially they pay for laws that suit them.
Larry Kotlikoff (BU economist) has a wonderful riff on limited purpose banking:
http://www.kotlikoff.net/sites/default/files/LimitedPurposeBanking1-27-09_0.pdf
I’m figuring that we’ll have a sensible health care system about 37 minutes after the return of Glass or upon the ambient temperature in hell reaching 0C, whichever comes last.
?? I’m sorry…do I have go to D.C. and Demand you get me a bankaccount? So, when I get sick, I won’t have to use it?
Windriven – ha! Silly me, I was looking for a GOOD reason why. Thanks for the link.
O did I get that one wrong? That one’s for the well off ..I get it.
and, so, if that ‘credit’ economy was the reason for the burst, I wonder what kind of burst that 16,000,000,000,000 ( 16 Trillion) $ “credit” bill we have in D.C. will cause.hmmmm
@mouse
“I was looking for a GOOD reason why.”
Laughter is really the only reasonable way to approach some of these issues because the alternative would involve opening an artery.
I’ve avoided this thread until now because Dr. Gorski (quite reasonably) seems to want to keep SBM at some distance from partisan politics. When I think about the issues involved with health care delivery, insurance, and the political process I just want to shriek incoherently.
I was just in D.C. for the American Society of Anesthesiologists annual meeting. While there I strolled down to the National Mall, past the Washington Monument to the memorials for veterans of WWII, Korea and Vietnam. It is a profoundly humbling experience. The memorials are just a short walk from both the White House and the Capitol. It is a measure of just how callow our politicians are that the likes of Eric Cantor and Chuck Schumer can argue who has the bigger schlong in the shadow of such sacrifice.
Just so you know also, this ‘weakest’ member has to pay more for gas (because of lw policies) food (because gas is so high because of lw policies), and now healthcare, because I have to pay for someone else’s bank account, 25 year olds who should be out of the house, and contraceptives for other’s sex life.
So, I have very little left over for a bank account to save for when I get sick and won’t have to use it! 
You didn’t hit the Hahnemann statue?
@Narad
I did, actually. But I paid it no more attention than to note that the pigeons were paying him his due.
Dr. Gorski: It’s now obvious that rustichealthy’s comments are under moderation. While they were entertaining thanks to their sheer stupidity, I wonder about the use of letting them appear, at least on this thread. There is nothing constructive left to say on this thread. The conversation derailed long ago. It seems a little cruel to let it go on, since all we are doing is making fun of rustichealthy’s talking points. Surely, there will be another opportunity to talk about insurance policy and science at a later point.
FL – i believe the SBM policy is to post all comments except in the case of extreme and obvious trolling and sockpuppets. What makes you think that RH’s comments are gong through moderation? Did I miss something.
Windriven – agreed, best to laugh, so you don’t cry.
RH – “O did I get that one wrong? That one’s for the well off ..I get it.
” I don’t understand this sentence. Are you saying that understanding the financial crisis is for the well-off? Are you saying joking about Glass-Steagall is for the well-off? You clearly have internet access, checking-out Wikipedia doesn’t cost extra.
Really, Really, Really. When looking for solutions. Don’t start with your preferred solution then make up the “evidence” to fit. You will never find a good solution that way.
Start with a good definition of the problem, look at the evidence, formulate possible solutions, compare them against the evidence, then select the best solution.
This should not be a left wing/right wing thing. It’s understandable that different parties would support different solutions in a complicated problem. But any valid solutions should be compatible with history and the evidence.
It’s NOT acceptable when a supposed solution relies on rewriting history or ignoring evidence to look good. Why is it not acceptable? Because it doesn’t work. It doesn’t work in engineering, it doesn’t work in economics, it doesn’t work in home budgets, it doesn’t work in medicine, it doesn’t even work in ART and that is saying something.
Really, RH, you must know this to be true. You wouldn’t try to fix your bike by deciding the tires need replacing when the evidence shows the chain is broken. You wouldn’t ignore the broken chain, because you prefer replacing tires.
Why would you ignore the history of the financial crisis?
Okay, lecturing over. If my numerous comments haven’t convinced you to educate yourself before formulating an opinion, then I doubt any additional ones will do the trick.
mouse..when I said: O did I get that one wrong? That one’s for the well off ..I get it.
I was referring to the hc provision that one can keep their bank account without going bankrupt in order to have health care coverage. In other words, complicated as it is that lw seem to make things, one can keep their savings (if they have one…those who are able to have one
more than likely well-off already! So, kiddingly, I was asking for a bank account, so I can have it when I get sick..so I don’t have to use …o…nevermind .. it’s complicated 
@mouse: rustichealthy’s comments don’t appear in my RSS feed at all. When I visit the SBM site, they also appear after I have read everyone else’s comments.
Okay – yeah, I haven’t been checking in enough to see when things pop-up and I don’t do RSS feed. But could be her comments are going through moderation. But I don’t think I’ve ever seen SBM stop posting someone’s comments on a particular topic. All I’ve seen is extremely rare but open bans on particular posters who are abusive or engage in solely trollish posting over an extended period of time.
Personally, I’m thinking this thread has just about reached the end of it’s lifespan. Things are heating up over in “American Medical Students Associate, etc” though
RH:
RH:
RH:
One wonders how she paid for the plane ticket and everything else that goes with international travel.