The Alien in the White House

[Mysterio]

For one thing, your source is dated April 12. The CBO revised the savings DOWN by $115 Billion on May 11. My information is more current than yours.

 

Your source dates to March 19, not May 11.

 

AND, if the "doc fix" is included in the cost calculations (and since that is a healthcare cost, it only seems fair that it be included, don't you agree?), this puts an additional $208 Billion on the Federal liabilities.

 

In the same document you cite, it says (referencing the technical document).......

We estimated that, if those changes were made, the legislation would increase federal deficits during the decade beyond 2019 relative to those projected under current law—with a total effect during that decade in a broad range around one-quarter percent of GDP.

 

You focus to much on your "doc fix", which I'm not entirely sure ever came close to being implemented, or even exists as stated.

 

1/4 of 1% isn't a whole lot (35 billion in today's GDP). Doesn't even say whether it will actually send it into deficit.

 

Define what is a "total success", and then name one country with similar demographics (and population distribution) as the United States that is now a total success, please.

 

How many times must I say this: All nations that have implemented universal health care have lower health care costs. France, Japan, Britain, etc. have worse demographics than we do and still have better care and lower costs. I define that as a total success, and likely this will be no different.

 

Cynicism comes from experience. I only went back 30 years (nice round number). Would you like me to go further?

 

You consistent sound like it's coming from ideology. I've yet see you demonstrate otherwise.

 

Then why does Biden call Iraq one of this (Obama's) administration one of its "greatest achievements"?

 

Red herring. The Iraq war is Bush's fault, period.

 

BP should pay the cost of cleanup and restitution for damaged property and economic damage to those whose lives are directly affected. That is where I leave it, and AFAIK the democrats have said the same thing.

 

Here's the part where the dems go too far.......(link to story)

 

It has been suggested that ON TOP of BPs already mounting liability (that has been established that we agree on), the dems want all deepwater activities in the Gulf related to oil recovery suspended (a moratorium). This would also affect much industry in the states of TX, LA, MS, and AL. As restitution for idling all those workers, BP should also pay them, as well. That is going too far, and were I BP (and the other affected companies), I would slap them with a lawsuit if they tried.

 

You cannot have the Government telling companies they cannot do business (and workers cannot work) simply because they are in the same business (or one that is related to it) as BP, and expect BP pay for it.

 

Even the experts advising the Obama administration say a moratorium goes too far.

 

Not only that, but it's been suggested that BP pay the government for lost oil royalties. First they say you can't pump, then you must pay them for not pumping.

 

So you see, the dems and I aren't saying the "same thing".

 

Then why does the administration that you hold in such high regard go along with it?

 

I'm not here to defend BP, except to say that there is no company I've done consulting for that has no "history". I'm more interested in BPs response to the crisis, and while I may agree that BP has a huge liability on their hands, I am not interested in seeking revenge as you seem to be.

 

No one's going too far. BP has more than enough assets to handle whatever liabilities coming their way. You already agree with this, so everything else you said are red herrings.

Edited June 12, 2010 by Mysterio

[RangerM]

Your source dates to March 19, not May 11.

The date of this CBO document is May 11, not March 19..

You focus to much on your "doc fix", which I'm not entirely sure ever came close to being implemented, or even exists as stated.

Your April 12 presentation makes specific reference to it, so if your document exists, then the "doc fix" exists. And since it is a healthcare cost, then it should be included in the overall calculation.

1/4 of 1% isn't a whole lot (35 billion in today's GDP). Doesn't even say whether it will actually send it into deficit.

Do the math.

How many times must I say this: All nations that have implemented universal health care have lower health care costs. France, Japan, Britain, etc. have worse demographics than we do and still have better care and lower costs. I define that as a total success, and likely this will be no different.

I guess you're going to have to keep going until you're blue. Let's see what British newspapers have to say.....

Patients denied surgery because of black hole in health budgets

Basic surgery denied by NHS trusts to cut costs, say surgeons

NHS Ordered to Stop Funding New Breast Cancer Drug

Tougher rules on operations in East Midlands hospitals

Dr David Black, director of public health at NHS Derbyshire County, said: "

The NHS has never been able to provide every treatment and service that everybody might want. It has never been able to do that and never will. No health service can do that. It is about making sure we use our resources very carefully and meet the needs of the people of Derbyshire the very best we can."

Smokers and the obese banned from UK hospitals

The drugs the NHS won't give you

Girl, 3, has heart operation cancelled three times because of bed shortage

Disabled children wait up to two years for wheelchairs

 

Total success fail.

You consistent sound like it's coming from ideology. I've yet see you demonstrate otherwise.

Stick around awhile.

Red herring. The Iraq war is Bush's fault, period.

Yeah, he did it all by himself.

No one's going too far. BP has more than enough assets to handle whatever liabilities coming their way. You already agree with this, so everything else you said are red herrings.

I gave you the links to estabilsh what I said was real and accurate. Denying it doesn't make it less so.

Edited June 13, 2010 by RangerM

[retro-man]

I don't know about Britain, having never experienced their health care system. But I still maintain (one BON member's experience notwithstanding) that Japan has us beat hands down. And I have repeated and up close experience with that system over the last 30 years. The last time the World Health Organization conducted a survey was in 2000 link . (They claim that they don't do it anymore because it has become too complex.) At that time, their ranking was based on 5 categories:

- responsiveness (having to do with your wait times and rationing)

- Fairness of financial contribution (according to means)

- overall level of health (this is going to correlate somewhat to average life expectancy - in which the US ranks 47th)

- Distribution of health (i.e. are the rich much healthier than the poor. According to some posters here the US health care consumer has access to the most advanced treatments and technologies available - for those who can afford them - and that the most worthy members of society (as self evidenced by their wealth) have access to that best treatment - while the poor unworthy schlobs don't - too bad. And why should the worthy - i.e. wealthy - have to support the unworthy schlobs in their pathetic attempts to prolong their dreary lives?)

- Distribution of financing

 

At that time, the WHO - no doubt a bastion of dashiki-wearing pinko liberal internationalists in bed with the commies in the UN - ranked the US number 37, between Costa Rica and Slovenia. France was number one, Japan was 10 and the UK was 18. For what it's worth. Aside from the above-mentioned BON member, none of the many people I know, Japanese living here or in Japan, American ex-pats or re-pats who have experience in Japan - and this is quite a number of people in my case - none of them think the US system is better. Not a one. Also, predictions of various health care systems in other countries "imploding" seem to be about as premature as predictions of a McCain / Palin landslide that I saw on here a couple of years ago.

Edited June 13, 2010 by retro-man

[retro-man]

double post

Edited June 13, 2010 by retro-man

[Mysterio]

The date of this CBO document is May 11, not March 19..

 

Your April 12 presentation makes specific reference to it, so if your document exists, then the "doc fix" exists. And since it is a healthcare cost, then it should be included in the overall calculation.

 

Do the math.

 

You're document still doesn't say what you think it does. It only describes the costs, not the additional revenue generated by HR3590. There's only one comprehensive analysis the CBO gave out and that was the one I pointed out earlier, and more legibly written on the wiki page: http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Deficit_impact

 

I guess you're going to have to keep going until you're blue. Let's see what British newspapers have to say.....

Patients denied surgery because of black hole in health budgets

Basic surgery denied by NHS trusts to cut costs, say surgeons

NHS Ordered to Stop Funding New Breast Cancer Drug

Tougher rules on operations in East Midlands hospitals

Dr David Black, director of public health at NHS Derbyshire County, said: "

The NHS has never been able to provide every treatment and service that everybody might want. It has never been able to do that and never will. No health service can do that. It is about making sure we use our resources very carefully and meet the needs of the people of Derbyshire the very best we can."

Smokers and the obese banned from UK hospitals

The drugs the NHS won't give you

Girl, 3, has heart operation cancelled three times because of bed shortage

Disabled children wait up to two years for wheelchairs

 

Total success fail.

 

The British system is no panacea, so it would be easy to find examples of it's shortcomings. But, as retro nicely pointed out our system is widely agreed to suck even harder than the British system. Something like 45,000 die every year due to inadequate health care.

 

Stick around awhile.

 

Yeah, he did it all by himself.

 

You're being pedantic.

 

I gave you the links to estabilsh what I said was real and accurate. Denying it doesn't make it less so.

 

Which were red herrings...

[Ford Jellymoulds]

UK's National Health Service is the 4th largest employer on the planet, pension liabilities have hit 1 trillion something the British government is struggling to plug. Big Greek style cuts are coming 23rd June just as we face a double dip..

LINK

 

 

Obama is not very popular in the UK at the moment as just about every UK pension fund has the lions share of its shares portfollio invested in BP who look like they are going to take just about every Brits pension down the Swannie River if they sink and go and under, British pension schemes were already looking very depleted to start with before the BP oil spill mainly due pickpocket Gordon Browns £200 billion and still growing tax raid on UK company pension funds, also the massive pensions holiday nearly all British companies had in the 1990 didnot not help as well, now most Brits are facing living a retirement of poverty gotta say l see those green shoots of recovery.

 

 

 

BARACK Obama was last night accused of delivering a death blow to the pensions of millions of Britons by calling on BP to halt its share payouts.

 

There were demands for David Cameron to get tough with the US President over his increasingly anti-­British rhetoric, which has helped to wipe billions of pounds off the value of the oil giant.

 

Grandstanding US politicians have been quick to join him in savaging BP over the Gulf of Mexico oil spill, fuelling suggestions that he is using a foreign company to score domestic political points.

 

Investors and business leaders in Britain warned that the President's ranting criticism had helped drive BP's London share price to its lowest level since 1997, wiping out almost £50billion nearly half of its value since the accident on April 20. The share price plunged a further seven per cent yesterday.

 

DEBATE: SHOULD BARACK OBAMA STOP HIS ANTI-BRITISH RANTS?

 

MORE LINK....

 

 

Edited June 13, 2010 by Ford Jellymoulds

[RangerM]

You're document still doesn't say what you think it does. It only describes the costs, not the additional revenue generated by HR3590. There's only one comprehensive analysis the CBO gave out and that was the one I pointed out earlier, and more legibly written on the wiki page: http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Deficit_impact

The source I gave was an amendment (in May) to the original analysis (in March). If there were additional revenues to be incorporated, I trust the CBO would have included it.

 

The following analysis updates and expands upon the analysis of potential discretionary spending under PPACA that CBO provided on March 13, 2010. In particular, it provides an update of the earlier tally of specified authorization amounts, as well as a list of programs or activities for which no specific funding levels are identified in the legislation but for which the act authorizes the appropriation of “such sums as may be necessary.”

 

Even your Wikipedia source confirms my dates (May vs. March) are correct. (since when is Wikipedia the ultimate source for truth, anyway?)

The British system is no panacea, so it would be easy to find examples of it's shortcomings.

You (yourself) described the British NHS as a "total success". Are you now revising that statement?

 

But, as retro nicely pointed out our system is widely agreed to suck even harder than the British system.

Sucks for some? Sure. Sucks for most? No.

 

And Retro wasn't comparing our system to the British; he was comparing it to the Japanese. He has experience with that system, and I trust his observations, however I think there is more going on than simply the difference between the Japanese and American systems. I believe there are aspects that are more culturally-based (diet, levels of education, homogeneity of the population, etc.), and have less to do with the quality of care, but can still affect the overall cost to implement the system.

Something like 45,000 die every year due to inadequate health care.

In 1992, when I was 22 years old, before I got my first job, I didn't have health insurance. According to the methodology of that Harvard study, if I had died by the year 2000, I would have been counted as one of those 45000, even though later in 1992 I had health insurance (and have ever since). Does Lack of Insurance Cause Premature Death? Probably Not..

 

This study found that the mortality rate was lower for those without health insurance than those on Medicaire/Medicaid.

 

A study by RAND found that having insurance wasn't the primary driving mechanism behind positive outcome, as much as seeking treatment in the first place, and the appropriate use of it.

 

We found that health insurance status was largely unrelated to the quality of care among those with at least minimal access to care. Although having insurance increases the ease of access to the health care system, it is not sufficient to ensure appropriate use of services or content of care. Indeed, within systems where access to care is more equitable, disparities in quality due to race or ethnic group or to other characteristics are often reduced or even reversed, but substantial gaps between observed and optimal quality remain. In the United Kingdom, with universal coverage, a study using our methods found that the overall proportion of recommended health care that was received was similar to what we have reported

.

 

We can cite contrary studies all day long and get nowhere. You can provide examples of persons who were victims of the American system, and I can provide examples to counter. But In the end, the statistics seem jumbled enough to make it a wash.

 

We are then left with the choice of who will determine our healthcare destiny; ourselves or a government bureaucracy.

You're being pedantic.

Accuse me of what you want, however I will provide citation with my assertions (to refute yours) for all to see. Eventually, once the economic arguments are gone, we'll get to the emotional argument for "universal healthcare" where all these discussions inevitably wind up. Emotional is the only (and most charged) type of argument you've got.

Which were red herrings...

Tell it to the dems who were using them. All I'm doing is taking them at their word.

[joihan777]

I don't know about Britain, having never experienced their health care system. But I still maintain (one BON member's experience notwithstanding) that Japan has us beat hands down. And I have repeated and up close experience with that system over the last 30 years. The last time the World Health Organization conducted a survey was in 2000 link . (They claim that they don't do it anymore because it has become too complex.) At that time, their ranking was based on 5 categories:

- responsiveness (having to do with your wait times and rationing)

- Fairness of financial contribution (according to means)

- overall level of health (this is going to correlate somewhat to average life expectancy - in which the US ranks 47th)

- Distribution of health (i.e. are the rich much healthier than the poor. According to some posters here the US health care consumer has access to the most advanced treatments and technologies available - for those who can afford them - and that the most worthy members of society (as self evidenced by their wealth) have access to that best treatment - while the poor unworthy schlobs don't - too bad. And why should the worthy - i.e. wealthy - have to support the unworthy schlobs in their pathetic attempts to prolong their dreary lives?)

- Distribution of financing

 

At that time, the WHO - no doubt a bastion of dashiki-wearing pinko liberal internationalists in bed with the commies in the UN - ranked the US number 37, between Costa Rica and Slovenia. France was number one, Japan was 10 and the UK was 18. For what it's worth. Aside from the above-mentioned BON member, none of the many people I know, Japanese living here or in Japan, American ex-pats or re-pats who have experience in Japan - and this is quite a number of people in my case - none of them think the US system is better. Not a one. Also, predictions of various health care systems in other countries "imploding" seem to be about as premature as predictions of a McCain / Palin landslide that I saw on here a couple of years ago.

 

If you mean me as the one BON member, it is because I have been in the medical field for nearly 15 years and I have worked in the best run and worse run hospitals. My experiences about Japanese healthcare are direct from friends and family that are Japanese natives or Americans that live there. I've also been a patient in the best & worse hospitals. I've also seen the political battles the worst-run systems use to gain more money while consistently wasting it. So if you mean me then I going to say that my opinion on the matter is relatively qualified much as I'd trust your opinion on architecture more than others. I know I don't have every single datum at my disposal but my experiences and those I know directly of trend consistently. I'm going to assume healthcare in Tokyo is better than in some dinky little town in the middle of nowhere.

 

OF COURSE nations have different rankings. Richer hospitals thus have better care, usually. So then why do foreigners come to US for healthcare? It is because the WHO averages include America's best hospitals, of which there are many, together with tiny rural facilities, reservation clinics, inner-city public systems etc. America's healthcare problem can't be fixed by pointing a gun at rich people and shouting 'pay up sucka!' The problem stems also from people's horrendous health-care decisions.

 

How many liquor shops/drug dealers infest the ghettos? Where do cigarette manufacturers sell the most product? Where does McFast Food sell the most product? It is in densely populated metropolitan areas full of people who throw their fortunes, and health, away. Until these people learn to value thier health, they will continue to strain the low cost/ public healthcare agencies. Also, public agencies are NOT held to the same scrutiny that private companies are. Even my own employer, a not-for-profit healthcare company, must account for it's decisions to a board of directors that answer to the employees. I don't agree with Obama-care because IMO it doesn't truly address the problem.... it just reinforces the band-aid. I would have prefered to study the BEST of individual systems, not just try to copy national approaches.

 

And I would have prefered Obama-care to apply to Mr. Obama and his staff too. Hmmm.

[retro-man]

Yeah Joihan777, it was you. Sorry I couldn't remember who it was. But I remembered what you said - you gotta give me credit for that. My experiences have been - chiefly in Osaka, next most in Tokyo, and once in Sapporo - and again through many conversations I have had with friends, relatives and my peer group of old Japan hands. I have to trust your experiences too. Certainly I cannot speak from the standpoint of somebody in the medical field. My experience is that of a regular consumer (and as the friend and relative of such people - and one, my wife's best friend from childhood, who is a doctor and runs a private clinic with her husband). From that perspective, in my experience - yours obviously does vary, their system is marvelously efficient, inexpensive, and - most of all - hassle-free. I am not a specialist in sorting out insurances, finance, pharmaceutical regulations and markets, and in their system I don't have to be. I can spend my time healing, or going back to work, rather than sitting with a mountain of paperwork, or going through agency after agency and endless automated voicemail systems and rejection letters in an effort to avoid bankruptcy. It is marvelous! I cannot express to you what a comfort that is to the ordinary consumer (not specialist) when you are sick or grieving.

 

I agree with RangerM (and obliquely with your more judgmentally expressed view) that lifestyle is no doubt a factor in health outcomes between the 2 countries. The lifestyle factor has many dimensions, and can't be plucked up from one country and transplanted to another. Japan is on the GINI index about where the US was in the 60s: a much more egalitarian society. As a rule, the less well off there are still somewhat more insulated from the crushing burden that poverty places on people here to maintain multiple minimum wage jobs just to provide bare essentials. When you make $20k a year for a full time job, you're not stopping at Whole Foods on your way home and picking up some fresh produce for the kids. Population density in Japan and European countries contributes to a better transit infrastructure and more opportunities to walk or bike. Family structure contributes to the maintenance of more multi-generation households, as does relative (again comparable to us in the 60s) job security so that people don't have to pick up and move across the country and away from family and support networks every 3 years when their job gets "outsourced" (though Japan is, regrettably, moving inexorably in our direction in that regard). Many many factors at work.

Edited June 13, 2010 by retro-man

[Mysterio]

The source I gave was an amendment (in May) to the original analysis (in March). If there were additional revenues to be incorporated, I trust the CBO would have included it.

 

The following analysis updates and expands upon the analysis of potential discretionary spending under PPACA that CBO provided on March 13, 2010. In particular, it provides an update of the earlier tally of specified authorization amounts, as well as a list of programs or activities for which no specific funding levels are identified in the legislation but for which the act authorizes the appropriation of “such sums as may be necessary.”

 

Even your Wikipedia source confirms my dates (May vs. March) are correct. (since when is Wikipedia the ultimate source for truth, anyway?)

 

That's not what that May CBO report was about. It was just about an update in cost estimates, as requested by Congressman John Lewis.

 

You (yourself) described the British NHS as a "total success". Are you now revising that statement?

 

I've already defined it as a significant improvement over the current system and at a lower cost. It was not about achieving perfection. My statement hasn't changed.

 

In 1992, when I was 22 years old, before I got my first job, I didn't have health insurance. According to the methodology of that Harvard study, if I had died by the year 2000, I would have been counted as one of those 45000, even though later in 1992 I had health insurance (and have ever since). Does Lack of Insurance Cause Premature Death? Probably Not..

 

That's a blog first of all. He cites hardly any sources (and a mountain of sources that specifically refute his own position strangely enough) and apparently made-up or speculated most of his argument. Given that he's a libertarian economist and not a doctor of any kind, this link doesn't mean much if anything at all.

 

This study found that the mortality rate was lower for those without health insurance than those on Medicaire/Medicaid.

 

Perhaps your understanding of statistics is insufficient? Correlation does not imply causation, and it clearly states that

 

Medicaid and Medicare for persons younger than age 65—have the highest mortality rates, presumably because access to those programs usually depends on disability status.

 

Disabled people tend to have very high mortality rates, so it is not clear what your study is really showing.

 

I also have doubts about the source of the study, EPI, given there known backing from the fast food and tobacco industry (source) and the founder of group, Richard Berman has a huge history of funding studies that favor big corporations.

 

A study by RAND found that having insurance wasn't the primary driving mechanism behind positive outcome, as much as seeking treatment in the first place, and the appropriate use of it.

 

We found that health insurance status was largely unrelated to the quality of care among those with at least minimal access to care. Although having insurance increases the ease of access to the health care system, it is not sufficient to ensure appropriate use of services or content of care. Indeed, within systems where access to care is more equitable, disparities in quality due to race or ethnic group or to other characteristics are often reduced or even reversed, but substantial gaps between observed and optimal quality remain. In the United Kingdom, with universal coverage, a study using our methods found that the overall proportion of recommended health care that was received was similar to what we have reported

.

 

It doesn't relate to the subject we're discuss; it relates to groups that already have health care AFAICT. And since you're not a doctor, you likely don't know enough to make conclusions about the uninsured from this study.

 

We can cite contrary studies all day long and get nowhere. You can provide examples of persons who were victims of the American system, and I can provide examples to counter. But In the end, the statistics seem jumbled enough to make it a wash.

 

The golden mean fallacy may have a word with you. The "wash" outcome is no more likely to be true than any other.

 

We are then left with the choice of who will determine our healthcare destiny; ourselves or a government bureaucracy.

 

Given that the bill passed only requires people to buy insurance and subsidizes people who can't afford it, this is a totally extraneous statement. Also, this statement seems to be a stereotypical conservative accusation regarding government.

 

Accuse me of what you want, however I will provide citation with my assertions (to refute yours) for all to see. Eventually, once the economic arguments are gone, we'll get to the emotional argument for "universal healthcare" where all these discussions inevitably wind up. Emotional is the only (and most charged) type of argument you've got.

 

Your sources are either misleading or blatantly false. You have yet to show otherwise. Like the previous statement, this is another stereotypical conservative accusation, this time regarding liberalism.

Edited June 13, 2010 by Mysterio

[Mysterio]

And I would have prefered Obama-care to apply to Mr. Obama and his staff too. Hmmm.

 

 

http://jacksonville.com/news/metro/2010-05-30/story/fact-check-health-care-law-still-applies-congress

 

The bill applies to everyone, even to Washington D.C lawmakers.

 

PS: It's also my anecdotal evidence that Japanese people smoke and drink a shed-load, though they are not as obesed as Americans.

Edited June 13, 2010 by Mysterio

[RangerM]

That's not what that May CBO report was about. It was just about an update in cost estimates, as requested by Congressman John Lewis.

That's the point. The "savings" were $143 Billion (estimated by the CBO) in March, and then in May the CBO revised the "savings" down by $115 Billion.

I've already defined it as a significant improvement over the current system and at a lower cost. It was not about achieving perfection. My statement hasn't changed.

I've provided the numbers to refute the "lower cost" argument, but apparently your presumption is supposed to trump all opposition. I'm sure the parents of that 3-year-old heart patient might think otherwise.

That's a blog first of all. He cites hardly any sources (and a mountain of sources that specifically refute his own position strangely enough) and apparently made-up or speculated most of his argument. Given that he's a libertarian economist and not a doctor of any kind, this link doesn't mean much if anything at all.

Apparently the fact that it's a blog undermines what he presented. Apparently Wikipedia is more accurate than any blog. You still didn't refute what he said, only the way he said it. (a blog)

Perhaps your understanding of statistics is insufficient? Correlation does not imply causation, and it clearly states that

Medicaid and Medicare for persons younger than age 65—have the highest mortality rates, presumably because access to those programs usually depends on disability status.

 

Disabled people tend to have very high mortality rates, so it is not clear what your study is really showing.

Thanks, I appreciate your attempt to teach me, but my understanding of statistics is fine. Apparently you missed this part....

 

In summary, we find as have others, that lack of health insurance is not likely to be the major factor causing higher mortality rates among the uninsured. The uninsured—particularly the involuntarily uninsured—have multiple disadvantages that in themselves are associated with poor health

.

Perhaps you can dismiss these authors as merely having a right-wing agenda, as well? Better still, perhaps you could prove their statistical analysis is wrong, since you apparently possess superior ability.

I also have doubts about the source of the study, EPI, given there known backing from the fast food and tobacco industry (source) and the founder of group, Richard Berman has a huge history of funding studies that favor big corporations.

Oh, I see you went with ad hominem. Surprise, surprise.

It doesn't relate to the subject we're discuss; it relates to groups that already have health care AFAICT. And since you're not a doctor, you likely don't know enough to make conclusions about the uninsured from this study.

I'm not making conclusions. If you wish to dispute the conclusions of the Rand Corporation, please do so. Otherwise, they have observation (a.k.a. evidence), and you have opinion.

The golden mean fallacy may have a word with you. The "wash" outcome is no more likely to be true than any other.

 

Given that the bill passed only requires people to buy insurance and subsidizes people who can't afford it, this is a totally extraneous statement. Also, this statement seems to be a stereotypical conservative accusation regarding government

Under the current system, anyone who seeks treatment gets treatment, and, as reported by Rand (and EPI), whether or not somebody has health insurance has little effect on the outcome of their treatment. Of course, it's not for me to prove the current system isn't worse, as much as it's up to you to establish why Obamacare is better.

 

BUT, since you're not a stereotypical liberal ideologue, I'm sure you can establish in no uncertain terms that Obamacare is better than the current system (in terms of cost and coverage), because you can provide an example of where it's been done before.

Your sources are either misleading or blatantly false. You have yet to show otherwise. Like the previous statement, this is another stereotypical conservative accusation, this time regarding liberalism.

You claim their inaccuracy, but you have yet to refute what I've said (or cited) with anything more than ad hominem and opinion (which you apparently think others should hold in high esteem).

Edited June 14, 2010 by RangerM

[Mysterio]

That's the point. The "savings" were $143 Billion (estimated by the CBO) in March, and then in May the CBO revised the "savings" down by $115 Billion.

 

There hasn't been any comprehensive cost analysis since the March report. In other words you still don't know what the May one is really saying. For all we know, the savings have increased.

 

]I've provided the numbers to refute the "lower cost" argument, but apparently your presumption is supposed to trump all opposition. I'm sure the parents of that 3-year-old heart patient might think otherwise.

 

Anecdote is not data BTW. There are 60 million people in Britain and I believe most of them are happily living.

 

Apparently the fact that it's a blog undermines what he presented. Apparently Wikipedia is more accurate than any blog. You still didn't refute what he said, only the way he said it. (a blog)

 

And the part where he basically made up stuff? He drew sources that only vaguely support his position, and speculated the rest. Meanwhile, he shows like 5 sources at the top of his entry clearly stating tens of thousands of people dying every year due to lack of health insurance. So what do you want to believe, his own sources or his speculation?

 

At least wikipedia doesn't contradict its own sources.

 

Thanks, I appreciate your attempt to teach me, but my understanding of statistics is fine. Apparently you missed this part....

 

In summary, we find as have others, that lack of health insurance is not likely to be the major factor causing higher mortality rates among the uninsured. The uninsured—particularly the involuntarily uninsured—have multiple disadvantages that in themselves are associated with poor health

.

Perhaps you can dismiss these authors as merely right-wing idealogues, as well? Better still, perhaps you could prove their statistical analysis is wrong, since you apparently possess superior ability.

 

You know the old saying, "lies, damn lies, and statistics." There's a lot of potential statistical manipulation in this article. For one thing does the author know that for many people who are uninsured, they simply can't buy insurance because they have poor health? Not accounting for this group would definitely make a big difference in your final numbers.

 

Perhaps not surprisingly the author removes that group from consideration in his final model, the "M3". Using their own "controls" they bring the fatality rate from around 11% to 1.7%, assuming I've read that right. In other words, they may have unfairly removed some of the biggest factors harming people without insurance. They also aren't considering their so-called "involuntary uninsured" at all in that model, AFAICT. That's a pretty sizable hole in their model.

 

Not being a statistician nor an health expert myself, you shouldn't take what I said above as irrefutable, or even close to that. However, I will claim that I have pointed out some very basic flaws in the study's reasoning

 

Oh, I see you already engaged in ad hominem.

 

Not to make an obvious logical fallacy myself, but...

 

It isn't a published paper in any major peered reviewed science journal, the authors are economists, not doctors, and the sponsors of the article have substantial conflicts of interests. By the strict standards of scientific studies, that article should not even be considered in the discussion. The only reason we are even using it is because this is a informal online discussion.

 

Meanwhile, the 45000 death per year study is in a published, peer-reviewed science journal (linked again for reference), who's credentials cannot be easily dismissed.

 

Besides, it's a bit obvious one shouldn't blindly accept studies from people with a history of very fraudulent studies and have never been published, AFAIK. Otherwise, one must accept that smoking is safe, drunk driving is safe, obesity is healthy, etc.

 

I'm not making conclusions. If you wish to dispute the conclusions of the Rand Corporation, please do so. Otherwise, they have observation (a.k.a. evidence), and you have opinion.

 

And you have your opinions as well. Since neither of us have the power to decipher the meaning of this study, I will defer to someone else: http://content.healthaffairs.org/cgi/reprint/23/6/107.pdf

 

The RAND HIE randomized families to health insurance plans that varied their

cost sharing from none (“free care”) to a catastrophic plan that approximated a

large family deductible with a stop-loss limit of $1,000 (in late-1970s dollars),

which was scaled down for the low-income population.

 

Like I said, the studies was one between different types of insurance coverage. An important debate, but not relevant to this one.

 

PS: It's not from the RAND Corporation. The name of the experiment is "RAND Health Insurance Experiment". I'd be laughing if the Rand Corporation actually wrote a health care paper.

 

And, as reported by Rand (and EPI), the fact that somebody has insurance had little effect on the outcome of their treatment. Under the current system, anyone who seeks treatment gets treatment. Of course, it's not for me to prove the current system isn't worse, as much as it's up to you to establish why Obamacare is better.

 

Rand doesn't say that. EPI does, and they're not believable (nor should ever be believed, if sanity is your goal) because they are not published and have a history of fictional studies.

 

BUT, since you're not a stereotypical liberal ideologue, I'm sure you can establish in no uncertain terms that Obamacare is better than the current system (in terms of cost and coverage), because you can provide an example of where it's been done before.

 

The cost reductions I've already demonstrated with the original CBO estimate from March. Hem and haw all you want, but you have not meaningful refuted it in all way. As for the coverage improvements, that's also in one of the CBO estimate from March: http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf

 

Effects of the Legislation on Insurance Coverage

CBO and JCT estimate that by 2019, the combined effect of enacting

H.R. 3590 and the reconciliation proposal would be to reduce the number

of nonelderly people who are uninsured by about 32 million, leaving about

23 million nonelderly residents uninsured (about one-third of whom would

be unauthorized immigrants). Under the legislation, the share of legal

nonelderly residents with insurance coverage would rise from about

83 percent currently to about 94 percent.

 

You claim their inaccuracy, but you have yet to refute what I've said (or cited) with anything more than ad hominem and opinion (which you apparently think others should hold in high esteem).

 

Not just inaccurate, but if you're being scientific you wouldn't never consider them in the first place, given their total lack of credibility. But feel free to believe those sources all you want, and reject my warnings as mere ad hominems in your mind. I certainly won't stop you. Besides, when have corporate sponsored propaganda ever lied?

Edited June 14, 2010 by Mysterio

[joihan777]

Yeah Joihan777, it was you. Sorry I couldn't remember who it was. But I remembered what you said - you gotta give me credit for that. My experiences have been - chiefly in Osaka, next most in Tokyo, and once in Sapporo - and again through many conversations I have had with friends, relatives and my peer group of old Japan hands. I have to trust your experiences too. Certainly I cannot speak from the standpoint of somebody in the medical field. My experience is that of a regular consumer (and as the friend and relative of such people - and one, my wife's best friend from childhood, who is a doctor and runs a private clinic with her husband). From that perspective, in my experience - yours obviously does vary, their system is marvelously efficient, inexpensive, and - most of all - hassle-free. I am not a specialist in sorting out insurances, finance, pharmaceutical regulations and markets, and in their system I don't have to be. I can spend my time healing, or going back to work, rather than sitting with a mountain of paperwork, or going through agency after agency and endless automated voicemail systems and rejection letters in an effort to avoid bankruptcy. It is marvelous! I cannot express to you what a comfort that is to the ordinary consumer (not specialist) when you are sick or grieving.

 

I agree with RangerM (and obliquely with your more judgmentally expressed view) that lifestyle is no doubt a factor in health outcomes between the 2 countries. The lifestyle factor has many dimensions, and can't be plucked up from one country and transplanted to another. Japan is on the GINI index about where the US was in the 60s: a much more egalitarian society. As a rule, the less well off there are still somewhat more insulated from the crushing burden that poverty places on people here to maintain multiple minimum wage jobs just to provide bare essentials. When you make $20k a year for a full time job, you're not stopping at Whole Foods on your way home and picking up some fresh produce for the kids. Population density in Japan and European countries contributes to a better transit infrastructure and more opportunities to walk or bike. Family structure contributes to the maintenance of more multi-generation households, as does relative (again comparable to us in the 60s) job security so that people don't have to pick up and move across the country and away from family and support networks every 3 years when their job gets "outsourced" (though Japan is, regrettably, moving inexorably in our direction in that regard). Many many factors at work.

 

Fair enough. Yes there are many factors that reduce American healthcare's efficacy. Within some systems, Kaiser Permanente for instance, navigating the system is fairly easy. It is the best comprehensive delivery model, as a patient (nurses get sick too), that I've experienced. It is well run and gives fairly good care. This is what I meant by looking at individual successes as opposed to the Obama administration trying to re-invent the wheel, at ours and our children's expense.

 

His administration, I believe, means well in some areas but I think the Republican approach would be better. Basically, he has no business leading the free world. He should have stayed in the Illinois Senate and learned.

 

Edit: I forgot to mention, Japan doesn't NEARLY allow as much immigration, legal or otherwise, as we do so their 'working poor' cannot be the same as ours.

Edited June 14, 2010 by joihan777

[joihan777]

 

http://jacksonville.com/news/metro/2010-05-30/story/fact-check-health-care-law-still-applies-congress

 

The bill applies to everyone, even to Washington D.C lawmakers.

 

PS: It's also my anecdotal evidence that Japanese people smoke and drink a shed-load, though they are not as obesed as Americans.

 

I didn't mean the Congressional branch of government..... I meant Obama & certain members of his Executive branch.

 

BTW, drugs are making inroads into Japan..... as well as obesity.

[RangerM]

There hasn't been any comprehensive cost analysis since the March report. In other words you still don't know what the May one is really saying. For all we know, the savings have increased.

The CBO updated their previous analysis to include factors that weren't included originally. However if there is another amendment (where the savings have increased), I'm sure you can provide the citation, right?

Anecdote is not data BTW. There are 60 million people in Britain and I believe most of them are happily living.

You say anecdote is not data, then proceed with an anecdote of your own?

And the part where he basically made up stuff?

 

He drew sources that only vaguely support his position, and speculated the rest. Meanwhile, he shows like 5 sources at the top of his entry clearly stating tens of thousands of people dying every year due to lack of health insurance. So what do you want to believe, his own sources or his speculation?

 

At least wikipedia doesn't contradict its own sources.

He provided links of contrary information, and proceeded to point out deficiencies. You can agree or disagree with him, but unless you provide something other than opinion, you fail.

 

And you're right, Wikipedia doesn't contradict its own sources, it leaves that to the sources themselves.

You know the old saying, "lies, damn lies, and statistics." There's a lot of potential statistical manipulation in this article. For one thing does the author know that for many people who are uninsured, they simply can't buy insurance because they have poor health? Not accounting for this group would definitely make a big difference in your final numbers.

 

Perhaps not surprisingly the author removes that group from consideration in his final model, the "M3". Using their own "controls" they bring the fatality rate from around 11% to 1.7%, assuming I've read that right. In other words, they may have unfairly removed some of the biggest factors harming people without insurance. They also aren't considering their so-called "involuntary uninsured" at all in that model, AFAICT. That's a pretty sizable hole in their model.

First, they aren't my numbers. Second, the study describes the methodology on page 7 beginning under the section heading "Ability-to-pay thresholds"

 

They used 3 models, each increasingly accounting for personal characteristics (which they explain) outside of health coverage status, in an effort to seek the most pure measurement of the effect of coverage on mortality.

 

It isn't a published paper in any major peered reviewed science journal, the authors are economists, not doctors, and the sponsors of the article have substantial conflicts of interests. By the strict standards of scientific studies, that article should not even be considered in the discussion. The only reason we are even using it is because this is a informal online discussion.

I never realized that only doctors are capable of performing statistical analysis.

Meanwhile, the 45000 death per year study is in a published, peer-reviewed science journal (linked again for reference), who's credentials cannot be easily dismissed.

No one has dismissed their credentials, merely pointed out the weaknesses in their analysis.

 

PS: It's not from the RAND Corporation. The name of the experiment is "RAND Health Insurance Experiment". I'd be laughing if the Rand Corporation actually wrote a health care paper.

Uh, the paper you cite isn't the one I did, and yes, the one I cited is from (in part, a division of) RAND Corporation.

 

The paper I cited is primarly authored by staff members working for RAND Heath of Santa Monica, CA. If you go to the RAND website, put your mouse over "RAND Divisions" you will see a link to RAND Health. Further, if you click on "Our Staff" (left side of the page), you will find the primary author (Steven M. Asch) of the paper I cited.

 

Another thing, the paper I cited is from the the New England Journal of Medicine. Perhaps you'd like to claim it's just a rag? (BTW, check the "from" on the right margin, note the primary source)

 

Rand doesn't say that

The paper says: We found that health insurance status was largely unrelated to the quality of care among those with at least minimal access to care.

 

The cost reductions I've already demonstrated with the original CBO estimate from March. Hem and haw all you want, but you have not meaningful refuted it in all way.

My calendar still has May coming after March, and CBO's update to the original March estimate is dated May. No hemming and hawing, just stating a fact that is pointed out by CBO itself in the first paragraph.

 

Not just inaccurate, but if you're being scientific you wouldn't never consider them in the first place, given their total lack of credibility. But feel free to believe those sources all you want, and reject my warnings as mere ad hominems in your mind. I certainly won't stop you. Besides, when have corporate sponsored propaganda ever lied?

I base my judgements on the merits of the argument, not the arguer.

 

Your opinion obviously differs.

Edited June 14, 2010 by RangerM

[suv_guy_19]

I didn't mean the Congressional branch of government..... I meant Obama & certain members of his Executive branch.

 

You really think that a man who has a doctor follow him around all day is going to have the bill apply to him?

[grbeck]

The CBO updated their previous analysis to include factors that weren't included originally. However if there is another amendment (where the savings have increased), I'm sure you can provide the citation, right?

 

You say anecdote is not data, then proceed with an anecdote of your own?

 

He provided links of contrary information, and proceeded to point out deficiencies. You can agree or disagree with him, but unless you provide something other than opinion, you fail.

 

And you're right, Wikipedia doesn't contradict its own sources, it leaves that to the sources themselves.

 

First, they aren't my numbers. Second, the study describes the methodology on page 7 beginning under the section heading "Ability-to-pay thresholds"

 

They used 3 models, each increasingly accounting for personal characteristics (which they explain) outside of health coverage status, in an effort to seek the most pure measurement of the effect of coverage on mortality.

 

 

I never realized that only doctors are capable of performing statistical analysis.

 

No one has dismissed their credentials, merely pointed out the weaknesses in their analysis.

 

 

Uh, the paper you cite isn't the one I did, and yes, the one I cited is from (in part, a division of) RAND Corporation.

 

The paper I cited is primarly authored by staff members working for RAND Heath of Santa Monica, CA. If you go to the RAND website, put your mouse over "RAND Divisions" you will see a link to RAND Health. Further, if you click on "Our Staff" (left side of the page), you will find the primary author (Steven M. Asch) of the paper I cited.

 

Another thing, the paper I cited is from the the New England Journal of Medicine. Perhaps you'd like to claim it's just a rag? (BTW, check the "from" on the right margin, note the primary source)

 

 

The paper says: We found that health insurance status was largely unrelated to the quality of care among those with at least minimal access to care.

 

 

My calendar still has May coming after March, and CBO's update to the original March estimate is dated May. No hemming and hawing, just stating a fact that is pointed out by CBO itself in the first paragraph.

 

 

I base my judgements on the merits of the argument, not the arguer.

 

Your opinion obviously differs.

 

These revised Congressional Budget Office (CBO) figures have been all over the place for quite some time. (Perhaps someone needs to remember the old adage, "When you're in the hole, stop digging.")

 

And it was well known from the first day the bill passed that one way the cost projections were made more palatable was by removing the increased reimbursement rates promised to doctors (the "doc fix") from the legislation. And then there is the CBO's track record of underestimating the long-term costs of federal health care plans by as much as 500 percent. The massaged figures and hopeful projections used to justify this bill remind me of the statements we used to get from the Old GM about how recovery was just around the corner. We all know how that one turned out...

[Mysterio]

The CBO updated their previous analysis to include factors that weren't included originally. However if there is another amendment (where the savings have increased), I'm sure you can provide the citation, right?

 

It was an update to the their previous analysis AFAICT. There were no updates to the actual bill in May. The only amendment to the original health care bill was the reconciliation act, also passed in March. There was another CBO report on that, showing no increase in the deficit.

 

Look, you're just chasing down a rabbit hole. Time to call it quits.

 

He provided links of contrary information, and proceeded to point out deficiencies. You can agree or disagree with him, but unless you provide something other than opinion, you fail.

 

http://www.harvardscience.harvard.edu/medicine-health/articles/new-study-finds-45000-deaths-annually-linked-lack-health-coverage

 

It's a peer-reviewed study and published. He is speculating with no direct facts and he has no credibility. Which one do you believe?

 

First, they aren't my numbers. Second, the study describes the methodology on page 7 beginning under the section heading "Ability-to-pay thresholds"

 

They used 3 models, each increasingly accounting for personal characteristics (which they explain) outside of health coverage status, in an effort to seek the most pure measurement of the effect of coverage on mortality.

 

And it's there's a big possibility the 3 models have been rigged in some way to produce a desired outcome. Exactly what you would expect from people with a history of potentially fraudulent studies.

 

I never realized that only doctors are capable of performing statistical analysis.

 

I expect people with a working knowledge of their research before doing studies. Otherwise, they are charlatans.

 

No one has dismissed their credentials, merely pointed out the weaknesses in their analysis.

 

Cite another peer-reviewed research paper that has been published in a major scientific journal. Then I'll believe you.

 

Uh, the paper you cite isn't the one I did, and yes, the one I cited is from (in part, a division of) RAND Corporation.

 

The paper I cited is primarly authored by staff members working for RAND Heath of Santa Monica, CA. If you go to the RAND website, put your mouse over "RAND Divisions" you will see a link to RAND Health. Further, if you click on "Our Staff" (left side of the page), you will find the primary author (Steven M. Asch) of the paper I cited.

 

Then I am wrong then.

 

Another thing, the paper I cited is from the the New England Journal of Medicine. Perhaps you'd like to claim it's just a rag? (BTW, check the "from" on the right margin, note the primary source)

 

It's not relevant to the debate. I've said this already, it's not a debate regarding the deaths from lack of health care.

 

The paper says: We found that health insurance status was largely unrelated to the quality of care among those with at least minimal access to care.

 

It's a study between people who have high deductible coverage and people with free care. The uninsured were never considered.

 

My calendar still has May coming after March, and CBO's update to the original March estimate is dated May. No hemming and hawing, just stating a fact that is pointed out by CBO itself in the first paragraph.

 

And I say again, it's an update to the original study. It doesn't show that the bill has actually lost more money.

 

I base my judgements on the merits of the argument, not the arguer.

Your opinion obviously differs.

 

There are holes in their argument, as I have pointed out. Just because I've criticized their lack of credibility (and high possibility of fraud) doesn't mean they are automatically right.

[sullynd]

I know it's OT, but every time I see this thread I read it as Tim Allen in the white house.

[retro-man]

I know it's OT, but every time I see this thread I read it as Tim Allen in the white house.

LOL :hysterical:

[retro-man]

Fair enough. Yes there are many factors that reduce American healthcare's efficacy. Within some systems, Kaiser Permanente for instance, navigating the system is fairly easy. It is the best comprehensive delivery model, as a patient (nurses get sick too), that I've experienced. It is well run and gives fairly good care. This is what I meant by looking at individual successes as opposed to the Obama administration trying to re-invent the wheel, at ours and our children's expense.

 

His administration, I believe, means well in some areas but I think the Republican approach would be better. Basically, he has no business leading the free world. He should have stayed in the Illinois Senate and learned.

 

Edit: I forgot to mention, Japan doesn't NEARLY allow as much immigration, legal or otherwise, as we do so their 'working poor' cannot be the same as ours.

Before this year, I always assumed that insurance in Japan was provided by the government. I have learned that it is not: it is provided by a network of some 200 private insurers. And almost all of the providers are private. However, the system is regulated so that rates and procedures are uniform. Kaiser Permanente, to use your example, may be absolutely great, but if that's not who my employer is with - or, worse yet, if I lose my job - it's not an option for me. Or it is a prohibitively expensive option. Between my wife and I - until she got laid off last Sept. - we had 2 insurances: Cigna and Blue Shield - and I can tell you, the Cigna, which we lost, was a far far better plan. My beef with our system is that it is such a hodge-podge, with no uniformity, no security, and the ever-present possibility of being left high and dry when you need it most (and this is not to mention costs escalating at many times the rate of inflation and millions uninsured).

[Mark B. Morrow]

I know it's OT, but every time I see this thread I read it as Tim Allen in the white house.

 

RRR!!!

[RangerM]

It was an update to the their previous analysis AFAICT. There were no updates to the actual bill in May. The only amendment to the original health care bill was the reconciliation act, also passed in March. There was another CBO report on that, showing no increase in the deficit.

 

Look, you're just chasing down a rabbit hole. Time to call it quits.

 

And I say again, it's an update to the original study. It doesn't show that the bill has actually lost more money.

Apparently you missed the part about taking into account the reconciliation act. Specifically, there were no changes between the orginal and reconciliation acts that apply to descretionary spending, and the letter adds previously excluded costs (that add to the overall cost of the bill). As the CBO blog said (there's that word again)

 

CBO estimates that total authorized costs in the first two categories probably exceed $115 billion over the 2010-2019 period. We do not have an estimate of the potential costs of authorizations in the third category.

 

CBO

previously issued

an estimate of the direct spending and revenue effects of PPACA,

in combination with the Reconciliation Act of 2010

(Public Law 111-152), which amended it. (Direct spending effects are those that do not require subsequent appropriation action.) CBO estimated that those two laws, in combination, would produce a net reduction in federal deficits of $143 billion over the 2010-2019 period as a result of changes in direct spending and revenues.

 

However, upon further scrutiny, I will acknowledge we are both partially correct and incorrect, in that approximately $86 Billion of the $115 Billion added to the cost of the bill were for programs that already exist (and not included in the overall cost of the bill, but presumably accounted for in deficit calculations). But, even with this reduction in savings adjustment, the $208 Billion cost of the "doc fix" (that was left out of the bill) is more than enough to offset any presumed savings. When taking into account the original CBO estimates, the reconciliation, the additional descretionary spending (May 11), and the "doc fix", the cost of the bill adds to the federal deficit.

 

http://www.harvardscience.harvard.edu/medicine-health/articles/new-study-finds-45000-deaths-annually-linked-lack-health-coverage

 

It's a peer-reviewed study and published. He is speculating with no direct facts and he has no credibility. Which one do you believe?

 

Cite another peer-reviewed research paper that has been published in a major scientific journal. Then I'll believe you.

How about if I use the paper you cite? Here's a link to the paper (itself) and not a news release.

 

Interestingly, the link to the paper is on a website for "Physicians for a National Health Program", and of the authors of the paper, one is an officer of PNHP and another is an editor of their newsletter. Since you can appreciate others' agenda, I wonder if the authors affilated with this organization have one. (From their website: PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program.)

 

But let's not impugn their motivations, let's read the paper.......(under the heading "Limitations")

 

Our study has several limitations. NHANES III assessed health insurance at a single point in time and did not validate self-reported insurance status. We were unable to measure the effect of gaining or losing coverage after the interview. Point-in-time uninsurance is associated with subsequent uninsurance. intermittent insurance coverage is common and accelerates the decline in health among middle-aged persons.33 Among the nearelderly, point-in-time uninsurance was associated with significant decline in overall health relative to those with private insurance. Earlier population-based surveys that did validate insurance status found that between 7% and 11% of those initially recorded as being uninsured were misclassified. If present, such misclassification might dilute the true effect of uninsurance in our sample. We excluded 29.5% of the sample because of missing data. These individuals were more likely to be uninsured and to die, which might also bias our estimate toward the null.

Of course the assertion that their estimate is low-biased is assumption, not fact. But at least they acknowledge that they only measured the "uninsured" at a single point in time, and could not ascertain that such "uninsured" status was temporary or permanent. They assumed permanent which would be worse case, even though there is no proof of this.

 

Looking at Table 1 (page 3), under "insurance status", Column 3 states that of the number of persons "Uninsured" (at the time of the study), 3.3% of them died.

Interestingly, for those "Privately insured", that same statistic is 3.0%. In other words, according the data in Table 1, those uninsured are only 0.3% more likely to die than those privately insured. As the paper states, those on government insurance (except Medicaire) were excluded. However adding the number of government insured persons (2023) in the survey to the total number of Privately insured, reduces this rate from 3.0% to 2.3%. (3.0 x 6655/8678) This assumes that noone receiving government insurance died (best case).

 

Therefore, using the data provided in the paper, the chances of a person with no health insurance dying is (at most) 1.0% greater than a person with insurance. Feel free to show me where my calculations are incorrect.

 

It's not relevant to the debate. I've said this already, it's not a debate regarding the deaths from lack of health care.

 

It's a study between people who have high deductible coverage and people with free care. The uninsured were never considered.

It's a study of the quality of care between sociodemographic groups,

 

The differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality of health care. Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care.

 

However the authors were able to make a conclusion by inference, because the data was sufficient to make the conclusion.....

We found that health insurance status was largely unrelated to the quality of care among those with at least minimal access to care.

 

They concluded that of those with access to and sought care (remember anyone who seeks care, gets it), their lack of insurance coverage was not a significant factor in the quality of care they received. That is entirely relevant.

Edited June 15, 2010 by RangerM

[Mysterio]

Apparently you missed the part about taking into account the reconciliation act. Specifically, there were no changes between the orginal and reconciliation acts that apply to descretionary spending, and the letter adds previously excluded costs (that add to the overall cost of the bill). As the CBO blog said (there's that word again)

 

CBO estimates that total authorized costs in the first two categories probably exceed $115 billion over the 2010-2019 period. We do not have an estimate of the potential costs of authorizations in the third category.

 

CBO

previously issued

an estimate of the direct spending and revenue effects of PPACA,

in combination with the Reconciliation Act of 2010

(Public Law 111-152), which amended it. (Direct spending effects are those that do not require subsequent appropriation action.) CBO estimated that those two laws, in combination, would produce a net reduction in federal deficits of $143 billion over the 2010-2019 period as a result of changes in direct spending and revenues.

 

However, upon further scrutiny, I will acknowledge we are both partially correct and incorrect, in that approximately $86 Billion of the $115 Billion added to the cost of the bill were for programs that already exist (and not included in the overall cost of the bill, but presumably accounted for in deficit calculations). But, even with this reduction in savings adjustment, the $208 Billion cost of the "doc fix" (that was left out of the bill) is more than enough to offset any presumed savings. When taking into account the original CBO estimates, the reconciliation, the additional descretionary spending (May 11), and the "doc fix", the cost of the bill adds to the federal deficit.

 

Well I guess we're in general agreement here. It was not my intention to say the May letter precluded any possibility of adding to the deficit. Just that it wasn't a clear statement that it will add to the deficit, so the letter could mean nothing at all when related to the deficit. I still stand by the claim that the original estimates in March are most credible estimates.

 

As for the"doc fix," I don't doubt it could add the deficit as it was written in the House. I don't doubt your numbers either. But since it hasn't pass the senate, it isn't law yet, assuming it does eventually passes the senate unchanged. However, since it is a future event, we should wait till actually passes before discussing it, since it is fully possible it changes before it passes.

 

How about if I use the paper you cite? Here's a link to the paper (itself) and not a news release.

 

Interestingly, the link to the paper is on a website for "Physicians for a National Health Program", and of the authors of the paper, one is an officer of PNHP and another is an editor of their newsletter. Since you can appreciate others' agenda, I wonder if the authors affilated with this organization have one. (From their website: PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program.)

 

But let's not impugn their motivations, let's read the paper.......(under the heading "Limitations")

 

Our study has several limitations. NHANES III assessed health insurance at a single point in time and did not validate self-reported insurance status. We were unable to measure the effect of gaining or losing coverage after the interview. Point-in-time uninsurance is associated with subsequent uninsurance. intermittent insurance coverage is common and accelerates the decline in health among middle-aged persons.33 Among the nearelderly, point-in-time uninsurance was associated with significant decline in overall health relative to those with private insurance. Earlier population-based surveys that did validate insurance status found that between 7% and 11% of those initially recorded as being uninsured were misclassified. If present, such misclassification might dilute the true effect of uninsurance in our sample. We excluded 29.5% of the sample because of missing data. These individuals were more likely to be uninsured and to die, which might also bias our estimate toward the null.

Of course the assertion that their estimate is low-biased is assumption, not fact. But at least they acknowledge that they only measured the "uninsured" at a single point in time, and could not ascertain that such "uninsured" status was temporary or permanent. They assumed permanent which would be worse case, even though there is no proof of this.

 

You've misread that paragraph. "Bias our estimate toward the null" means those groups are making the null hypothesis more likely, i.e. they are reducing the effect between insured and uninsured. This is because some people were only part-time insured, but were mark as fully uninsured. Either way, they try their best to eliminate such that effect by removing people in which they have missing data. Indeed, the paper goes on to state:

 

Indeed, earlier analyses

suggest that the true effect of uninsurance is

likely larger than that measured in multivariate

models.13,40 In addition, Hadley found that

accounting for endogeneity bias by using an

instrumental variable increases the protective

effect of health insurance on mortality.40

 

In other word they are stating that health insurance is potentially an even bigger protector of health than they are saying, but they are not willing to do so due to insufficient information.

 

Looking at Table 1 (page 3), under "insurance status", Column 3 states that of the number of persons "Uninsured" (at the time of the study), 3.3% of them died.

Interestingly, for those "Privately insured", that same statistic is 3.0%. In other words, according the data in Table 1, those uninsured are only 0.3% more likely to die than those privately insured. As the paper states, those on government insurance (except Medicaire) were excluded. However adding the number of government insured persons (2023) in the survey to the total number of Privately insured, reduces this rate from 3.0% to 2.3%. (3.0 x 6655/8678) This assumes that noone receiving government insurance died (best case).

 

Therefore, using the data provided in the paper, the chances of a person with no health insurance dying is (at most) 1.0% greater than a person with insurance. Feel free to show me where my calculations are incorrect.

 

Going from 3.0% to 3.3% is a 10% increase(.033/.03-1), not a 0.3%. 2.3% to 3.3% is a 43.5% increase(0.033/0.023 - 1), not 1.0%.

 

More important is the conclusion they drew from the increase in the fatality rate. The conclude that lack of health insurance is significantly associated with dying:

 

Results. Among all participants, 3.1% (95% confidence interval [CI]=2.5%,

3.7%) died. The hazard ratio for mortality among the uninsured compared with

the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44,

2.26). After additional adjustment for race/ethnicity, income, education, self- and

physician-rated health status, body mass index, leisure exercise, smoking, and

regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40;

95% CI=1.06, 1.84) than those with insurance.

Conclusions. Uninsurance is associated with mortality. The strength of that

association appears similar to that from a study that evaluated data from the

mid-1980s, despite changes in medical therapeutics and the demography of the

uninsured since that time.

 

It's a study of the quality of care between sociodemographic groups,

 

The differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality of health care. Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care.

 

However the authors were able to make a conclusion by inference, because the data was sufficient to make the conclusion.....

We found that health insurance status was largely unrelated to the quality of care

among those with at least minimal access to care.

 

They concluded that of those with access to and sought care (remember anyone who seeks care, gets it), their lack of insurance coverage was not a significant factor in the quality of care they received. That is entirely relevant.

 

Let me highlight this phrase for you: "among those with at least minimal access to care." That is, among people who actually have insurance. This is not a study between the insured and the uninsured, because the uninsured have no access to care in the context of that paper and were never part of the survey.

 

Are we clear on this yet?