HEALTH CARE HOLOCAUST

People, real people by the thousands every year, are dying for lack of medical treatment in the world’s richest nation, and after a week of politicians posturing over piles of paper, policy wonks are stunning us with this truth.

A new study shows 68 Americans under age 65 die every day because they don’t have health care, a number that will rise to 84 by 2019–a total of 275,000 needless deaths in a decade.

The numbers from an advocacy group, Families USA, comport with earlier estimates by the Urban Institute and the Institute of Medicine, dry statistics that conceal mass murder by indifference without concentration camps or gas chambers.

Sophisticates who consider such statements overwrought should explain how their cost-benefit analyses make such an outcome inevitable as they advocate, in Sen. Tom Coburn’s response to the President’s weekly address today, that we “scrap the current bills, which will lead to a government takeover of health care, and we should start over.”

Along with this prescription for indifference, a leading GOP presidential hopeful for 2012, Tim Pawlenty, wants to change federal law to allow emergency rooms to turn away patients–”do a little triage,” even for those who come in with what Fox’s Greta Van Susteren described as “horrible chest pains.” (Pace Sarah Palin and her Democratic death panels!)

At the Health Care Summit Thursday, several Democrats tried to focus the discussion on what their constituents are suffering under the current system, but the Republican response was typified by smug Eric Cantor tapping his pile of papers and insisting that “we Republicans care just as much about health care as the Democrats do,” while questioning the legality of forcing all Americans to buy health insurance.

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Author: ROBERT STEIN

  • Silhouette

    I still think the Countdown show with Keith Olbermann should switch from the “mission accomplished in Iraq” countdown to the number of deaths from lack of adequate health coverage to date each day.

    THAT would grease the wheels of getting the new less-costly Public Option [instead of today's ER-Public Option at eight times the expense and half the effectiveness in care].

    “as of tonight, “x” americans have died this year from lack of adequate health coverage. Good night and good luck.”

  • JSpencer

    And so the world greatest democracy continues it's slide toward banana republicanism. Let's hear it for the 21st century celebration of low standards!

  • merkin

    There are two problems that must be faced. This one where people are dying because they have no access to health care. And the second where we are going bankrupt paying for the inadequate health care we have. The second will cause more of the first problem in the long run.

    The Democrats are paying attention to the first and only limited attention to the second problem. The Republicans don't believe there are any problems. And as long as they continue to close their eyes and put their fingers in their ears and stomp their feet no one will convince them otherwise.

    The Republicans are right about one thing about the current bill. It over time will cost the government a lot of money. But they are are wrong about the reason. Once again we have all agreed, without any discussion, to provide a critical function by paying huge subsidies to private companies to do something the government can do better and much cheaper. The reason the United States pays so much for so little today is because of the inefficiency of private enterprise to do it. Now we will compound the problem and gave them a much bigger job to do even more inefficiently.

  • Silhouette

    Unless the Public Option is introduced and good old competition forces them to become more efficient.

  • Priscilla

    I can only assume that you believe that government rationing of healthcare will be more efficient and fairer than market rationing. Because if you think that there will be no rationing in the government-run system, then I would submit that you are not being remotely realistic.

    I have seen how rationing works under the Canadian model that the Dems seek to emulate and I have seen deaths result directlly from the long waits and denial of treatment based on “efficacy” and cost. I brought my own child to the US for cancer treatment that was considered experimental in Canada, but standard protocol in America.

    If horror stories and death resulting from failed healthcare policy is what you are looking to prevent, Obamacare is not your answer.

  • DaMav

    Most people recognize that these kinds of studies are pumped out by advocacy groups as talking points in the debate.

    A sure sign of this is the way they are used uncritically. Here are the links in the OP:

    * new study — goes to a handwringing article in the NY Times that neither examines the methodology nor contains any balancing point of view on the study. It's pure “politics of fear” people are dropping like flies rubbish. There is no link to the study and no discussion of how these conclusions were reached.

    * sophisticates — goes to an NY Times blog unrelated to the issue

    * Pawlenty – just another attempt to bash, nothing on the study.

    In summary we have a typical propaganda piece. Tens of thousands will die if you don't give us our way politically. This stuff went on all last year and frankly not very many people fell for it then. Now we have a new year, and more the same but they've upped the number a bit.

    I didn't bother trying to find the details of the study because it's obvious that those trying to scare people with it aren't interested in how they got the numbers, only how they can use them to further their personal agendas.

    Here's something to put this into perspective. About 2.4 million Americans die every year, with or without insurance. So even if the study were correct, it is postulating a difference of 27,000 deaths a year, or about 1% reduction in mortality if insurance somehow saved the lives of every uninsured who died. But within that 1% are no doubt a lot of people who would have died anyway. If you've got a major killer cancer, for example, you don't go from a six month prognosis to fully cured just because you have insurance. And many people are covered but don't take advantage of the coverage. We've already had Obama try to blame insurance for a poor woman who died of breast cancer when she had access to free mammograms. Many uninsured children are eligible for full coverage, but their parents don't bother to apply for the program. Yet if they haven't applied and die, do they get counted as an uninsured death? Are we getting the worst case scare statistic here, or something that was carefully controlled to ensure only genuine 'solely because of a lack of insurance' numbers were used?

    Maybe, just maybe, this latest study controlled for all these factors. But if you personally are not familiar with the details of the study, please don't be upset by those who retain a modicum of skepticism about the numbers you are throwing around with such careless abandon. Not being gullible is not the same as not caring.

  • kathykattenburg

    DaMav, your long list of objections above are all just rationalizations for not caring. When you want or approve of a government policy or programs, you show no inclination to be skeptical of claims you have read or heard in its favor. I'm tired of people dismissing the real and obviously real horrors of our health care non-system and then asking us to believe it's not that they don't care.

  • SteveK

    DaMav, your long list of objections above are all just rationalizations for not caring.

    Yep, and he hasn't a clue about what you're saying… None of them do.

  • DaMav

    It must be great to consider yourself to be such a paragon of virtue. The point I keep making is that nobody but the liberals themselves believes they are doing anything more than pushing their own feel good agenda at everyone elses expense. I'm sure that's upsetting to those who believe they are suprior moral beings but that's the price you pay for falling for your own propaganda.

  • DaMav

    I understand that you believe that you are Beings of Light bringing caring and wisdom to the masses and that anyone who is skeptical is one of the Malevolent Uncaring Spawn of Beelzebub. (“He MUSB!”)

    It's not that I don't understand. It's just I don't agree that your self-annointment is anything more than self-annointment.

    Oh, and another way to tell that a study is basically intended for propraganda is that when you question it, you get attacked personally. Question the methodology and the liberal shaman begin the incantations to declare you an unbeliever and burn you in the fire of self-righteousness at the stake.

  • Dr J

    I'm tired of people dismissing the real and obviously real horrors of our health care non-system and then asking us to believe it's not that they don't care.

    And I'm tired of people imagining that the horror stories they happen to have heard about are the only ones that exist, and that treating those–at whatever the cost–must make everything better for everyone.

    It's liberals who fall short of caring. They eagerly pour their hearts–and other people's wallets–out for people they read about in the news today, but how about they people they didn't read about? Liberals don't care about them, cannot craft policies that make any accommodation for them, and appear to believe they don't exist.

  • JSpencer

    The reason the United States pays so much for so little today is because of the inefficiency of private enterprise to do it.

    Well… inefficiency and greed – both conditions that grow and expand in a system with limited competition and little oversight. Getting high on the hog as it were… to the detriment of our country. Plain enough to see – only requires open eyes. Therein lies the rub. ;-)

  • Dr J

    Plain enough to see – only requires open eyes. Therein lies the rub. ;-)

    Sure does. You'd have to notice that fully half of the inefficient system–the 800-pound gorilla, which sets the rules the other half plays by–is run by the government. It takes once-in-a-generation acts of congress (if we're lucky) to fix inefficiencies in Medicare that would be routine matters in the private sector. And fixing the big problems–paying for quality rather than quantity, for example, or getting the friggin' books to balance–isn't even on the radar.

    Inefficiency is the disease, greed is the cure.

  • woosey

    I care. I work for free to take care of uninsured people everyday. I take time away from my family and I take risk that someone will sue the hell out of me because I carry no malpractice.

    You can't just bury your head in the sand because you have lost faith in human compassion. You must always question studies like this with obvious political consequence. Whichever side the results fall on.

    Why? Because the fall out from whatever the federal government decides is the 'cure' will be HUGE.

  • woosey

    'them'
    that doesn't help

  • SteveK

    I understand that you believe that you are Beings of Light bringing caring and wisdom to the masses and that anyone who is skeptical is one of the Malevolent Uncaring Spawn of Beelzebub. (“He MUSB!”)

    I rest my case.

  • woosey

    I thought this was a hub for moderates.
    This is just a bunch of pig headed people not willing to compromise their views or consider anyone elses in the slightest. Just attack attack attack.
    Both sides
    Shame on you

  • SteveK

    comment read (?)

  • Dr J

    This is just a bunch of pig headed people not willing to compromise their views or consider anyone elses in the slightest. Just attack attack attack.

    Well, you're not doing a lot better there yourself, Woosey.

    Personally, I find the crowd here a bunch of well-meaning people who are curiously unable to communicate with each other. And I'd like to. And my frustration with being called stupid, blind, uncaring or morally inferior comes out from time to time. You're seeing a bit of that tonight.

  • SteveK

    Personally, I find the crowd here a bunch of well-meaning people who are curiously unable to communicate with each other.

    Do you include yourself in this rant or is this another of your “it's them” arguments?

  • Dr J

    Chill out, Steve.

  • archangel

    hi there, woosey. Please read the commenters rules at the top of the home page at TMV. Debate with your facts and opinions but in a civil manner.

    Thanks
    dr.e
    deputy managing editor TMV

  • archangel

    Hi commenters, Debate with your facts and opinions but in a civil manner. Some of the topics at TMV are predictable in causing some people's blood pressure to rise, but keep it civil. Thanks.
    dr.e

  • DaMav

    I questioned the validity of the study. This led to responses questioning the validity of me. oh well :-)

    Thus far nobody has sought to defend the study, or express certitude that a 1% variance in death rate might not be explainable by other factors besides lack of insurance.

    Here's a thought. We know that there is a sizable chunk of people who voluntarily choose not to buy health insurance. Might these also be people who are less attentive to their health status in general, i.e. more likely to engage in unhealthful behavior based a fatalistic approach to life in general? That would certainy tilt the death rate toward the uninsured. How did the study control for this group, or did it even consider it?

    And another. People who have chronic health problems may have difficulty getting or keeping a job, and therefore are less likely to be insured. If those health problems eventually result in death, they get counted as uninsured with a higher death rate, even though it was the health problem that led to the lack of insurance and not vice-versa.

    Point is, it doesn't take very much to create a 1% difference in two groups, even when the group size is large. So shouldn't we be skeptical of a study like this when none of these factors is even addressed by the partisans?

    Last point. Public health schools turn out people who often work in choice jobs for the government. People rarely go into public health in order to go into private practice. So the schools and faculty have a vested interest in pushing for government control of health care. That by itself doesn't make the study invalid, but it should inject a note of caution into taking the results at face value.

  • kathykattenburg

    They eagerly pour their hearts–and other people's wallets–out for people they read about in the news today, but how about they people they didn't read about?

    You mean, like the six-figure and up corporate leaders and top professionals who want the federal government to give them nice big tax breaks but scream socialism when anyone talks about funding programs and policies that would help low-income and working- and middle-class Americans who are struggling to survive in the worst recession since 1939?

  • kathykattenburg

    Inefficiency is the disease, greed is the cure.

    “Inefficiency”: def: (1) Grandma and grandpa with food on their tables, roofs over their heads, and filled prescriptions in their medicine cabinets, only because of the existence of Medicare and Social Security. (2) Too many sick people who need health insurance draining the health insurance industry's profits by asking their insurers to provide the health insurance coverage they've been paying for all these years.

    “Greed” (aka “the cure”): def.: (1) Throwing Grandma and Grandpa to the Wall Street bankers and stockbrokers, who will be happy to take their Medicare and Social Security checks and gamble it away until the next real estate bubble breaks; (2) losing those losers who need health insurance the most because they have health problems so the insurance companies can get back to the point: making lots of money from selling insurance policies they will never have to pay out on.

  • kathykattenburg

    Some of the topics at TMV are predictable in causing some people's blood pressure to rise, but keep it civil.

    Especially important for those of us who don't have health insurance.

  • http://polimom.com Polimom

    From the article, with emphasis:

    “The new study, by liberal advocacy group Families USA, applied the same methodology used in the previous reports to drill down and calculate, on both a national and state-by-state basis, the latest figures.”

    If it's okay to accept advocacy group data as facts, folks, then all sense of balance or perspective is lost.

  • http://www.facebook.com/people/Axel-Kaspar-Edgren/635450085 Axel Kaspar Edgren

    Either America selfishly leaves the uninsured hanging in order to get “a better bill later” or it does as I say and avoids a lot of future difficulties.

    As long as nations suffer for going in directions I disagree with, I am fine either way.

  • casualobserver

    Rasmussen Reports – 41% Support – 56% Oppose
    Newsweek – 40% – 49%
    Pew Research – 38% – 50%
    ABC News/Wash Post – 46% – 49%
    Quinnipiac – 35% – 54%
    Ipsos/McClatchy – 37% – 51%
    NBC News/Wall St. Jrnl – 31% – 46%
    CNN/Opinion Research – 38% – 58%
    NPR – POS/GQR – 39% – 55%
    USA Today/Gallup – 39% – 55%

  • Dr J

    You mean, like the six-figure and up corporate leaders…

    Of course not, you read about them constantly. And every time the word “corporation” comes up, you write about them, as predictably as dirty dishes after dinner.

    You appear to think those few people and their millions are a good representation of corporate interests, that all corporations follow that model, and that no other beneficiaries or influencers of corporations exist.

    I could forgive such a distorted perspective as a rhetorical device, except you also advocate legislation based on it. Your justification for campaign finance laws muzzling corporations is rooted in exactly that oversimplified image of them.

  • steveinch

    Let's lower the speed limit to 5mph on all highways. We'd save more lives and it wouldn't cost the government a penny. Oh and auto insurance rates would decline substantially. What a win/win/win.

    While we're at it, let's ban bathtubs, you know people die in those too.

    My point is simple. Even if you accept the argument made by the “advocacy groups” and the argument is pretty hotly debated, it ought not to be the role of the government to prevent all preventable deaths. To argue that it is is to give government total control over your life in the interest of preventing your death.

    So if you want to draw the line somewhere, explain how you want to do it. Personally, I am in favor of a limited Federal government. I'll accept that that means that sometimes, maybe lots of times, bad things will happen that don't need to happen but I find that preferable to surrendering to the will of those who are only trying to protect me from myself.

  • steveinch

    America could easily get a better bill now.

    Increased Medicaid eligibility and high risk pools with guaranteed returns would solve the problems of most of the “involuntarily” uninsured and could be done in a lot less than 2000 pages. You could of course add things that Rs and Ds agree on to that bill but that bill could pass the Congress if the public would stomach the cost (which they might or might not).

    That bill would be a far more honest way to address the problem that the current bill which in large part pays for health reform via cost shifting (individual mandate and higher premiums than would exist all other things equal)

  • DLS

    Agitation and desperation drive more emotional and hysterical hype, IN ALL CAPS, EVEN. [snicker]

    Never mind that limiting the effort to true reform was always the correct thing, and easy to do.

  • pbjb51703

    I think you have a great point here. We just had one of our co-workers die from a heart attack 3 days after going to the doctor and asking that the MD not go crazy with tests because he didn't have insurance. He was 56 years old a wonderful man who helped take care of the less fortunate by working in adult foster care. It's not only a shame it's a sham what healthcare has become in the US.

  • DLS

    “Increased Medicaid eligibility and high risk pools with guaranteed returns”

    Pre-existing condition and recission reform — likely coupled (as it's seen as needed) with some kind of pay-in by everyone (“mandatory participation”) of some kind. Antitrust exemption repeal — add that.

    Insurance reform was what has been needed. Nothing else is essential; overreach is inappropriate.

    Insurance reform does not include any new federal intrusion and price controls. This is a state issue.

    Can things be added? Yes, but they must be limited (libs and Dems have yet to grow up!). Start with what else is overdue for work, such as what you mentioned (Medicaid, which also could use some stimulus money to aid the states, anyway), and probably including one more thing, addressing the Medicare drug benefit “doughnut hole” as well as correcting other Medicare problems right now. Give the Dems what they want in removing Medicare + Choice if they detest that HMO plan as much as they may. Make sure Medicare is saved or at least stable before extending federal entitlements to others, obviously (at least, it should be obvious, it's so blatantly — obvious already.)

    This always was easy. Get rid of everything else and just pass what's needed right now.

    Of course, libs and Dems face another emotional challenge — it's not in the GOP's interest to pass anything. That only starts a trend that encourages and threatens us all (and the GOP) with more Dem overreach, so people shouldn't place ignorant or naive hope (or immature demand) on the GOP to pass anything. The GOP is generous (working against its interests, its November prospects) to approve anything, so don't be surprised if it doesn't.

    We'd be better off if they approved a bill that was strictly limited to what should be considered at this time — true reform, nothing more.

  • JSpencer

    greed is the cure

    Sure thing, got some more of those for you too: War is peace. Slavery is freedom. Ignorance is strength. Good luck with that. ;-)

  • DLS

    “68 Americans under age 65 die every day because they don’t have health care”

    The modern retirement age is seventy, if not older, between 72 and 73 now.

    Adjustment of the retirement age is overdue, and indexing the age for increasing longevity is possible.

    Government retirement reform is long overdue. It will be inevitable once it is unaffordable.

    Only dinosaurs from the 1960s (when it was already excessive) want lowering of the retirement age for Medicare and Social Security, en masse, to 55 or even lower. (True dinosaurs are in the union and Marxism group, the Proletarian Victims of the Plutocrats “zero-sum fixed amount of work” myth sect, and they define the age of menopause or presbyopia as the start of old age and an entitlement to a lavish retirement the rest of their lives at “society's” expense in the high 40s or the low 50s.)

    We know what modern lives are like. Onset of disability with aging is in the seventies, not fifties.

    We know what modern lifespans are like, and what the dependency ratios in our nations will be like.

    The retirement age needs to be raised, not lowered — obviously. Less, not more, person-year costs!

    http://www.twq.com/02spring/hewitt.pdf

    fmwww.bc.edu/ec-p/wp424.pdf

    http://www.heldrich.rutgers.edu/uploadedFiles/…/WT16...

    (AARP) Social Security Financing — Restoring Solvency

    assets.aarp.org/rgcenter/econ/2009_01_socsec.pdf

    etc.

    Social Security Administration itself states what I've stated before, that average lifespan isn't the correct figure to use (it is abused by opponents of raising the retirement age, pointing to a reduced average for blacks, neglecting violence by youth that causes excess deaths during youth), but the remaining years of life, which I've often shown from CDC Survival Tables. SSA also makes this point:

    “A more appropriate measure is probably life expectancy after attainment of adulthood.”

    http://www.socialsecurity.gov/history/lifeexpec

  • DLS

    “the Public Option”

    Wait and see what the House does. It has no place being added to this bill, but the House might try.

  • sandymchoots

    I think you ought to hold your posters to the same standards as commenters. In particular you might want to discuss those standards with Robert Stein, who wrote in his original post:

    “The numbers from an advocacy group, Families USA, comport with earlier estimates by the Urban Institute and the Institute of Medicine, dry statistics that conceal mass murder by indifference without concentration camps or gas chambers.”

    Or is this site titled ironically?

    As a matter of simple fact, “studies” like the Urban Institute report–written by a highly partisan advocate–do not meet any reasonable standards of policy analysis. Many studies have been performed by people who make a serious effort to distinguish correlation from causation, and those studies largely cannot find a causal link from lack of health insurance to worse health outcomes.

    But no one would know anything about such studies from reading the innumerable posts on this site about the moral imperative of government micromanagement of one of the most technologically advanced and continually innovative sectors of the economy. So why not just call this site The Strident Voice and be done with it?

  • http://www.facebook.com/people/Axel-Kaspar-Edgren/635450085 Axel Kaspar Edgren

    but, casualobserver, a person like me doesn't think a worthy society's politicians only does what the majority wants.

  • mar2371

    You made a good point in questioning the validity of the study. Having an advocacy group of any kind sponsor a study is grounds for caution. I did a little research to see whether there are better studies available. The first two I found did support the general findings in this article (not to say that other studies might have different results). I admit to being biased in favor of studies by Harvard Medical School, but it's hard to analyze details of studies like these because ordinary people like me would have to pay to see the result. Please refer to links for more details of the studies.

    quote from “Health consequences of uninsurance among adults in the United States: recent evidence and implications.”, by McWilliams JM., Department of Health Care Policy, Harvard Medical School (2009)

    “Recent studies have found consistently positive and often significant effects of health insurance coverage on health across a range of outcomes. In particular, significant benefits of coverage have now been robustly demonstrated for adults with acute or chronic conditions for which there are effective treatments.”

    http://www.ncbi.nlm.nih.gov/pubmed/19523125

    =======

    quote From “Does extending health insurance coverage to the uninsured improve population health outcomes?”, by Thornton JA, Rice JL., Department of Economics, Eastern Michigan University (2008)

    “The results indicate a negative relationship between private insurance and mortality, thus suggesting that extending insurance to the uninsured population would result in an improvement in population health outcomes. The estimate of the marginal effect of insurance coverage indicates that a 10% increase in the population-insured rate of a state reduces mortality by 1.69-1.92%.”

    http://www.ncbi.nlm.nih.gov/pubmed/19382821

  • mar2371

    “Many studies have been performed by people who make a serious effort to distinguish correlation from causation, and those studies largely cannot find a causal link from lack of health insurance to worse health outcomes.”

    Please see my previous post. I would be interested in where these studies are and when they were done. Recent studies that I saw seem to reach the opposite conclusion.

  • Leonidas

    I read the title and skipped the rest. I couldn't see much point.

  • DLS

    Families USA (misleading name — liberal activist group seeking federal health care) is just contributing their own alarmism to the emotional stew being cooked up by the Democrats to appeal (sadly, too easily) to their confidently susceptible.

    I'm surprised Al Gore in his latest defense of alarmism and political perversion science for his pet cause (to make him a wealthy eco-fascist baron) didn't include the health care “crisis” in it.

    http://www.nytimes.com/2010/02/28/opinion/28gor

  • DLS

    “Having an advocacy group of any kind”

    … including the Obama administration, is a bad idea. ObamaCo refers to “families” when discussing not family plans, but the individual insurance market(!). That's amaturish or pathetic — take your pick.

    http://www.healthreform.gov/reports/insurancepr

  • http://www.facebook.com/people/Mark-Sanford/100000119110135 Mark Sanford

    Yet more garbage about how one either votes to pass the terrible Democrat bill or wants people to die. And to top it off, if the piece wasn't already ludicrous enough, gas chamber and concentration camp references are made. I guess Tom Coburn is Joseph Goebbels then, right?

  • DLS

    No — the contenders for JG are Glenn Beck and Rush Limbaugh, if I'm not mistaken.

  • kathykattenburg

    If identifying with, feeling for, and caring about people who don't fit into the mold of rugged individualism, and who struggle to survive in our American “you're on your own, do for yourself or die but don't bother me with your problems” culture means I'm a self-identified “paragon of virtue,” so be it. I'm not a paragon of virtue, I just have never been able to convince myself that a decent society lets its own people live in fear, anxiety, terror, and need. Nor have I ever suffered from the belief that the best use of public monies is to enrich the very people who create and spread the misery. Nor do I cling to a notion that food, shelter, employment, and health for my neighbor comes at my expense.

    I do feel good when I work for and/or support good things. I don't know why you would think good things come at everyone else's expense, or why you would believe that feeling good because you're trying to do good and be good is a bad thing.

  • LionAslan

    hey, thats a great idea old sandymchooz, why dont you open your own site called the Whining Weenie Commenter. Yeah, yeah, dont bother to whine back. Youre about as sharp for debate as a kleenex

  • kathykattenburg

    I'm not sure what your point is here. Regardless of what particular percentage of corporations “follow that model” (and I'm not even sure what model you're talking about), corporations are still not people, and they still do not have a constitutional right to use their billions of dollars to drown out competing voices — and while being allowed to hide their identity at that.

  • Dr J

    I'm not sure what your point is here.

    My point was that your accusations that conservatives don't care are misplaced. My compassion is simply spread wider than yours.

  • kathykattenburg

    My point was that your accusations that conservatives don't care are misplaced. My compassion is simply spread wider than yours.

    Well, needless to say I do not agree with you on that, but more to the point right now, if that was your point, I do not have any idea how your most recent comment to me before this one conveys it.

  • Dr J

    I do not have any idea how your most recent comment to me before this one conveys it.

    Then it must not have conveyed it. To recap, you said:

    I'm tired of people dismissing the real and obviously real horrors of our health care non-system and then asking us to believe it's not that they don't care.

    And I said: “[Liberals] eagerly pour their hearts–and other people's wallets–out for people they read about in the news today, but how about they people they didn't read about? Liberals don't care about them.”

    You immediately offered up a demonstration of exactly that behavior, equating corporations to overpaid executives, thereby turning a blind eye to the hundreds of millions of people who actually comprise the corporate ecosystem:

    You mean, like the six-figure and up corporate leaders…

    And I pointed out as much: “You appear to think those few people and their millions are a good representation of corporate interests.”

    So here we are. I'm writing about the millions, you're writing about the few.

  • kathykattenburg

    If I'm understanding you correctly, you are telling me that hundreds of millions of people who work for corporations are not high-paid executives, they are just ordinary people, like secretaries and file clerks and janitors and mailroom assistants. And you are telling me that all of these type of employees “are a good representation of corporate interests.” That last quoted phrase is a bit opaque, too, but I'm guessing what you mean is that the corporate interest includes and reflects these ordinary, non-executive, non-high paid employees' interests. That the “corporate interest” is the same as the individual interests of the employees who work for it.

    Before I tell you that that is laughably untrue, I just want to make sure it's actually what you're saying. Have I understood your meaning correctly?

  • Dr J

    And you are telling me that all of these type of employees “are a good representation of corporate interests.”

    They're a step closer to reality than the greedy-executive caricature on which you'd have us legislate. But reality also includes the hundreds of millions of consumers who depend on corporations for products and the scores of millions of Americans saving for retirement and relying on mutual fund returns. And reality includes other kinds of corporations and their constituents, from labor unions to the AARP. You seem prepared to muzzle them all because you don't like greedy executives.

    By all means, tell me this is laughably untrue, that greedy executives are what it's all about, and there's no need to even consider anyone else in the picture. You'll prove my point better than I have.

  • kathykattenburg

    Perhaps we're talking at cross-purposes. Perhaps I still don't understand your point. Or perhaps I've just fallen down the rabbit hole. Dr J, when I say that corporations have too much power and influence over legislation and public policy, and that the recent SCOTUS decision will allow them to drown out all other voices even more than they do now, who exactly did you imagine I was suggesting that corporations have too much power OVER?

    When Republican senators like Bob Corker and Jim DeMint try to put an amendment in the auto bailout bill requiring auto workers — not high-paid executives, Dr. J, assembly line auto workers — to take a pay cut to make their wages match the much lower wages of non-unionized foreign auto manufacturers, he's doing that to help the auto workers and their families, not the high-paid executives, right?

    When Wal-Mart and other top corporations hire union-busting law firms to — euphemism alert — “discourage” employees from joining a union, corporate management is doing that to help the checkout clerks and their families — not the high-paid executives themselves, right?

    When corporations ship American jobs overseas, that's to help Americans save for retirement, right?

    And this:

    But reality also includes the hundreds of millions of consumers who depend on corporations for products and the scores of millions of Americans saving for retirement and relying on mutual fund returns. And reality includes other kinds of corporations and their constituents, from labor unions to the AARP. You seem prepared to muzzle them all because you don't like greedy executives.

    What in the name of blue tarnation are you talking about? How does campaign finance reform muzzle employees within corporations? And how does the Citizens United decision serve those employees' interests? You're not trying to suggest that the interests of corporate entities like General Electric or Bank of America, for example, are the same as the individual interests of the temps in the typing pool, or the window tellers, or the guy who sweeps the floors at night, are you?

  • Dr J

    When Republican senators like Bob Corker and Jim DeMint try to put an amendment in the auto bailout bill requiring auto workers — not high-paid executives, Dr. J, assembly line auto workers — to take a pay cut to make their wages match the much lower wages of non-unionized foreign auto manufacturers, he's doing that to help the auto workers and their families, not the high-paid executives, right?

    Oh yes. Detroit auto companies ended up bankrupt in large part because auto workers in Michigan were paid a lot more than auto workers in Tennessee. I don't fault the UAW for fighting hard to protect their interests, but they ended up killing their golden goose. A lot more of them would have jobs today if they'd been less greedy, starting decades ago.

    When Wal-Mart and other top corporations hire union-busting law firms to — euphemism alert — “discourage” employees from joining a union, corporate management is doing that to help the checkout clerks and their families — not the high-paid executives themselves, right?

    In trying to keep their labor costs down, they're certainly representing the interests of their hundreds of millions of customers who benefit from their low prices.

    When corporations ship American jobs overseas, that's to help Americans save for retirement, right?

    It certainly is. If my IRA includes Dell stock, and Dell expands operations or trims cost by opening warehouses in Mexico or Singapore or wherever, it helps my retirement savings.

    How does campaign finance reform muzzle employees within corporations?

    Most directly by muzzling their unions, which are themselves corporations. The Citizens United case was in fact about gagging a non-profit.

  • kathykattenburg

    At least now you are clearly telling me where you are coming from.

    I find your identification of all Americans' interests, on every possible level — general, specific, employed, unemployed, low-income, high income, etc. — with corporate interests to be chilling — Orwellian even. I find your definition of “greed” — auto workers who have been steadily agreeing to cuts in wages and benefits for decades and who are still expected to give more, but not the top corporate executives who reap billions more in addition to the billions they already reap from what the auto workers have given up — to be odious. I find it reprehensible that you applaud greed — literally — when it's corporations reaping the billions at the expense of their employees' wages and often their jobs, but imply that greed is a low and counterproductive error when it's auto workers giving up those wages and benefits. If greed is a good thing, as you have said it is, then it cannot suddenly become a bad thing when you're referring to auto workers fighting against cuts in their wages and benefits.

    You obviously view your own personal self-interest, and the self-interest of Americans in general (i.e., the public interest) very differently from how I do. That is your right, but I think you err when you equate the interests of a corporation with the interests of everyone who works for that corporation; and, indeed, with everyone in general — all Americans, of every economic, social, and political status. I think it's very presumptuous to tell the assembly line workers at Dell, to use your example, that it's in their self-interest for Dell to lay them off and ship their jobs to Singapore or Malaysia, just because your stocks might go up as a result.

  • Dr J

    Kathy, you're still writing on behalf of thousands, I'm still writing on behalf of millions. Who has the greater claim to compassion?

  • sandymchoots

    @mar2371,

    I just saw your reply, so pardon my delay in responding. There is an excellent survey of all these types of studies by Helen Levy and David Meltzer, “The Impact of Health Insurance on Health,” in the April 2008 issue of the Annual Review of Public Health. At the risk of oversimplifying a thorough survey, I think it's fair to say that these basic findings emerge (with my own observations on those findings included):

    1) There is evidence that giving coverage to people with current health problems improves their health outcomes.

    This, of course, could be attributable to a large degree by the fact that currently sick people who did not previously have insurance cannot buy it after they get sick, so that giving them coverage is equivalent to giving them directly subsidized health care. It is understood that subsidizing people's health care leads them to get more of it–that's one of the reasons why our current system (which induces overinsurance by making it tax-exempt) contributes to our high share of GDP devoted to health care. It's part of the purported problem, not a solution to it.

    2) There is evidence that giving coverage to poor children improves their health outcomes.

    This is, of course, the rationale behind S-CHIP. It has nothing to do with subsidizing the health insurance of working-age adults.

    3) The three studies that seem to control best for the fact that healthy people may simply also be people who tend to buy health insurance–studies of the effect of Medicare eligibility– find no evidence that becoming eligible for Medicare leads to changes in individuals' life expectancy.

    Of these three basic findings, this last one is the most directly relevant to the current health-insurance-restructuring debate.

    Of course, what's most relevant is the effect of expanded insurance coverage on the health outcomes of those who are currently uninsured. On that topic, I will quote directly from Levy and Meltzer:

    “Moreover, for most of the population at risk of being uninsured (adults ages 19 to 50), we have limited reliable evidence on how health insurance affects health. This lack of evidence and the resulting lack of consensus indicate that to summarize the effects of health insurance on health is, inevitably, to misrepresent.”

    To all this I will add what I consider to be the most important point: Every single one of these studies takes the state of medical technology and the supply of medical personnel to be unaffected by the changes in insurance that they study. Indeed, it's hard to see how they could do otherwise. Yet we are considering the initiation of a series of “reforms” that are very likely to have substantial effects on both the rate of medical and pharmaceutical innovation and the supply of medical personnel in the long run. I am weary of reading posts like the one that initiated this comment thread, that not only asserts as fact something that is really uninformed speculation but also goes on to portray those who doubt the wisdom of uninformed restructuring of the medical sector in terms that compare them to either Holocaust deniers or maybe even Holocaust enthusiasts. That is utterly reprehensible.

  • kathykattenburg

    You are still not getting the point, Dr J. You are not speaking on behalf of the people you say you are speaking on behalf of, whether they are thousands, millions, or billions. We can agree to disagree, but you don't even understand the point we're disagreeing on.

  • Dr J

    No, Kathy, I'm not speaking on behalf of the people *you* say I am.

    I write “moving the factory helps millions of investors,” you read “moving the factory helps hundreds of employees” and then denounce me as not only wrong but wicked.

    Between readings like that and the Dickensian backgrounds you like to paint behind my comments, I find you an extremely difficult person to communicate with.

  • kathykattenburg

    I write “moving the factory helps millions of investors,” you read “moving the factory helps hundreds of employees” and then denounce me as not only wrong but wicked.

    That is SO not an accurate statement about what you wrote.

    1. Here is what you wrote:

    I don't fault the UAW for fighting hard to protect their interests, but they ended up killing their golden goose. A lot more of them would have jobs today if they'd been less greedy, starting decades ago.

    A lot more of “them”? That means auto workers, right? Auto workers seeing their wages and/or benefits and/or safety rules cut, slashed, removed, and weakened are not “investors being helped” when factories close and ship their jobs overseas. Furthermore, “millions” is very misleading. The vast majority of “investors” hold very small amounts of stock — not enough to make any significant amount of money. Auto workers whose jobs are shipped overseas and/or who give back thousands of dollars in wages and benefits suffer far more directly and severely from those losses than they benefit from a rise in the company's stock consequent on moving all those jobs to Thailand. The investors who make big money are the ones who are already wealthy and can afford to buy large amounts of high-ranked stock.Those are the ones who benefit the most from taking American workers' jobs away from them.

    2. Here is what you wrote:

    In trying to keep their labor costs down, they're certainly representing the interests of their scores of millions of customers who benefit from their low prices. Millions of them don't have jobs at all.

    These are the same customers who used to be their employees. Or who are or used to be the employees of other companies just like Wal-Mart who “try to keep their labor costs down” (i.e., pay low, try to pay even less, and cut people's jobs). “Millions of them don't have jobs at all” because their jobs were cut and/or shipped overseas! So they're slashing employees wages and benefits or sending their jobs overseas, or all of those, in order to create more customers who can buy their products? That is truly twisted, Dr J.

    Most directly by muzzling their unions, which are themselves corporations and are (or were) restricted by McCain-Feingold. The Citizens United case was about gagging a non-profit.

    Yes, and the Supreme Court decision took that original case and used it to do a massive judicial legislation from the bench that gives corporations even more power than they already had to buy legislators, and in fact, buy Congress, period.

    How does campaign finance reform “muzzle” unions? Do you believe that the only way not to be “muzzled” is to be able to spend billions of dollars to support candidates who will vote your way? And even if campaign finance reform *did* “muzzle unions,” how would that “muzzle” employees who work for unionized workplaces? Does campaign finance reform prevent individual citizens from petitioning their government or from voting?

    The Citizens United decision, in opening the floodgates to corporations' ability to control legislation and essentially buy candidates' support for their wishes, is much more harmful to labor interests than it is helpful. Most corporations are not unionized, and the green light given to corporations by the SCOTUS ruling is much more likely to keep it that way than the reverse. Now I can understand why you would like that, since you are anti-union, but don't make it out to be some great boon for unions or for individual workers.

    I find you an extremely difficult person to communicate with.

    You're no piece of cake yourself.

  • Dr J

    Kathy, you posed me a series of challenges a few comments ago. One was about how the UAW's interests were served by pay cuts. My answer was that it was better than losing even more of their jobs, which is the only alternative given the shape Detroit is in. Not great choices, for sure, but the writing has been on the wall for them for decades, they had a hand in writing it, and it's simply the reality. I didn't say anything about shipping factories overseas, nor investors' interests, because that was not the question you asked.

    Second, you asked how Walmart's maneuvers to keep employees from unionizing serve the employees' interests. I hadn't claimed that it did, but I pointed out it did serve the interests of a much larger group of people: consumers. You've now painted one of your Dickensian backgrounds around the comment–casting those consumers as victims of other alleged Walmart misdeeds. Very poignant, and probably true in at least a few cases, but irrelevant to the scenario you asked about: these people still exist, still have to buy stuff, and there are a lot more of them than there are Walmart employees.

    Third, you asked how shipping jobs overseas helps future retirees, and I told you exactly how: by helping investors. Now you've slyly morphed those investors into employees who lost those jobs. No, I didn't say the employees would benefit (obviously they don't), and I didn't even endorse closing the hypothetical factory. I simply answered your question: how might a company offshoring jobs be serving the interests of millions of retirees? That's how.

    Does campaign finance reform prevent individual citizens from petitioning their government or from voting?

    McCain-Feingold didn't prevent anyone from voting, and to the extent it takes money to circulate a petition, it didn't restrict rich citizens from funding such a thing on their own. Nor making political ads, nor all sorts of other things. But ordinary citizens can't fund ads on their own–they form corporations to raise money from a lot of people so they can get their message out.

    Whether the SCOTUS ruling is a net plus or minus to unions is a good question. We've got a union-friendly administration in place today, unlikely to interpret M-F's restrictions on “too political” messages “too close” to elections very repressively. (Though it was pretty chilling to hear the government lawyer claim they could ban books if they wanted.) But imagine if we'd had another four or eight years of someone like George “Wiretapper” Bush, plus maybe another big terrorist attack to pump up the fascism? It could get ugly for unions, and for a lot of groups. I support the ruling for exactly that reason: independent of whether I support the groups speaking, the government shouldn't be metering speech.

    You're no piece of cake yourself.

    :^) I welcome your suggestions for how I can do better.

  • kathykattenburg

    :^) I welcome your suggestions for how I can do better.

    Give me a straight, clear answer to the following question: Who are the thousands and who are the millions? You can look back to the beginning of this discussion if you've forgotten what that refers to.

    Give me a straight answer to that question and you'll be doing better.

  • Dr J

    The thousands are employees, the millions are investors and customers.

  • kathykattenburg

    Okay, you're doing better. Thank you.

    Next question(s): Who are the customers? Why and how are they a separate group from the employees?

  • mar2371

    Thanks for your thoughtful reply. I was unable to find a full copy of the article you referenced, so I can't comment on the details or methodology.

    >> This, of course, could be attributable to a large degree by the fact that currently sick people who did not previously have insurance cannot buy it after they get sick, so that giving them coverage is equivalent to giving them directly subsidized health care. <<

    That could be one interpretation of the result. A lot depends on the methods they used to come to their conclusions. It sounded to me from the articles I saw that methodology has improved in recent years, to take into account underlying factors. Another possibility is that a large number of people can't afford medical insurance, especially if their company does not offer it, so when they do get sick, they can't afford treatment. It's not surprising that giving coverage allows them to get treatment, and their health improves. This is one of the problems with discussing health care coverage – there are many possible factors to consider, and no one perfect answer.

    >> It is understood that subsidizing people's health care leads them to get more of it–that's one of the reasons why our current system (which induces overinsurance by making it tax-exempt) contributes to our high share of GDP devoted to health care. It's part of the purported problem, not a solution to it. <<

    I do agree with most of this. e.g. I have health insurance through my employer. When I go to the doctor, I pay a $10 co-pay. I have no idea what the actual cost of the visit is. I think this whole setup is ridiculous. Plans like this lead to more use of health care services, because the co-pay is too low, and the patient has no knowledge of or responsibility for the real cost. I don't agree with you totally, because there are situations where a person is unable to buy affordable health care insurance because the cost is too high. So either cost has to come down, or the government or charity needs to provide a way for this person to get medical care. I'd prefer that cost came down, but if not, then I can't see allowing people to suffer.

    >> The three studies that seem to control best for the fact that healthy people may simply also be people who tend to buy health insurance–studies of the effect of Medicare eligibility– find no evidence that becoming eligible for Medicare leads to changes in individuals' life expectancy. <<

    That is an interesting finding. Thank you for sharing that. Do you know if there have been similar studies that look at health outcomes? I have known people who lived quite long, but were in a great deal of pain because they couldn't get treatment for chronic illnesses when they were middle aged.

    I regret that I am unable to read the full versions of the article you posted and the ones that I did. I cannot comment on the reliability of evidence, since the articles I posted were newer, but they may not have been reliable either.

    I am tired of reading extreme articles on both sides of this issue. I am very Liberal in most of my views, but I am totally disgusted by the bills that the House and Senate came up with. I don't like the Republicans either. What seems to be missing is any attempt to understand both points of view. In my opinion, both sides have good ideas and valid concerns. But there is this continuous barrage of fear tactics that distract everyone to the point where it's difficult to have a thoughtful discussion.

    Thank you for the information you provided. It gave me some ideas to think about.

  • Dr J

    Who are the customers? Why and how are they a separate group from the employees?

    They're a whole bunch of diverse people. I'm not sure how to answer your question.

  • kathykattenburg

    They're a whole bunch of diverse people. I'm not sure how to answer your question.

    I'll take responsibility for that. The truth is, this is a very nebulous, confusing concept you've expressed (I mean, in general, this thing about “investors, customers, and employees”), and It's very difficult for me to even nail down how to identify what I don't understand about it.

    Basically, I don't know how you are defining these categories. The categories themselves are so sweeping, and if you think about it they are almost interchangeable. At any given moment, anyone could be in any of these categories, or all of them simultaneously.

    I am similarly confused when you talk about the “corporate interest” — or, more precisely, what you have in mind when you use that term. When I use that term, I define “corporate interest” as the economic or financial interests of the top governing strata: senior management, and the Board of Directors, as well as the stockholders. If I'm an employee of Dell, and especially if I'm a low-level employee, the government policies that will serve the corporate interest will almost certainly not serve mine. It doesn't serve my interest to lose my job.

    So what I've been trying to do here is somehow clarify how you define these terms, who you are putting into these categories, and who — specifically — you have in mind when you refer to the “corporate interest.”

  • sandymchoots

    This is the sort of exchange I wish were possible more often here and elsewhere. Thanks for your thoughtful comments. Your observations about people who lived for a long time but were in pain also jibes with the literature survey I cited–people's self-reported perception of their health rises, even though measurable outcomes like life expectancy do not. So it really is a complicated issue.

    One thing that makes this issue even more difficult for me is that, while I could design my own ideal system (which, incidentally, would look something like the German system), I simply can't conceive of a way to keep U.S. politics from mucking it up down the road. In particular, I have no objection to providing treatment to those who truly cannot afford any. However, I do not believe that it is at all possible to provide cutting-edge treatment to all–the cost of that would ultimately probably exceed our ability to raise taxes to pay for it. What we *could* afford–and what would be far better than either our current system or anything that's been proposed so far–would be a “free” standard of care that is relatively bare-bones, while letting anyone who wants to buy private care do so out of his or her own pocket. This would leave intact the incentives for technological and pharmaceutical innovation that I personally place the highest value on, while still providing a decent level of care for the indigent.

    The people for whom I have little compassion are those twenty- and thirty-somethings who “can't afford” catastrophic health insurance (which would cost them anywhere from 60 to 200 a month, depending on what state they lived in), but can afford nice cars, in-town apartments, and plenty of nights out. They are just rolling the dice, all the while counting on the rest of us to bail them out if something goes terribly wrong. Then, after it's too late, they may find that their pre-existing condition keeping them from buying insurance.

    It's too bad that we can't have a public debate that distinguishes between the truly destitute and those who are simply making lousy decisions. Because if it does turn out to be true that having health insurance gives people better health outcomes, then before we start dismantling the current system–flawed as it may be–why in the world are people not buying at least minimal coverage on their own? It is most definitely not because it's not affordable, because it is. I've checked, and so can anyone else who wants to find out.

    Finally, I ask you–and any one else who is sincerely interested in improvement and is not driven by some innate hatred of corporations or the like–why not start out slowly and see what happens? After all, even full-bore Democare wouldn't kick in for 4 years. So why not address the most basic issues, such as eliminating the strong ties between employment and health insurance without reducing people's total after-tax compensation, and see what happens in the following two years? Personally, I'd like to try the proposals made by the CEO of Whole Foods as a start.

    Anyway, thanks for an educational exchange. I hadn't seen the 2009 research paper you cited.

  • Dr J

    At any given moment, anyone could be in any of these categories, or all of them simultaneously.

    Yes, very true. These people don't have any common identity, other than they hold a few shares of the same stock or buy stuff at the same place. Some of them may be struggling, others may be sitting pretty.

    What I do know is that there are a lot of them, and the customers will all be hurt a little if prices go up, shareholders if the stock goes down.

    When we consider an issue like whether company X should pay workers more, workers' and customers' needs are at odds, because higher wages means higher prices at the register. Either way we decide the issue, one group is going to benefit, the other will be hurt. So we have to decide whether to favor the small group of workers with the acute stake in the issue (a “special interest”) or the large group of customers with a small stake (a “general interest”).

    It's hard to do, because the customers are a diverse, unknowable group, and they're individually not affected enough by the issue to go protesting in the streets and call themselves to our attention. But their needs are nonetheless real and matter a lot. This is why I find policy questions interesting and charges of non-compassion unfair.

    I am similarly confused when you talk about the “corporate interest” — or, more precisely, what you have in mind when you use that term.

    I have a great variety of things in mind, because what corporations are likely to consider in their interests depends hugely on the situation. Corporations lobby on all sorts of issues with complicated implications for shareholders, employees, customers, neighbors, competitors, the environment, and so on. They may fight against regulation, or like big tobacco they may embrace it because it beats perpetual lawsuits. Walmart supports Obamacare, the National Retail Federation opposes it.

    Silicon Valley firms a few years ago lobbied for easier visa processes for foreign students and workers; UPS has recently lobbied to be put under the National Labor Relations Act. On the other hand companies may lobby for things workers won't like. And although there can be tension between what management wants and what labor wants, I see a great deal of overlap too. Detroit shows clearly that both are ultimately in the same boat: companies cannot operate without a cooperative staff, and workers won't have jobs unless the company is successful.

  • kathykattenburg

    Detroit shows clearly that both are ultimately in the same boat: companies cannot operate without a cooperative staff, and workers won't have jobs unless the company is successful.

    Corporations and workers are not ultimately in the same boat, Dr J. It's a sweet thought, but it's not reality. Corporations can always find workers and will always be able to hire workers for low and even lower wages, or with no benefits, etc.; but workers will not always have jobs, and when they do have jobs, it won't always be at wages that allow them to keep their homes and feed their kids.

    There is a huge power differential between employees and the corporations they work for. Which is why big business doesn't want unions in the workplace and will fight tooth and nail to keep them out. Unions tend to level the playing field — certainly not entirely, but a strong union in a workplace does offset a lot of a corporation's power to do badly by employees. Anything that makes it easier to join a union will be opposed by companies that don't want them.