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Tilting at Windmills

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January 10, 2006
By: Kevin Drum

HEALTHCARE: STILL A PROBLEM....To absolutely no one's surprise, overall healthcare costs rose at a breathtaking rate yet again last year. Healthcare now accounts for 16% of U.S. GDP, compared to about 10-11% in our nearest competitor.

And what do we get for all that dough? Not much. Healthcare quality rose only marginally, which means we still suck on virtually every aspect of healthcare compared to industrialized countries with sane national healthcare policies.

But it could be worse. And for a lot of people it is. As the Washington Post chart above shows (taken from the National Healthcare Disparities Report), if you're black, native American, Hispanic, or poor, your healthcare sucks even worse than if you're middle class and white.

It sort of feels like whistling into the wind to keep harping on this, but it's still hard to believe that more Democrats aren't willing to put their reputations behind a genuinely sane, comprehensive, modern national healthcare plan. Not a patch, not "catastrophic insurance," and certainly not HSAs. After all, lots of countries already have decent systems for us to borrow ideas from, and citizens in those countries generally have greater choice of physicians, better (and more equal) care, lower costs, wider coverage, and better outcomes. Sure, it won't happen anytime soon, but it would still be the most effective rallying cry I can think of to truly differentiate Democrats from Republicans. Only a madman would prefer our bizarre hodgepodge system.

Kevin Drum 12:19 PM Permalink | Trackbacks | Comments (170)

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Only a madman would prefer our bizarre hodgepode system.

Cue the madmen...

Posted by: craigie on January 10, 2006 at 12:23 PM | PERMALINK

If you are black, hispanic or poor it's because god is punishing you or because you aren't working hard enough. No excuses.

Posted by: WhoSays on January 10, 2006 at 12:28 PM | PERMALINK

Craigie: Yeah, the statistics about waiting times for hip replacements in Canada should start rolling in shortly....

Posted by: Kevin Drum on January 10, 2006 at 12:29 PM | PERMALINK

GRRRRAH GABLAH RAGGER BLAH RAH LABBA BLAH BLAG LEFTIST MOONBAT FRANCE BLAGGA CLINTON-CARE RAHBLAH!!! GRRRR GRABBA READ MY ARTICLE ON POWERLINE GABLAH RAAAAAH!!!!!

Posted by: madman #1 on January 10, 2006 at 12:29 PM | PERMALINK

This is an area where our collective USA #1 mantra gets us. Our politicians continually tell us (and we believe them) that US "has the best healthcare in the world". But it isn't true.

And that's part of the problem towards solving it - no-one likes the bearer of bad news. The Democrats would have to tell Americans:

"No, we don't have the best health care in the world, not even close. We pay more and get lessAnd to fix the problem we will have to learn from all those nasty wimpy Europeans and other folks."

It will also take an acceptance, that no, free markets don't automatically produce the best results. And that we need to adopt a solution that means more direct government control.

So, despite the overwhelming logical evidence that the US has to address the health care issue, it will be a tough framing and phrasing job for the Democrats to sell a national health plan.


Posted by: Samuel Knight on January 10, 2006 at 12:30 PM | PERMALINK

I apologize for chasing off Don P. He had all of those Canadian hip replacement stats well in hand the last time Kevin blogged about health care.

Posted by: Pale Rider on January 10, 2006 at 12:30 PM | PERMALINK

In theory, I think there is a lot to be gained from universal healthcare although i still am on the fence as I do not think we have adequatelt addreessed the repurcussions in terms of how healthcare will change.
Bot even more importantly, I have to say that the govt cannot afford this. The American people are on a heroin high from tax cuts while the repubs have done nothing to tell people that what they have actually costs something. As long as we beleive that taxes are the worst thing since Hitler, the pipedream of universal healthcare will remain just that. Eventually, the pressure from private industry will push this to the front by simply not offering health insurance at all and Americans may finally decide to pay up what is needed for this program. But we are not there yet. And given the cowardice of the current crop of Dems, what do you really expect. Leadership?

Posted by: Don B on January 10, 2006 at 12:34 PM | PERMALINK

madman #1 makes more sense on this topic than any other apologist we've seen before. Well done!

Posted by: craigie on January 10, 2006 at 12:34 PM | PERMALINK

Pale Rider: I apologize for chasing off Don P. He had all of those Canadian hip replacement stats well in hand the last time Kevin blogged about health care.

I'd say we should foist Don P on Canada, but even I don't hate the Canucks that much.

Posted by: alex on January 10, 2006 at 12:35 PM | PERMALINK

Only a madman would prefer our bizarre hodgepode system.....

or an insurance company executive....

Posted by: mudwall jackson on January 10, 2006 at 12:35 PM | PERMALINK

Here you omly have to wait fifty years for a hip replacment.We don't do hip replacment untill you are in your sixties.

Posted by: scott on January 10, 2006 at 12:36 PM | PERMALINK

Healthcare now accounts for 16% of U.S. GDP, compared to about 10-11% in our nearest competitor.

I believe the difference is explained by CEO pay levels in the US, isn't it? ;-)

Posted by: craigie on January 10, 2006 at 12:36 PM | PERMALINK

Quick comment on the waiting time stats:

A national health care plan will involving longer waiting for certain surgeries. There's no getting around that. Because statistically some health care results in a significant statistical improvement in health and some doesn't.

Statistically pre-natal care, sanitation, long term preventive care have a huge impact, and most surgeries don't. So national health care systems do fund more long term care and take the emphasis off many surgeries - and thus increase the waiting times for those surgeries.

However, most national health care systems give people a greater access to their own doctors and much simpler paperwork than in the US. Also, the rate of bankruptcy due to health care costs is much lower. So there are some significant upsides.

Posted by: Samuel Knight on January 10, 2006 at 12:37 PM | PERMALINK

...or insurance company lobbyist

Posted by: mudwall jackson on January 10, 2006 at 12:37 PM | PERMALINK

Aren't most Democrats in the pocket of the pharmaceutical companies and HMOs like the Republicans? Health care change may have to await campaign reform. (don't hold your breath for that)

Posted by: Peter Branigan on January 10, 2006 at 12:39 PM | PERMALINK

Trying to figure out how they classify quality of care as "better" or "worse"...

Posted by: Javier on January 10, 2006 at 12:40 PM | PERMALINK

This is a Global Citizen thread, and I hope she weighs in on this before the thing gets out of hand.

The Frist company, HCA, is one place to look at for a prime culprit in the rise of costs and the decline of good health care. GC is an expert on HCA.

Posted by: Pale Rider on January 10, 2006 at 12:41 PM | PERMALINK

Good joke on the insurance company executive - because that's where one big pot of money is to fund national health care - in the insurance industry.

Nationally, about 1 1/2 percent of the entire US GDP is health care processing paperwork costs. Most of that is insurance paperwork. If you come up with a fairly straightforward national plan (like Germany or France) those costs go away and we can grab them to fund more care.

However, the funds are in different pots. We would still need to raise taxes to grab that cash. So most people would see a quite visible hike in taxes - and not see the less visible decrease in paperwork charges.

Posted by: Samuel Knight on January 10, 2006 at 12:42 PM | PERMALINK

Socialized medicine, like Hillarycare, would suck. Cost too much. Harry and Louise told me so.

Posted by: A Madman on January 10, 2006 at 12:49 PM | PERMALINK

So who's model should we follow?

Posted by: Freedom Fighter on January 10, 2006 at 12:50 PM | PERMALINK

Statistically pre-natal care, sanitation, long term preventive care have a huge impact, and most surgeries don't.

I read somewhere that childhood obesity is one of the risk factors for a hip replacement later in life. So less healthcare in early life = more expensive healthcare later in life.

Of course, health insurance companies have zero incentive to put any money into preventative care because people change health insurance with every job change, so it's their competitors that will benefit. Why would they bother to spend money on something that will benefit their competitors?

Posted by: Mnemosyne on January 10, 2006 at 12:50 PM | PERMALINK

The Democratic party as it exists needs to be destroyed. Those Dems who in congress now have survived by compromising everything of value. Yes, there are exceptions, but they are few very few. It is the one thing Faux news get's right, Demo's are gutless, self-serving wimps.

Posted by: S Brennan on January 10, 2006 at 12:52 PM | PERMALINK

Kevin: "it's still hard to believe that more Democrats aren't willing to put their reputations behind a genuinely sane, comprehensive, modern national healthcare plan."

Well, it appears to me as though the Democrats have been effectively neutered by the GOP. They are either afraid now to speak up for the citizens they purport to represent or they agree with Republicans on just about every aspect of public policy, including health care. Either way, the life of the average non-affluent American is getting harder by the day.

Posted by: Taobhan on January 10, 2006 at 12:52 PM | PERMALINK

This is an area where our collective USA #1 mantra gets us. Our politicians continually tell us (and we believe them) that US "has the best healthcare in the world". But it isn't true.
And that's part of the problem towards solving it - no-one likes the bearer of bad news. The Democrats would have to tell Americans:
"No, we don't have the best health care in the world, not even close. We pay more and get lessAnd to fix the problem we will have to learn from all those nasty wimpy Europeans and other folks." It will also take an acceptance, that no, free markets don't automatically produce the best results. And that we need to adopt a solution that means more direct government control. So, despite the overwhelming logical evidence that the US has to address the health care issue, it will be a tough framing and phrasing job for the Democrats to sell a national health plan.


Posted by: Samuel Knight on January 10, 2006 at 12:55 PM | PERMALINK

So who's model should we follow?

Germany's system would probably lead to the least painless transition, since it's the most similar to what we have now:

http://tinyurl.com/9hyrt

The British model definitely wouldn't work -- our population is too large and the economies they practice just wouldn't be practical.

What would probably work best would be a federal mandate to the states about the minimum level required. Then states could add their own requirements to attract employers and employees. Sort of like car insurance: most states mandate an absolute minimum of insurance that you must have, but you can add on to that as you like.

Oh, I'm sorry, you wanted me to say, "There is no system that would work better, so we should tear down the whole thing and make it pay-as-you-go for everyone." Gosh, sorry -- there is an actual solution. I know you're looking forward to letting people die in the streets as you drive to the plastic surgeon in your Escalade.

Posted by: Mnemosyne on January 10, 2006 at 12:58 PM | PERMALINK

Kevin: Only a madman would prefer our bizarre hodgepodge system.

Or someone who is getting rich off it.

Posted by: SecularAnimist on January 10, 2006 at 12:59 PM | PERMALINK

"And to fix the problem we will have to learn from all those nasty wimpy Europeans and other folks."

Not only are they wimpy, but Europe is at the threshold of a death spiral of no return. We are supposed to learn from them?

Posted by: Freedom Fighter on January 10, 2006 at 1:01 PM | PERMALINK

Samuel -

Good points, but I think that by now most people realize that their health care isn't so hot. They may have vague feelings of discomfort about "foreign" (yuck!) systems, but they also know they are being reamed.

It just takes some guts. Clinton was willing to do it, but, amazingly, he failed the political test - it was the way he went about it that was a problem as much as anything. Plus, we are now 10+ years down the road, and people are that much more aware of the problems.

It's coming. It's inevitable, as long as we don't completely break down as a society. Hey, maybe that's the real GOP plan...

Posted by: craigie on January 10, 2006 at 1:04 PM | PERMALINK

Not only are they wimpy, but Europe is at the threshold of a death spiral of no return. We are supposed to learn from them?

A. Right wing talking point, and
B. of absoutely no relevance.

Europe's birth rate and immigration policies are not the topic. But thanks for being against anything that might be an improvement. Apparently, this system right here is as good as it gets.

Posted by: craigie on January 10, 2006 at 1:05 PM | PERMALINK

Until somebody actually itemizes the term "health care costs," I'm not sure this is a useful number.

As one example, it costs a pharmaceutical company around $800 million to clear a drug for sale in the U.S. Does such a drug, imported to Europe, go through a second approval process at European expense? If so, how much?

Are research and development costs for medical technology factored into "health costs?" Medical university costs?

To get numbers like "16 percent," somebody must have added everything up somewhere. Where are the numbers?

Posted by: tbrosz on January 10, 2006 at 1:06 PM | PERMALINK

Kevin wrote: ... healthcare costs rose at a breathtaking rate yet again last year. Healthcare now accounts for 16% of U.S. GDP, compared to about 10-11% in our nearest competitor [...] it's still hard to believe that more Democrats aren't willing to put their reputations behind a genuinely sane, comprehensive, modern national healthcare plan.

This is not about "healthcare". It is about medical care, which is to say the treatment of disease and injury.

A "genuinely sane, comprehensive, modern national healthcare plan" would focus on prevention of disease and injury, particularly the prevention of the completely avoidable, and extremely costly, epidemics of degenerative disease that are the result of the standard American diet that is heavy in meat and dairy products combined with the standard American lifestyle of an almost completely sedentary existence.

Widespread adoption of a vegan diet and regular vigorous exercise would drastically reduce the cost of medical care in this country.

In addition to examining the medical care systems of other countries, we should be examining their diets and lifestyles, and encouraging Americans to adopt dietary and lifestyle approaches that prevent disease.

Posted by: SecularAnimist on January 10, 2006 at 1:07 PM | PERMALINK

"I know you're looking forward to letting people die in the streets as you drive to the plastic surgeon in your Escalade."

So if you don't have insurance you die in the streets?

If you are forced to buy insurance, what's preventing the insurance companies from jacking up the price?

Posted by: Freedom Fighter on January 10, 2006 at 1:07 PM | PERMALINK

"vegan diet"

BOOOOOOOOOOOOOOOOO!!!! BOOOOOOOOOOO!!!!

I don't have time to sit outside all day waiting for fruit to fall off of trees.

Posted by: madman #1 on January 10, 2006 at 1:08 PM | PERMALINK

"If you are forced to buy insurance, what's preventing the insurance companies from jacking up the price?"

I keep asking Geico that. The dancing gecko won't answer.

Posted by: madman #1 on January 10, 2006 at 1:10 PM | PERMALINK

"Europe's birth rate and immigration policies are not the topic. But thanks for being against anything that might be an improvement. Apparently, this system right here is as good as it gets."

But it is related since the Europeans can't pay for their expensive and generous programs.
Sorry, but you haven't shown why Europe is an improvement. Fact is, the EU is going to collapse within 30 years.

Posted by: Freedom Fighter on January 10, 2006 at 1:12 PM | PERMALINK

I suspect that the substantial increase in health care costs can mainly be attributed to the general acceptance of the notion that everyone deserves equal level of care independent of his or her ability to pay for it.

Posted by: tbrosz on January 10, 2006 at 1:13 PM | PERMALINK

That fact that we are the most violent, reckless, self indulgent, and self destructive of the first world countries has to be considered. Also, I wonder how much health care professional compensation varies in the first world. How much money is extorted from the consumer to pay for pie in the sky research? How much of the cost is due to drug company schemes to perpetuate their patents and eliminate generics? How much money is wasted on bureaucracy and insurance?

Let's face it the American health care system is a free market success story. It's only real problem is frivolous malpractice lawsuits.

Posted by: Michael7843853 GO in 08! on January 10, 2006 at 1:15 PM | PERMALINK

Fact is, the EU is going to collapse within 30 years.

Oh, okay. Meanwhile, China buys Euros and divests itself of US currency. Keep drinking that Kool-Aid, son...

Posted by: Pale Rider on January 10, 2006 at 1:16 PM | PERMALINK

I'd say we should foist Don P on Canada, but even I don't hate the Canucks that much.

Don P is Canadian, if my linguistic antennae are accurate, or at least he's originally from there.

Clinton was willing to do it, but, amazingly, he failed the political test - it was the way he went about it that was a problem as much as anything. Plus, we are now 10+ years down the road, and people are that much more aware of the problems.

I'd argue that it was the way he went about it that was THE problem. But excellent point about the 10+ years opening a lot more eyes.

Posted by: shortstop on January 10, 2006 at 1:16 PM | PERMALINK

As one example, it costs a pharmaceutical company around $800 million to clear a drug for sale in the U.S.

It would be interesting to know where the $800 million number comes from. If a pharmacutical company uses research from a gov't resource, does that get counted ? Do marketing costs get counted ? Do expenses paid by gov't subsidies get counted ?

Posted by: Stephen on January 10, 2006 at 1:19 PM | PERMALINK

shortstop: Don P is Canadian, if my linguistic antennae are accurate, or at least he's originally from there.

Make sure you get your facts straight. Because if they foisted him on us, it means war (or at least pity).

Posted by: alex on January 10, 2006 at 1:20 PM | PERMALINK

So much do you think Cheney paid for his little trip to the doc yesterday? See a problem with that.Most of the people that can afford healthcare pay nothing for it.See a problem with that?

Posted by: scott on January 10, 2006 at 1:21 PM | PERMALINK

I apologize for chasing off Don P. He had all of those Canadian hip replacement stats well in hand the last time Kevin blogged about health care.

The last thing I would want would be for our FBI agents to be hobbbled, waiting for hip replacements, under the ticking bomb scenario.

Posted by: Bud on January 10, 2006 at 1:22 PM | PERMALINK

"Oh, okay. Meanwhile, China buys Euros and divests itself of US currency. Keep drinking that Kool-Aid, son..."

Shouldn't you at least wait until China becomes a first world economic power before using it as a leading world economic indicator?

Posted by: Freedom Fighter on January 10, 2006 at 1:24 PM | PERMALINK

So who's model should we follow?

While there are no doubt elements of existing universal models which could be incorporated, I don't see that we need to follow anyone's model, so much as learn from all of them (including non-universal models like our own.) Some existing models, including perhaps our status quo model, may provide more in the way of negative examples than things we want to emulate, but its just as important to be guided by an understanding of what features have been tried and work poorly as which have been tried and worked well.

Posted by: cmdicely on January 10, 2006 at 1:25 PM | PERMALINK

Alex and Bud--damn funny!

Posted by: shortstop on January 10, 2006 at 1:25 PM | PERMALINK
Fact is, the EU is going to collapse within 30 years.

Your guesses about the future are not the same thing as "fact".

Posted by: cmdicely on January 10, 2006 at 1:27 PM | PERMALINK

There are downsides, however, with a bit of foresight, and to be honest, political balls, the downsides can be overcome rather easily.

The whole, waiting list for hip replacements, in Canada, isn't really a matter of resources. It's a matter of a lack of doctors, because America doesn't train enough doctors to handle its own needs and market demands.

A radically redesigned health care system combined with government funding for the training and education of additional doctors and medically trained nurses should eliminate most of the downsides over 10-20 years.

Not to mention, that change would probably eliminate most of the health care problems in Canada and the UK as a side benefit.

Posted by: Karmakin on January 10, 2006 at 1:27 PM | PERMALINK

vegan = commie

Posted by: nutty little nut nut on January 10, 2006 at 1:28 PM | PERMALINK

One trick to get physicians on board will be to have the government plan cover medical malpractice insurance, or it will just self-insure. This is relatively cheap, actually (10 billion/year or so). And getting the majority of physicians behind the program would do a lot to counteract the 'socialized = communist' medicine outcries.

Posted by: robert the red on January 10, 2006 at 1:30 PM | PERMALINK
This is an area where our collective USA #1 mantra gets us. Our politicians continually tell us (and we believe them) that US "has the best healthcare in the world". But it isn't true.

Actually, it is probably literally true. The best healthcare in the world, or close enough as to make no difference, can be found in the US. The problem is that, as well as having the best healthcare in the world, the US has the worst, or very nearly so, healthcare delivery system in the developed world.

Posted by: cmdicely on January 10, 2006 at 1:30 PM | PERMALINK

citizens in those countries generally have greater choice of physicians, better (and more equal) care, lower costs, wider coverage, and better outcomes.

But the physicians aren't as rich (and therefore superior to the general population) as they are here, and the middle classes here wouldn't be able to feel as superior if even the riffraff had access to the same level of care. I can't even imagine well-heeled McMansion owners being willing to share a waiting room with the lower classes... that might mean that they'd be stuck reading Car & Driver instead of Architectural Digest or something. Not only are there class distinctions in the levels of coverage, but they exist between practices, with frequently-redecorated, soothing office environments being the choice for the well-insured. My sister chose an attachment-parenting-friendly ped in a diverse neighborhood for her kids, but most of the parents in the waiting room are teens or are chain-smoking formula feeders; it doesn't affect the care her kids receive, but her family is very much an anamoly in that practice. Anyway, universal healthcare would at least in theory break down some class distinctions that are more subtle than insured vs. uninsured, and the privileged types wouldn't like that.

Posted by: latts on January 10, 2006 at 1:32 PM | PERMALINK

The last thing I would want would be for our FBI agents to be hobbbled, waiting for hip replacements, under the ticking bomb scenario.

I cannot take credit for being the only person who helped chase him off--many, many others did fantastic work battling that insane maniac for, literally, weeks on end. I think that when I linked him to a little demographic info, it helped. Otherwise, someone probably killed him. I think someone close to him drove a wooden stake through his heart or poisoned him. Either way, wow...what a frickin' maniac.

The ticking time bomb scenario...I'd completely forgotten about that. And no wonder.

Shouldn't you at least wait until China becomes a first world economic power before using it as a leading world economic indicator?

Shouldn't you have your diaper changed before you use your daddy's computer to comment on blog threads? Are you seriously downplaying the importance of China's economy and their decision to switch from subsidizing our debt to buying Euros?

If the dollar declines in value, what will those health care costs do? How will they be valued?

Posted by: Pale Rider on January 10, 2006 at 1:33 PM | PERMALINK

I'm looking at that chart, and I see:

  • 57% of Blacks have the same, or better, health care than whites.
  • 79% of Asians have the same, or better, health care than whites.
  • 59% of Native Alaskan/American Indians have the same, or better, health care than whites.

We see a comparison of poor to "high-income," which makes it clear that health care for the poor is far worse in comparison to "high-income."

(In the original page Kevin references, "high-income" is defined as 400% or more over federal poverty level, a figure which varies quite a bit depending on family size: for an individual, you're "high-income" if you're making $37,240 and live in the Contiguous Sates or DC: see the official definitions.)

So, Kevin, where do you get:

As the Washington Post chart above shows (taken from the National Healthcare Disparities Report), if you're black, native American, Hispanic, or poor, your healthcare sucks even worse than if you're middle class and white.

We have no data to compare the middle class to others in this chart, and the chart shows that majorities of Asians, Blacks and native Americans have the same or better healthcare compared to whites.

I'm not sure how you can, based on this chart, make any assertion about the relative level of health care the white middle class gets compared to the poor, Native Alaskans/American Indians or blacks.

Are you referring to another chart? Was the referenced link given in error?

As it is, your assertion is not backed by that chart.

Posted by: Nemo Ignotus on January 10, 2006 at 1:33 PM | PERMALINK

With all respects to Blue Girl, she's not the only game in town, Pale Rider. http://healthy policy.typepad.blog/

Posted by: opit on January 10, 2006 at 1:34 PM | PERMALINK

opit,

Yes. I see you comment over there all the time as well. Her blog is one of my favorites.

Posted by: Pale Rider on January 10, 2006 at 1:36 PM | PERMALINK

A national health care plan will involving longer waiting for certain surgeries. There's no getting around that. Because statistically some health care results in a significant statistical improvement in health and some doesn't.

It may result in longer wait times for certain surgeries for some, but it will involve shorter wait times for those who, because they lack health insurance, now cannot obtain those surgeries at all. If you don't have decent insurance now your wait time for certain procedures is infinity -- you can't afford it, so you'll never ever get it.

Posted by: Stefan on January 10, 2006 at 1:41 PM | PERMALINK

"Are you seriously downplaying the importance of China's economy and their decision to switch from subsidizing our debt to buying Euros?"

Sounds like to me you are downplaying the most powerful economy in the world.

"If the dollar declines in value, what will those health care costs do? How will they be valued?"

Why would it have any effect on domestic health care costs? A weaker dollar would only hurt Chinese exports, that's why China has kept her yuan artificially low.

Posted by: Freedom Fighter on January 10, 2006 at 1:45 PM | PERMALINK

Nemo Ignotus,

Thanks for demonstrating the truth of the saying "figures don't lie, but liars figure."

I'm looking at that chart, and I see:

57% of Blacks have the same, or better, health care than whites.
79% of Asians have the same, or better, health care than whites.
59% of Native Alaskan/American Indians have the same, or better, health care than whites.

Well, yeah, choosing to group the same with better is a popular method of misleading; you reverse it and you get:

89% of Blacks have the same or worse healthcare than whites;
62% of Asians have the same or worse healthcare than whites;
86% of Native Americans/American Indians have the same or worse healthcare than whites;
85% of Hispanics have the same or worse healthcare than non-Hispanic whites.

Hey, why are my majorities so much bigger -- except for Asians -- than yours? Why did you not say anything about Hispanics?

Oh, is it because -- except for Asians -- in each of those groups the share getting worse healthcare than whites was far greater than the share getting better healthcare, which is the critical comparison, not whether you can include the middle to get a majority that is either equal or on one side? And even trying to do the "mislead by including the middle" trick, you still couldn't make it work with Hispanics.

Posted by: cmdicely on January 10, 2006 at 1:45 PM | PERMALINK

I'm genuinely curious: tbrosz, freedom, others -

Is the US system actually the best anyone can do? Is that your position?

If not, then what are you for? Why can't you be for something? (hey, this channeling GOP talking points is fun!)

Posted by: craigie on January 10, 2006 at 1:49 PM | PERMALINK

"Oh, is it because -- except for Asians -- in each of those groups the share getting worse healthcare than whites was far greater than the share getting better healthcare, which is the critical comparison, not whether you can include the middle to get a majority that is either equal or on one side?"

So what's the conclusion here? Should we punish the Asians for taking more than their equal share or are the Asians doing something right and encourage others to learn from them? Judging from Affirmative Action policies, I have a hunch where you liberals would come down on this issue.

Posted by: Freedom Fighter on January 10, 2006 at 1:51 PM | PERMALINK

The Democrats are terribly behind on this issue. Is their 2006 slogan going to be "At least we're not as bad as the Republicans"?

Promise people something they want. HEALTHCARE.

Posted by: reino on January 10, 2006 at 1:57 PM | PERMALINK

If not, then what are you for? Why can't you be for something? (hey, this channeling GOP talking points is fun!)

They are for staying the course, of course. They are social Darwinists of a sort: survival of the richest.

Posted by: Bud on January 10, 2006 at 1:57 PM | PERMALINK

Judging from Affirmative Action policies, I have a hunch where you liberals would come down on this issue.

So that's what he's for--he's for sticking it to brown people!

Way to take a stand! No health care for minorities! Clap louder! USA is Number One!

Posted by: Pale Rider on January 10, 2006 at 1:58 PM | PERMALINK

LOL on that one craigie.

Posted by: opit on January 10, 2006 at 2:02 PM | PERMALINK

Asians should be used to teach the blacks to be less uppity and more healthy. That will solve more than one problem in one fell swoop. :)

Posted by: lib on January 10, 2006 at 2:05 PM | PERMALINK

I don't think Tbrosz is necessarily for survival of the richest, he just doesn't want to have any of HIS money go to help someone else besides himself.

Posted by: WhoSays on January 10, 2006 at 2:08 PM | PERMALINK

"But it is related since the Europeans can't pay for their expensive and generous programs.
Sorry, but you haven't shown why Europe is an improvement."

Yet miraculously we are doing fine paying for our far more expensive and less generous programs?

We pay 50-100% more than those nations as a share of GDP (and more than that in absolute terms), you aparrantly think thier systems are also more generous so why are thiers worse? Is generous bad? That makes a sick sort of sense in the right wing world view. Maybe our system is better because it punishes the poor and ill more effectively?

Western europe (and canada, japan, israel, etc) spends less and has better outcomes. Thats what all the statistics people keep posting over and over here show, so yea, we have shown why it is an improvement.

In response people like tbrosz post far narrower statistics, like waiting time after diagnosis and admission, that omit the worst problems of US healthcare (like how many people are waiting for care without being diagnosed and admitted).

Posted by: jefff on January 10, 2006 at 2:11 PM | PERMALINK

Mnemosyne,

Exactly how is childhood obesity going to be treated by nationalized healthcare? Every parent already knows being obese is bad for their children and they know how to fix it, but they increasingly do nothing about it. You may as well propose that nationalized healthcare will curtail smoking or reckless driving.

Posted by: Yancey Ward on January 10, 2006 at 2:14 PM | PERMALINK

I don't think Tbrosz is necessarily for survival of the richest, he just doesn't want to have any of HIS money go to help someone else besides himself.

But he is happy to take your money to support himself via consulting fees for useless government funded boondoggles.

Posted by: lib on January 10, 2006 at 2:14 PM | PERMALINK

In response people like tbrosz post far narrower statistics, like waiting time after diagnosis and admission, that omit the worst problems of US healthcare (like how many people are waiting for care without being diagnosed and admitted).

Very good point, and similar to one I made above about how you have to factor in those who never receive health care at all in this country. As I said, if you have no health insurance your wait time is effectively infinity, since you will never receive the care you need. But dishonest right-wing partisans cherrypick their statistics, preferring to count only those who receive care at all and excluding those who never receive care from their analyses of waiting times and recovery rates.

Posted by: Stefan on January 10, 2006 at 2:16 PM | PERMALINK

Exactly how is childhood obesity going to be treated by nationalized healthcare? Every parent already knows being obese is bad for their children and they know how to fix it, but they increasingly do nothing about it. You may as well propose that nationalized healthcare will curtail smoking or reckless driving.

Families with healthcare will be able to take their children to the doctor, presumably, where that doctor will be able to the parents on the dangers to their child of unchecked obesity. All evidence in this country points to the fact that right now many parents don't, in fact, know how to fix obesity in their children.

Posted by: Stefan on January 10, 2006 at 2:18 PM | PERMALINK

Hillarycare was roughly the German model of healthcare which includes (regulated!!) insurance companies as part of the delivery system. Politically, I think that is more likely to be acceptable. The insurance industry is big business and knocking them out of the loop is not likely to happen.

Even though I wasn't a huge John Kerry fan, I did think the catastrophic care idea was a good one. That's a different plan than other countries have, but I think that it has a lot of potential at least as a starting point for universal healthcare.

As a physician, I continue to be amused by the belief that cutting my income will result in a huge cost savings. It's kind of like saying that cutting the pay for carpenters will reduce the cost of real estate. It will, but not by much. Take, as an example, an elderly patient with hypertension, congestive heart failure, hyperlipidemia, and COPD (not an unusual combination -- think Dick Cheney without the diabetes). If they are getting standard of care medication, they'll probably be taking 6 or more drugs, in our example let's say Coreg, generic lisinopril, generic lovastatin, generic aspirin, Norvasc, generic albuterol, and Q-var. That comes to $350-400/month or $4000-$5000/year(1). Now if they also visit my office every three months, I'm being compensated by Medicare about $35/visit or $140 per year. Sure, cutting my pay by 10% would result in a $14 saving to Medicare, but cutting drug costs by 10% would result in $400 savings. My engineering background would suggest that cutting drug costs would be the better choice, but some of you liberal arts majors seem to have different ideas. Unfortunately, a vegan diet isn't going to do much to help this patient, either.

1) www.drugstore.com

Posted by: J Bean on January 10, 2006 at 2:19 PM | PERMALINK

Stefan,

That is bullshit. Obesity comes from eating too much, eating the wrong kinds of food, and from getting too little physical activity. Those who claim to not know this are liars.

Posted by: Yancey Ward on January 10, 2006 at 2:21 PM | PERMALINK

Obesity comes from eating too much, eating the wrong kinds of food, and from getting too little physical activity.

I thought obesity came from Wal-Mart.

Posted by: craigie on January 10, 2006 at 2:25 PM | PERMALINK

Obesity comes from eating too much, eating the wrong kinds of food, and from getting too little physical activity.

Of course, if your thyroid acts up, that can make you fat. But why bring science into it, right?

Posted by: Pale Rider on January 10, 2006 at 2:26 PM | PERMALINK

Pale Rider,

All these obese adults and children have thyroid conditions? I am sorry, but I refuse excuse poor personal habits due to this alleged ignorance. I have just as much sympathy for smokers, alcoholics, and other drug abusers.

Posted by: Yancey Ward on January 10, 2006 at 2:31 PM | PERMALINK

Yancey Ward: I have just as much sympathy for smokers, alcoholics, and other drug abusers.

How about meat eaters?

Posted by: SecularAnimist on January 10, 2006 at 2:34 PM | PERMALINK

That is bullshit. Obesity comes from eating too much, eating the wrong kinds of food, and from getting too little physical activity. Those who claim to not know this are liars.

Since Americans are the most obese people in the developed world, isn't Yancey saying that Americans eat too much, eat the wrong kinds of food, and don't get enough physical activity? Why does Yancey hate Americans?

Seriously, though, yes, that is the general cause of obesity, and that is behavior that Americans have been overindulding in. More frequent access to healthcare, though, would point out to parents the dangers to their children of unchecked obesity, and would enable parents to work with doctors to come up with a reasonable diet and exercise plan for their children.

Posted by: Stefan on January 10, 2006 at 2:34 PM | PERMALINK

cmdicely,

Let's look back at what Kevin said:

As the Washington Post chart above shows (taken from the National Healthcare Disparities Report), if you're black, native American, Hispanic, or poor, your healthcare sucks even worse than if you're middle class and white.

I had several problems with this.

First, that chart offers no basis to say anything about the white middle class. It does allow one to say things in comparison to whites as a group, but not all whites are middle class, and the only data we are given with regard to class is for the generic "poor" (which includes whites, blacks, Hispanics, Asians, etc.) vs "high-income" Americans which, by the definition given, includes people who would probably be considered middle-class by most people, as well as people who woulc be considered rich.

Second, Kevin is saying that the health care of those groups is worse than that of middle-class whites. Let's be generous, and assume that Kevin actually meant that their health care was worse than that of whites in general. For most of the groups, that doesn't seem to be true, since, at least where I come from, if I am treated "the same as" someone else, I'm not be treated worse than they are. So adding the numbers in the way you suggest doesn't make sense in light of Kevin's claim which I am challenging.

Now, his claim might hold for Hispanics, were it not for the first problem I had with the data he presents, namely that there is nothing in the data he presents which allows one to compare any of those groups to middle-class whites. (This is why I didn't even bother with those numbers: I did with the other ones because, in those case, there was another reason to disagree with Kevin. Even if you assume that my first objection doesn't hold, by the numbers shown, my second one does for every group but Hispanics, and since we're talking about Kevin's claim quoted earlier, his claim doesn't seem to hold up to me.)

I said nothing about the share getting worse healthcare in comparison to the share getting better healthcare, and neither did Kevin, so I'm not sure why you've decided it's the critical comparison. That would be another argument entirely.

Even though I was specifically addressing Kevin's claim, I don't think it's misleading to say that, when comparing the healthcare of racial groups in America, to note that majorities in several groups are getting care that is the same as, or better, than whites, based on the chart Kevin provided. (I'd want better numbers and a lot more study before I'd chop off "based on the chart Kevin provided," since I think it's easily possible that the chart's data will not hold up. But Kevin made his assertion based on that chart.)

One suggestion I'll make for you: I know it is the standard, when arguing on politicized blogs like this, to start off by insulting people. It does not, however, strengthen one's argument.

The start to your response is pretty much an appeal to ridicule combined with a personal attack.

I realize logical fallacies are popular things in political discussion (like, say, Byron York's application of Ad Hominem Tu Quoque to defend President Bush), but not using them makes for better discussion and, in the case of personal attacks, it certainly makes for a much more civil discussion.

Posted by: Nemo Ignotus on January 10, 2006 at 2:36 PM | PERMALINK

I have just as much sympathy for smokers, alcoholics, and other drug abusers.

Why bring George W. Bush and Rush Limbaugh into this?

Posted by: Stefan on January 10, 2006 at 2:36 PM | PERMALINK

As more and more employees are cast adrift by the corporations for whom they work, the young and not sick will chose not to carry healthcare, reducing the number of participants, driving the cost per participant ever higher, not just because the reduced headcount but because those remaining will use the "services" in an ever costly manner.

It is self feeding.

Posted by: Sky-Ho on January 10, 2006 at 2:36 PM | PERMALINK

Yancey,

All these obese adults and children have thyroid conditions? I am sorry, but I refuse excuse poor personal habits due to this alleged ignorance.

Of course, refusing to acknowledge that science has anything to do with it renders you incapable of having an open mind on the subject.

Obesity is caused by a number of factors, the largest factor clearly being diet and exercise--no one would argue otherwise. Stefan is correct that better access to the health care expertise of a physician could help prevent or reduce some forms of childhood obesity.

But when you bring a little science into it and open your mind, whoa...things start to change.

From: http://thyroid.about.com/cs/basics_starthere/a/mystery.htm

The reality is that symptoms such as fatigue, anxiety, unexplained weight gain or loss, hair loss, depression, and palpitations may indicate that you have an undiagnosed thyroid condition.

A February, 2000 research study found that the estimated number of people with undiagnosed thyroid disease may be 10 percent -- a level that is double current estimates, and may represent as many as 13 million Americans currently undiagnosed. For women, the risk is even higher. A woman faces as high as a one in five chance of developing thyroid problems during her lifetime. That risk increases with age and for those with a family history of thyroid problems.

Posted by: Pale Rider on January 10, 2006 at 2:43 PM | PERMALINK

J Bean: As a physician, I continue to be amused by the belief that cutting my income will result in a huge cost savings. ... My engineering background would suggest that cutting drug costs would be the better choice

My engineering background says the three types of lies are lies, damn lies and anecdotes. You may be right about the cost of doctor compensation, but your non-ues of statistics does nothing to make your argument.

Posted by: alex on January 10, 2006 at 2:46 PM | PERMALINK

Yancey: Every parent already knows being obese is bad for their children and they know how to fix it, but they increasingly do nothing about it.

You're arguing from the position of an educated person with the means to buy a variety of foods. Unfortunately, you really don't know what you're talking about on this one.

Many parents do not know how to fix the problem of childhood obesity, which may involve a very wide range of factors: parental nutrition knowledge, family income, amount of parental supervision based on work and other commitments, children's emotional problems, community sports and fitness resources, local school district meal plans, etc. The American Dietetic Association, the surgeon general, NIH, the CDC, Tufts University and countless other universities and agencies have fully documented the education and information gap on this topic, which--surprise!--corresponds largely with income level. There's more than one multidisciplinary national task force, plus a whole lot of community, school and church programs, that are currently addressing some very specific pieces of this information gap.

A big part of the problem, incidentally, is that medical school curricula dealing with nutrition is very limited, so doctors are quite often the last person you should be asking about how to make permanent changes in the family diet. Fortunately, awareness on this point is growing and registered dietitians and other actual nutrition experts are starting to lead more programming and dialogue on this topic.

Posted by: shortstop on January 10, 2006 at 2:46 PM | PERMALINK

But it is related since the Europeans can't pay for their expensive and generous programs.
Sorry, but you haven't shown why Europe is an improvement. Fact is, the EU is going to collapse within 30 years.

no, it isn't. it just won't be majority white and christian anymore. is that a 'collapse'?

Posted by: spacebaby on January 10, 2006 at 2:48 PM | PERMALINK

"no, it isn't. it just won't be majority white and christian anymore. is that a 'collapse'?"

Unless Moslems somehow become all of a sudden "enlightened", then it's pretty much a foregone conclusion.

Posted by: Freedom Fighter on January 10, 2006 at 2:57 PM | PERMALINK

Unless Moslems somehow become all of a sudden "enlightened",

That's kind of a loaded statement. How can you tell what color people are from under that white bedsheet? Did your daddy cut eyeholes in it for you so you could march with the Klan?

Posted by: Pale Rider on January 10, 2006 at 3:00 PM | PERMALINK

Why do people even bother to talk to this FF yahoo?

Posted by: shortstop on January 10, 2006 at 3:01 PM | PERMALINK

It will also take an acceptance, that no, free markets don't automatically produce the best results. And that we need to adopt a solution that means more direct government control.

The current US health care delivery system has very little to do with a free market. Its roots are in evasion of WWII wage controls (a new benefit wasn't a pay raise). It has evolved into a situation where consumers (as opposed to employers) have a severely contrained or prohibitively expensive set insurance choices. If fortunate enough to get to the point of care decisions, the extreme imbalance of relevant knowledge between doctor and patient or (duh!) ill health at the time choices need to be made frequently make the idea of an informed health care consumer a fantasy.

Killing off the meme that the current system represents some kind of "free market" solution would be a useful contribution to getting to a better one.

Posted by: VAMark on January 10, 2006 at 3:01 PM | PERMALINK

When one man is uninsured, it's a tragedy. When millions go uninsured, it's a statistic.

I mean, come on, folks, these are just a bunch of faceless citizens (oops, I mean "consumers") who aren't Bush Pioneers and don't even have a portfolio. They don't matter -- don't you get that? They are useful only as props in election years. Otherwise -- hey, Dick Cheney's plan covers him just fine. And you don't see Paris Hilton doing without, do you? So what's the problem?

In a similar vein, I see a mention in the news that credit card delinquencies remain at an all-time high. But so the fuck what? The big story is that the Dow hit 11,000!

Posted by: Alek Hidell on January 10, 2006 at 3:03 PM | PERMALINK

Unless Moslems somehow become all of a sudden "enlightened", then it's pretty much a foregone conclusion.

so, basically, it is collapse in your opinion because you're a bigot.

Posted by: spacebaby on January 10, 2006 at 3:03 PM | PERMALINK

As a physician, I continue to be amused by the belief that cutting my income will result in a huge cost savings

Actually, I'm inclined to think that physicians have suffered some financially as a result of managed care, but by & large US docs are still pretty highly compensated compared to their peers in the rest of the civilized world. I strongly suspect that universal health care would result in better compensation overall for front-line docs-- GPs, internists, pediatricians, OB-GYNs-- and relatively less for the hotshot specialists, but it's possible that little would change wrt doctors' incomes. My earlier comment was more about the fear & hostility so many MDs display regarding universal healthcare & what it would do to their incomes... however, keep in mind that both my hometown & my current city of residence are very much hospital-oriented towns in which MDs tend to enjoy even more inflated social status than their incomes would indicate, and behave accordingly.

Posted by: latts on January 10, 2006 at 3:04 PM | PERMALINK

As one example, it costs a pharmaceutical company around $800 million to clear a drug for sale in the U.S. Does such a drug, imported to Europe, go through a second approval process at European expense? If so, how much?


Whoa nelly! That number is too high. I'd estimate 200-300 million to develop and get a drug to market including European market as well as US - still a lot- all at company expense. More if you try for Japan because they want additional clinical trials with Japanese patients and it takes an incredibly long time.

Posted by: ckelly on January 10, 2006 at 3:07 PM | PERMALINK

"That's kind of a loaded statement. How can you tell what color people are from under that white bedsheet? Did your daddy cut eyeholes in it for you so you could march with the Klan?"

When did religion become a color? If Europe regressed to the level of the rest of the Moslem world, wouldn't that be considered a collapse?

Posted by: Freedom Fighter on January 10, 2006 at 3:11 PM | PERMALINK

Unless Moslems somehow become all of a sudden "enlightened", then it's pretty much a foregone conclusion.

"Moslems"? How long has it been since Muslims have been called that? Maybe in your next post you can call them "Mahometans" or "filthy Saracen devils."

But shortstop is right (as usual!) - why waste my time on Freedom Fighter [sic], whose every post reeks of young white male ignoramus?

Posted by: Alek Hidell on January 10, 2006 at 3:13 PM | PERMALINK

shortstop,

I am not buying the argument. Everyone has access to the same foods that I buy everyday since I don't buy in upscale food marts, and the healthy choices are not expensive compared to the non-healthy varieties, and are often cheaper. Seriously, I am to accept that parents don't know healthier foods to eat than eating KY Fried Chicken every day for dinner?

Pale Rider,

I realize that there is a small fraction of those who suffer from conditions that make obesity much more likely, but even still the cure for obesity is largely the same prescription of diet and exercise, the actual following of which is still a matter of personal discipline. If someone is happy being obese, more power to them- it is their personal choice in most cases, but don't expect a pat on the back and a "You can't help it" from me if you are unhappy with this personal choice.

Posted by: Yancey Ward on January 10, 2006 at 3:13 PM | PERMALINK

When did religion become a color? If Europe regressed to the level of the rest of the Moslem world, wouldn't that be considered a collapse?

why are you assuming that europe is going to 'regress to the level of the rest of the Moslem world'? what does that mean exactly, and could you explain what the 'Moslem' world is?

you do know that when those civilized europeans came over to north america with their delicate manners and cultured ways, they introduced the practice of scalping and engaged in biowarfare against the 'savages'?

so, what is about european culture that makes it more civilized?

Posted by: spacebaby on January 10, 2006 at 3:14 PM | PERMALINK

If Europe regressed to the level of the rest of the Moslem world

What's so funny about this comment is that it's the US that's regressing... on reproductive rights, the environment, education, business ethics, torture, civil liberties, honoring treaties, and in any number of smaller ways, we're (or the right wing is, anyway) more temperamentally similar to several Middle Eastern regimes than we are like Europe already.

Posted by: latts on January 10, 2006 at 3:18 PM | PERMALINK

"why are you assuming that europe is going to 'regress to the level of the rest of the Moslem world'? what does that mean exactly, and could you explain what the 'Moslem' world is?"

Poor, backward, intolerant, war torn, etc...

"you do know that when those civilized europeans came over to north america with their delicate manners and cultured ways, they introduced the practice of scalping and engaged in biowarfare against the 'savages'?

so, what is about european culture that makes it more civilized?"

Since I am not European, I really don't care if the Euros go the way of the dodo. All, I am saying is, we not follow in their suicidal foot steps.

Posted by: Freedom Fighter on January 10, 2006 at 3:20 PM | PERMALINK
Exactly how is childhood obesity going to be treated by nationalized healthcare? Every parent already knows being obese is bad for their children and they know how to fix it, but they increasingly do nothing about it.

Well, certainly, where healthcare is a public cost, there will be an incentive for public programs aimed at youth -- such as in the schools -- not to actively work to magnify the problem for small profits by commercial deals with junk food companies.

Further, and more directly, better healthcare access will improve diagnosis and treatment (or adapting weight loss programs to) conditions which contribute to obesity and difficulty in losing weight. Thyroid problems are one of the biggies here, but not alone, especially as you get into young adulthood; and its not all that uncommon that multiple conditions that mask each other are involved.

And, frankly, most people do not know how to treat obesity, even in the simple cases where it is not complicated by one or more underlying health conditions that make it more difficult to address, any more than most people know how to treat drug addiction. Deeply seated behaviors are non-trivial to alter, and most people are completely clueless on how to do that -- even for themselves, much less someone else. And the research on the usual success of people attempting diet and exercise programs demonstrates that most people don't have the skills necessary to treat obesity.

Posted by: cmdicely on January 10, 2006 at 3:21 PM | PERMALINK

But it is related since the Europeans can't pay for their expensive and generous programs.

Canada has universal coverage and they are running budget surpluses.

Taiwan has universal coverage and they do alright.

Posted by: Stephen on January 10, 2006 at 3:23 PM | PERMALINK
So what's the conclusion here? Should we punish the Asians for taking more than their equal share or are the Asians doing something right and encourage others to learn from them?

Er, you are assuming that the distribution of results are the results of differences in the choices and preferences of the involved persons, rather than non-voluntary differences in access due, directly or indirectly, to race, economic background, or other non-chosen conditions.

(I rather suspect that, if you controlled the race figures for income, and vice versa, you'd find that income explains a lot more of the variation than race/ethnicity.)

Posted by: cmdicely on January 10, 2006 at 3:26 PM | PERMALINK

I once read that there are about 200,000 physicians in the United States and that the average compensation is about $200,000. By my math this comes to about $40 billion dollars, or about one-half of one percent of GDP. I think universal care would bring this compensation level down to something closer that in a country like Canada, but it will not be the source of big healthcare savings in the United States.

Posted by: Yancey Ward on January 10, 2006 at 3:26 PM | PERMALINK

But Feedom Fighter isn't invading countries that have done nothing to you [ poland ], The same thing were doing [iraq]. So does that mean we are following in their footsteps?

Posted by: dim on January 10, 2006 at 3:27 PM | PERMALINK
I am not buying the argument. Everyone has access to the same foods that I buy everyday since I don't buy in upscale food marts, and the healthy choices are not expensive compared to the non-healthy varieties,

In general, actually, they are, and even moreso when preparation time and resources are an issue, which they tend to be when you are, e.g., a single parent working two jobs to be able to pay the bills and put any kind of food on the table at all.

Posted by: cmdicely on January 10, 2006 at 3:32 PM | PERMALINK

"(I rather suspect that, if you controlled the race figures for income, and vice versa, you'd find that income explains a lot more of the variation than race/ethnicity.)"

You should tell that to Kevin Drum and the rest of your fellow liberals trying to push the race angle... again.

BTW, that's a pretty interesting theory... wealthier people being able to buy more stuff and all.

Posted by: Freedom Fighter on January 10, 2006 at 3:32 PM | PERMALINK

No, cmdicely, it demonstrates that people don't care enough to fix their obesity problem, should they view it as such. Changing one's behavior isn't easy, but it can be done if one is willing to sacrifice to do it. Science may come to the "rescue" and develop a pharmaceutical that keeps the fat off, but I wouldn't bet on it.

Posted by: Yancey Ward on January 10, 2006 at 3:33 PM | PERMALINK

cmdicely,

Let's grant that single parents don't have the time to prepare a healthier diet for their children, then how is universal healthcare to solve this?

And I still am not buying the argument that unhealthy foods are cheaper than the healthy ones, and even if it were true, how does universal healthcare solve this?

Posted by: Yancey Ward on January 10, 2006 at 3:38 PM | PERMALINK

If Europe regressed to the level of the rest of the Moslem world

What's so funny about this comment is that it's the US that's regressing...

And FF is behind it one hundred percent.

Posted by: ckelly on January 10, 2006 at 3:39 PM | PERMALINK

"In general, actually, they are, and even moreso when preparation time and resources are an issue, which they tend to be when you are, e.g., a single parent working two jobs to be able to pay the bills and put any kind of food on the table at all."

So which is it? Too much food, thus obesity, or not being able to put food on the table, and thus obesity?

Posted by: Freedom Fighter on January 10, 2006 at 3:43 PM | PERMALINK

Everyone has access to the same foods that I buy everyday since I don't buy in upscale food marts, and the healthy choices are not expensive compared to the non-healthy varieties, and are often cheaper.

That's an astonishingly ignorant statement considering that, in point of fact, healthy foods such as fresh fruit and vegetables are indeed more expensive than junk food. Moreover, in many poor neighborhoods the choice of where to shop for food is extremely limited, and the merchants who cater to such communities jack their prices up accordingly. Most inner-city communities don't have a gleaming white A&P or Fairway on the corner -- they have a deli or bodega, where prices are marked up 50% and the cheapest thing you can buy is a bag of high-fat chips.

Posted by: Stefan on January 10, 2006 at 3:45 PM | PERMALINK

"(I rather suspect that, if you controlled the race figures for income, and vice versa, you'd find that income explains a lot more of the variation than race/ethnicity.)"

You should tell that to Kevin Drum and the rest of your fellow liberals trying to push the race angle... again.

Yes FF, because that's SO much better. More non-whites are poor and more poor can't get proper healthcare. The ever-widening disparity between the Haves and Have-Nots courtesy of the Bush administration and Republican party. Yes, SO much better.

Posted by: ckelly on January 10, 2006 at 3:47 PM | PERMALINK

"Moreover, in many poor neighborhoods the choice of where to shop for food is extremely limited, and the merchants who cater to such communities jack their prices up accordingly."

Then how come when Wal-Mart wants to open shop and provide less expensive products for consumers, liberals are always in the forefront to shut them down?

Posted by: Freedom Fighter on January 10, 2006 at 3:52 PM | PERMALINK

Stefan,

Sorry, Stefan, I am not buying the argument. If prices are being "jacked up" in poorer neighborhoods, then they are being jacked up for all varieties of food. Are you telling me that fruits and vegetables are unavailable in poorer neighborhoods? Really, why can't you just accept that people have different habits and desires when it comes to food and exercise, and that these are not forced onto them? Believe me, I see a lot of obese but wealthy adults and children. American's seem to be increasingly obese by a matter of culture, not because they don't have the option to be otherwise which is the point I am making.

Posted by: Yancey Ward on January 10, 2006 at 4:03 PM | PERMALINK

shortstop,

I am not buying the argument. Everyone has access to the same foods that I buy everyday since I don't buy in upscale food marts, and the healthy choices are not expensive compared to the non-healthy varieties, and are often cheaper. Seriously, I am to accept that parents don't know healthier foods to eat than eating KY Fried Chicken every day for dinner?

You're not buying the argument because it conflicts with your beloved theory of an even playing field.

A word on food pricing: With a few exceptions, such as dried legumes, healthy food does in fact cost more than cheap food. Fruits and vegetables are expensive. Yogurt and milk (which have been shown in recent studies to aid in weight loss, besides having other health benefits), aren't cheap. If you eat meat, the lean versions cost more than the fatty cuts. Whole-grain breads cost more than generic white. And it's almost always cheaper to feed your family on frozen or canned foods, which are generally loaded with salt and fat, than on creating a fresh and healthier meal from scratch. Fast food is also remarkably cheap in comparison to cooking with fresh ingredients.

Morever, food prices are far higher in poorer neighborhoods, and much of the available food is uneatable. Stop by a low-income neighborhood's mom-and-pop grocery sometime and see if any of the produce is unrotted enough to consider purchasing.

I note you're sticking with the food pricing topic and ignoring our points about information and education. You don't know very much about buying and preparing food, and that's okay. What you should be able to admit is that people are woefully uninformed about the practicalities of healthy eating. Most people can tell you that ingesting fewer calories than you burn will make you lose weight, but people are quite often clueless about how to put good nutrition into long-term practice in everyday life. This isn't just a problem with less-educated people--witness the number of educated idiots on Atkins--but when people are less informed, the obstacles to making lasting lifestyle changes multiply.

Healthcare isn't just about going to primary-care practitioners, although they can play an important role in nutrition education if they're knowledgeable enough on the subject, and obviously you need to be able to see a doctor if you're going to address disease-related components of obesity. Dietetics professionals, who are very much part of the healthcare system whether you are aware of it or not, are trained to address the educational, environmental, cultural, economic and emotional aspects of making permanent lifestyle changes.

Both cmdicely and I also have pointed out that multifaceted education and resources are key to addressing the childhood obesity epidemic from a public-health perspective, yet another point you're choosing to ignore.

Posted by: shortstop on January 10, 2006 at 4:11 PM | PERMALINK

Then how come when Wal-Mart wants to open shop and provide less expensive products for consumers, liberals are always in the forefront to shut them down?

So Wal-Mart's now opening megastores in inner-city neighborhoods?- who knew?

Their produce & meats are crap, too, although probably better than a lot of little dive groceries I see in poorer neighborhoods... however, the processed foods still take up much more of their retail space and are more consistently palatable, and are cheaper in relative terms. I don't shop there any more if I can help it, but since I did happen to have a choice, I only bought packaged foods there.

Posted by: latts on January 10, 2006 at 4:16 PM | PERMALINK

Yancey Ward: Everyone has access to the same foods that I buy everyday since I don't buy in upscale food marts

Yancey, in our nation's capital, Washington DC, where I live, there are in fact low-income neighborhoods where there are no supermarkets or grocery stores within walking or even reasonable transit distance of many low income families. The only stores available are small convenience stores, which have little or no produce or fresh foods and are packed with prepared foods, mostly junk food.

Posted by: SecularAnimist on January 10, 2006 at 4:20 PM | PERMALINK

Shortstop:

With a few exceptions, such as dried legumes, healthy food does in fact cost more than cheap food.

Not where I shop (I'm the cook here). Almost any processed or "fast" food is more expensive than the raw ingredients. I think you could make a much stronger case that the much greater time required to prepare proper foods cheaply (Lord knows I don't do it that often) is a real problem for families where there is only one parent who has to work, or some other situation where the parents don't have the luxury of a lot of home time.

Of course, if you are comparing healthy home-prepared meals with less-healthy ones, then you are correct that things like low-fat meats or higher-quality ingredients do cost more.

Posted by: tbrosz on January 10, 2006 at 4:28 PM | PERMALINK

Various:

I got my numbers for drug approval costs from this source, among others. Note that they don't get the money back if the drug doesn't make the grade.

I think there's a LOT of room for improvement in this process.

For the record, the drug industry spends more each year of its own money on research than the entire NIH budget. While universities and other public organizations do come up with a lot of basic research, the development and all the rest of the costs come out the company's money.

A bit here on drug company profits.

Posted by: tbrosz on January 10, 2006 at 4:37 PM | PERMALINK

Addendum to the food thing: SecularAnimist's post about access to better stores in some environments is also valid. You aren't going to have much of a produce aisle at the corner convenience store.

Posted by: tbrosz on January 10, 2006 at 4:40 PM | PERMALINK
You should tell that to Kevin Drum and the rest of your fellow liberals trying to push the race angle.

To whom do you think I am communicating (rather than merely responding) when I post comments on PA?

Posted by: cmdicely on January 10, 2006 at 4:43 PM | PERMALINK

shortstop,

You are wasting your time trying to convince me that poor people don't know how to eat healthy, and that they don't largely have access to the food. However, let us grant that some neighborhoods don't have grocery stores within easy transit distance. Why is that? Why is it that they have convenience stores or fast food outlets, but not grocery stores? My entire point is that people choose their foods and their activity levels, these are not forced on them.

So you get a doctor that tells you little Johnny needs to eat fruits and vegetables and fewer Big Macs for dinner, and that he needs to stop watching television 6 hours a day- who doesn't already know this? Really, your's and other's opinions of poor people's fundamental nutritional knowledge is more than a little insulting and elitist. If you want to make the argument that schools could do better in preparing meals and providing real physical education (see cmdicely above), then you have my unqualified support, but quit trying to tell me that people are largely obese through their ignorance their lack of access to healthier foods- this is just excusing poor behavior.

Posted by: Yancey Ward on January 10, 2006 at 4:50 PM | PERMALINK
Let's grant that single parents don't have the time to prepare a healthier diet for their children, then how is universal healthcare to solve this?

That aspect of the problem -- which, as has been stated, is not the whole of the problem -- is not something that is solved, mainly, by universal healthcare (though, depending on the exact benefit mix and the indirect incentives that universal healthcare creates for other public programs, better information which results in better decisions based on better comprehension of long-term costs, despite short-term squeeze, may address some of that problem. Or may not. That depends on how much the problem is perfectly rational behavior in less than ideal circumstances, and how much is a result of failure of rationality through lack of perfect information producing distortion in perceived long-term costs vs. actual long-term costs resulting in bad decisions that is merely magnified by the cost squeeze in other areas.)

And I still am not buying the argument that unhealthy foods are cheaper than the healthy ones,

I really don't care if you personally believe it or not. Its true, whether or not you "buy" it.

and even if it were true, how does universal healthcare solve this?

Again, no one said universal healthcare solved this problem (although, of course, given that universal healthcare is by all available evidence far cheaper in total costs than the status quo US system, it logically follows that even ignoring any improvements in cost distribution compared to the present system, the additional funding would provide more resources for other solutions to that problem, whether tax cuts for low-income families, expanded targetted benefits to provide healthier food via vouchers or otherwise, or subsidies to producers of healthy foods to reduce the costs.)


Posted by: cmdicely on January 10, 2006 at 4:54 PM | PERMALINK

The food-availability environment that children are in is vastly different today than it was 50 years ago. Food is incredibly cheap and plentiful. Advertising pushes it constantly. Parents who were hungry as children might understandably want to ensure that their children aren't hungry.

The problem is, our bodies aren't adapted for this environment. They are adapted for an environment in which food, if not actually scarce, could readily become scarce. Some populations have not had to endure major fluctuations in food supply for some time. They tend to be less obese.

I'm not arguing that we should ban junk food or any such thing. I object to the moralizing tone, however. This issue needs to be thought about in a systemic way and dealt with in a systemic way.

Were you aware that the idea that the body has "set point" at which it attempts to maintain your weight at is widely accepted by scientists? For many folks, the "set point" is at a point that isn't really accepted socially. Whether it's healthy or not is hard to sort out, since it's so emotionally and socially charged.

High blood cholestorol, high blood pressure, diabetes...all of these things are genuinely bad for you. But being fat, in and of itself, without those other factors, is a lot more ambiguous.

Posted by: Doctor Jay on January 10, 2006 at 5:06 PM | PERMALINK

No, cmdicely, you believe it is cheaper to eat unhealthfully, when, in fact, it is not. Now, you are free to believe this if you wish, but it doesn't make it so.

Posted by: Yancey Ward on January 10, 2006 at 5:11 PM | PERMALINK

So you get a doctor that tells you little Johnny needs to eat fruits and vegetables and fewer Big Macs for dinner, and that he needs to stop watching television 6 hours a day- who doesn't already know this? Really, your's and other's opinions of poor people's fundamental nutritional knowledge is more than a little insulting and elitist.

And yet you ignorantly blew past my point that there are quite a few people with a thyroid condition and quite a few who don't even know they have a thyroid condition.

The only way you can cure that problem is with medication, which can be given to people to regulate their thyroid hormone levels. You take a pill to replace the thyroid. Hint: you can't get it over the counter and it ain't cold medicine.

Now, the point of all this is, you can regulate quite a bit through diet and exercise, but there are millions of Americans who are obese because of thyroid disorders. Access to health care is critical for these people, and too often, they don't have it.

Preventative medicine is crucial towards fixing various ailments. Whether it is a simple checkup, a prenatal exam or a regular visit to the doctor, far too often the first time someone finds out they have a serious medical problem is from an overworked and understaffed emergency room.

Posted by: Pale Rider on January 10, 2006 at 5:11 PM | PERMALINK

Pale Rider,

Really, how common is this thyroid problem you keep mentioning? Does it exist in even 10% of the obese people? 20%? 30%? Please put a number on it.

Posted by: Yancey Ward on January 10, 2006 at 5:16 PM | PERMALINK

And remember, over 75% of Americans have health care, so this undiagnosed thyroid problem can't begin to explain the increases in obesity that we are seeing.

I realize I may seem a little insensitive on this issue, but I was pretty overweight myself at one point in my life, and it was entirely my fault. However, I have the same reaction to people who smoke or are alcoholics. I will not accept lame excuses for poor behavior, even if modifying that behavior is emotionally difficult.

Posted by: Yancey Ward on January 10, 2006 at 5:22 PM | PERMALINK

The facts on Health Care are these:

Canada (vs. USA)
Per Capita expenditure in US$ 2163 (4887)
Life Expectancy 79.3 (77.0)
Infant Mortality 5.6 (6.4)

On the other hand we have the satisfaction that our money is not being spent on ignorant balcks and latinos.

Posted by: lib on January 10, 2006 at 5:24 PM | PERMALINK

Does it exist in even 10% of the obese people? 20%? 30%? Please put a number on it.

Here's an estimate from this website:

http://thyroid.about.com/b/a/139157.htm

But for 27 million Americans, this small but important gland; located at the base of the neck and regulating essentially every organ, tissue and cell in the body; does not function properly. More than half of the people with thyroid disorders are unaware that they have this medical problem. Additionally, many people being treated for thyroid disorders don't know the potential health impact of switching medications without physician supervision; especially in people with thyroid cancer, cardiovascular disease, pregnant women and the elderly where precise dosing is critical.

Posted by: Pale Rider on January 10, 2006 at 5:27 PM | PERMALINK
No, cmdicely, you believe it is cheaper to eat unhealthfully, when, in fact, it is not.

Strangely, my grocery bills from times when I tried to adhere to a more rigourously healthy diet (not even considering the additional time costs imposed by the effort) disagree with you.

Now, you are free to believe this if you wish, but it doesn't make it so.

No, the basic market realities and the fact that the qualities of food which make it easy to ship and store (a big factor in the costs paid in markets) are not the same as make it healthy make it so.

I believe it because it is true, rather than vice versa.


Posted by: cmdicely on January 10, 2006 at 5:28 PM | PERMALINK

Yancey Ward

I don't know about the statistics for the general population, but hypothyroidism is not very easy to diagnose. The attendant symptoms, such as obesity, fatigue, sleepiness etc., can easily be mistaken for general laziness on the part of the patient. Although I have not seen any studies, and no physician has ever confirmed my suspicions, but I think that it has something to do with diet, as many people in my immediate and extended family, who are all mainly vegetarians, have this disease.

Posted by: nut on January 10, 2006 at 5:30 PM | PERMALINK
Really, how common is this thyroid problem you keep mentioning? Does it exist in even 10% of the obese people?

Um, PR already gave numbers earlier in the thread:

I'll repeat what he quoted before:

February, 2000 research study found that the estimated number of people with undiagnosed thyroid disease may be 10 percent -- a level that is double current estimates, and may represent as many as 13 million Americans currently undiagnosed. For women, the risk is even higher. A woman faces as high as a one in five chance of developing thyroid problems during her lifetime. That risk increases with age and for those with a family history of thyroid problems.
Posted by: cmdicely on January 10, 2006 at 5:31 PM | PERMALINK

Hey, Pale Rider, when somebody inevitably leans on me for the pharmaceutical statistics I gave, saying they're from "tainted" sources, I can point out that the information you gave on thyroid conditions was funded by a company that makes the leading drug for thyroid conditions.

Just kidding...good link.

Posted by: tbrosz on January 10, 2006 at 5:36 PM | PERMALINK

Thanks, cmdicely, I missed it. So the epidemic of obesity is caused by the thyroid problem?

Posted by: Yancey Ward on January 10, 2006 at 5:39 PM | PERMALINK
And remember, over 75% of Americans have health care, so this undiagnosed thyroid problem can't begin to explain the increases in obesity that we are seeing.

That 75% has varying quality. Merely having some degree of health insurance is not a guarantee of diagnosis, or even reasonable access to non-emergency services.

I realize I may seem a little insensitive on this issue,...

You seem both ignorant and malevolent, not "a little insensitive", but go on...

...but I was pretty overweight myself at one point in my life, and it was entirely my fault.

It is quite possible that you were overweight, and it is quite possible that your personal weight problem was entirely your own fault.

How is that relevant?

However, I have the same reaction to people who smoke or are alcoholics.

Yeah, well, given what is known about the physiology and psychology of addiction, this just goes to prove either the "ignorant" or "malevolent" prong above, or perhaps both.

I will not accept lame excuses for poor behavior, even if modifying that behavior is emotionally difficult.

Modify certain types of behavior -- and this is true of eating patterns, to an extent, as well as drug and alcohol use -- is not merely emotionally difficult (although it is that, which is one reason why social support is key to treatment of conditions involving these types of behaviors) but also physiologically difficult (indeed, the emotional difficulty is in part caused by the physiological difficulty.)


Posted by: cmdicely on January 10, 2006 at 5:39 PM | PERMALINK

Well, cmdicely, my grocery bills tell me a story opposite from yours. When I am eating only healthy foods, my grocery bill is lower, not higher.

Posted by: Yancey Ward on January 10, 2006 at 5:41 PM | PERMALINK

Yancey, I'm not going to reiterate the long list of facts that have been laid before you regarding the multifaceted character of the childhood obesity epidemic. You either simply deny straightforward facts about the availability or cost of food, or you try to pretend that any of the factors we've mentioned--knowledge, access, money, parental availability, parental supervision, school meals, fitness and sports opportunities, emotional issues surrounding eating and food--is supposed to be a standalone reason for overweight kids.

No one but you has presented the problem as one-sided. No one but you has argued that there's a single solution, a single area that, when addressed, will magically fix the problem.

We've seen this completely binary thinking from you before ("No two things can be true simultaneously! Arrgh! Too much thinking!"), with similarly fatal results to your argument. But your use of the word "excuses" to describe simple statements of fact...well, you just don't want to know what's going on, Yancey. I have to retract my earlier assessment of you as honest.

As for your comments about addiction, I really, really recommend that you refrain from making a bigger ass of yourself on subjects about which you are manifestly ignorant and even more manifestly unwilling to be educated.

Posted by: shortstop on January 10, 2006 at 5:43 PM | PERMALINK

cmdicely: That 75% has varying quality. Merely having some degree of health insurance is not a guarantee of diagnosis, or even reasonable access to non-emergency services.

Not to beat a dead horse, but those non-emergency services would, of course, include the services of a registered dietitian, the healthcare professional most able to address the complex physiological and psychological aspects of this significant lifestyle change.

Posted by: shortstop on January 10, 2006 at 5:45 PM | PERMALINK

Well, that's it for Yancey. Hubris, wherefore art thou?

Posted by: shortstop on January 10, 2006 at 5:46 PM | PERMALINK
So the epidemic of obesity is caused by the thyroid problem?

Like many things, it doesn't have one simple cause. Thyroid problems are an important component, but not the sole cause. There are a variety of social, economic, medical, and other contributing factors.

But thyroid problems are fairly common, underdiagnosed, and treatable, so they are certainly one place (though not the only place) where universal healthcare offers an opportunity to make a big dent in the problem, contrary to your claims that obesity was not something it would effect.

Posted by: cmdicely on January 10, 2006 at 5:47 PM | PERMALINK
Not to beat a dead horse, but those non-emergency services would, of course, include the services of a registered dietitian, the healthcare professional most able to address the complex physiological and psychological aspects of this significant lifestyle change.

Heck, my wife's insurance (and we are hardly poor, and don't have particularly bad insurance) doesn't cover the services of a registered dietitian for anyone not diagnosed with diabetes (a big frustration for her because she has both hypothyroidism and another condition which makes it difficult to lose weight, and puts her at substantially elevated risk of developing diabetes.)

Posted by: cmdicely on January 10, 2006 at 5:50 PM | PERMALINK

Wow, no one has ever described me as malevolent. That actually sounds kind of cool. Of course, I have been accused of being ignorant many times, and that doesn't sound as cool, but that would just puts me in the mainstream of most of the commenters on this blog, by my estimation.

However, I stand by this unrefuted assertion- if you are obese and want to lose weight, you eat less and/or eat more healthfully, and you get more physical activity. These are changes in behavior. With the exception of that small fraction that have some undiagnosed and/or untreated medical condition that actually makes them obese, those that are obese are that way through their own choices. To try to excuse it as otherwise is just that, an excuse.

Posted by: Yancey Ward on January 10, 2006 at 5:51 PM | PERMALINK

However, I stand by this unrefuted assertion- if you are obese and want to lose weight, you eat less and/or eat more healthfully, and you get more physical activity. These are changes in behavior.

Similarly, if you are a drug addict and want to stop taking drugs, you simply stop taking drugs. If you are an alcoholic and want to stop drinking, you simply stop drinking. See how easy it is? Why do we even bother to have rehab and AA and other drug and alcohol treatment programs? It's not like there any physiological and/or psychological factors involved. After all, everyone who's ever known a drug addict or alcoholic can attest to how easy it was for them to change that behavior....

Posted by: Stefan on January 10, 2006 at 5:59 PM | PERMALINK

Compare Matt Yglesias on education, which is importantly similar in its labor-intensivity:

Richer countries have higher wages. Thus, if you want to be an efficient employer in a rich country you need to one of two things. You can substitute capital for labor and make your workforce more productive, or you can outsource your work to a low-wage country. As it happens, it's very hard to effectively substitute capital for labor in the context of education. Kids need to be supervised if they're going to learn, so it's an intrinsically labor-intensive process. Truly poor countries have trouble building good school systems because they find it hard to put together the baseline capital necessary -- school buildings, textbooks, etc. -- but once you reach that baseline further capital investments don't do you very much good.

As a result, once a country reaches a certain point educating children becomes an intrinsically less-and-less efficient process.[...]The United States, as the richest country on earth, is destined to have a school system that's an outlier on the inefficiency score. As a country gets richer, it needs to invest a higher and higher proportion of its income to schooling unless it wants its education system to deteriorate.[...]

Posted by: Jacob T. Levy on January 10, 2006 at 6:00 PM | PERMALINK

shortstop,

How do you break an addiction? Ultimately, it must come from within, with the addicted actually stopping the behavior. The problem is that no one else can do this for them. You and others are making the issue to complex. If you are overeating, eating the wrong types of food, or are not getting enough exercise, and you become obese, which is what we increasingly see in this country at all age levels, then, really, what are the solutions? The choices of foods of all varieties, healthy and unhealthy, have never been better in the United States, but it is undeniable that Americans increasingly choose more of the unhealthy variety, and it can't be explained by cost, since food of all varieties has never been cheaper than it is today. I am more sympathetic to the argument that life is more inherently inactive, but again, being so inactive is still mostly a choice. When I read people excusing the epidemic of obesity as caused by food advertising, lack of access to healthy food, lack of time, new wider-spread thyroid conditions, what is one to think. These are all lame excuses for the most part. The solution to obesity, for most of the obese, is eating less, eating more healthfully, and getting more exercise. Where do I have it wrong?

Posted by: Yancey Ward on January 10, 2006 at 6:07 PM | PERMALINK

When I read people excusing the epidemic of obesity...

Yancey, like most moralists, cannot see the difference between "explaining" something and "excusing" it -- to him, with his binary worldview, they are one and the same. To note that obesity is caused by a variety of separate and/or overlapping factors such as poverty, cost of food, inadequate access to food, lack of time, medical factors, etc. is not necessarily the same thing as excusing it.

Posted by: Stefan on January 10, 2006 at 6:11 PM | PERMALINK

Stefan,

Where did I say it was easy? What are we to do, have government funded WeightWatchers, government funded gym memberships, or government funded Couch Potatoes Anonymous? Where does it end?

The initial contention was that Americans are obese because they don't know any better. That was and is BS.

Posted by: Yancey Ward on January 10, 2006 at 6:13 PM | PERMALINK

Stefan,

The claim that poor people don't know how to eat a healthy diet is an excuse, not an explanation. Trying to blame the increase in obesity on poverty is even more stupid since poverty has decreased over the last half-century while obesity has increased. Trying to "explain" the increase in obesity by claiming that healthy foods have somehow gotten more expensive is also stupid.

The only explanation anyone has offerred for the increase in obesity is the more inherently sedentary lifestyle, but again, people don't have to go home and watch television for 4 hours. No one is forcing them to do this.

Posted by: Yancey Ward on January 10, 2006 at 6:20 PM | PERMALINK

Breakdown of insurance coverage in Vermont
58.2 percent Private Insurance
16.7 percent Medicaid, a federal and state program for children, the disabled and very low income.
15 percent Medicare, a federal program for the elderly
10.1 percent uninsured

Who pays for health care?
Private insurance's share of the annual $3 billion health care bill in Vermont is growing even though enrollment in private plans has decreased. (VT population 600,000)
40.7 percent Private Insurance
25.1 percent Medicaid
17.5 percent Medicare
13.3 percent Individual out-of-pocket payments for deductibles, co-payments and expenses not covered by insurance -- but not premium expenses.
3.4 percent Other government programs such as Veterans Administration.

Who uses health care?
45 percent of Vermont's Medicare dollars were spent on 5 percent of the state's Medicare population.
3 percent of Vermont's Medicare dollars covered costs for 50 percent of the state's Medicare population -- those with few or no health problems

National impact of chronic diseases:
78 percent of health care dollars are spent on chronic care.
76 percent of hospital admissions are for chronic diseases.
72 percent of doctor visits are because of chronic conditions.
88 percent of prescriptions are for chronic diseases.

More than half of Vermont adults have a chronic disease.
High cholesterol: 31 percent of adult Vermonters have it.
Arthritis: 27.3 percent
High blood pressure: 23.1 percent
Obesity: 19.8 percent
Asthma: 8.4 percent
Cardiovascular disease: 7.5 percent
Diabetes: 5.8 percent
Osteoporosis: 4.1 percent
Chronic obstructive pulmonary disease: 3.8 percent

Burlington Free Press
Burlington Free Press

An estimated 800,000 adult New Yorkers - more than one in every eight - now have diabetes, and city health officials describe the problem as a bona fide epidemic. NY Times


Posted by: Fanny on January 10, 2006 at 6:42 PM | PERMALINK

I think this is relevant, and hopefully not offensively long. I would suggest that every dollar spent on programs such as this might save multiple dollars on medical care down the road.

School cafeterias offer vegetarian-only options
January 10, 2006
Associated Press

ATLANTA, Georgia (AP) -- Miriam Archibong remembers the food offerings her high school cafeteria used to serve for vegetarians: bland salads and greasy cheese pizza.

But salads are "not sufficient to survive," she says. "Cheese pizza -- that's not healthy because of all that grease."

Archibong often brought her own food, lunching on applesauce, carrots and water. Finally, she and other vegetarians at Grady High School demanded -- and won -- some changes two years ago.

Today, Grady High has a separate vegetarian lunch line with a menu as varied as veggie eggrolls, pasta salad, vegetarian pizza and sloppy joes made of tofu.

"My favorite thing was the veggie burger. It was so good," said Archibong, who graduated in 2005 and now is pursuing more vegetarian options at her new school -- Spelman College, an all-girls and historically black school, also in Atlanta.

For years, school cafeterias have tried to please students with vegetarian offerings. The American School Food Service Association says more than a third of U.S. high schools have meatless items that include salads and cheese pizza.

However, a new trend -- vegetarian-only lunch lines -- has started in the unlikeliest of places -- the South, home of the "Stroke Belt," long known for its trademark fried and fatty foods and higher rates of heart attacks and strokes than other parts of the country.

The urban Atlanta high school's vegetarian-only lunch line is believed to be one of the first in the country. It's an odd birthplace for such a healthy innovation, considering the school is only blocks from the city's downtown bastions of Southern cuisine, including the fried chicken and fried green tomatoes at the historic Mary Mac's Tea Room and the fried peach pies at the landmark Varsity restaurant.

Schools in Eugene, Oregon, and in other progressive, health-conscious cities of the Pacific Northwest are beginning to look to Atlanta's example, said Tom Callahan, senior vice president of Sodexho Inc., the company that provides Grady's food service.

Emphasis in the past was simply on making sure there were meatless options, Callahan said. Last year his company brought the separate vegetarian menu to Eugene "and now we're starting to see some momentum building," he said.

In the middle of a national obesity epidemic in which up to 30 percent of U.S. children are overweight or obese, health officials long have been concerned about what students eat, or whether they eat. For example, Atlanta schools' cafeterias only serve meals to about one in five high schoolers, who aren't allowed to leave campus for lunch. School officials worry that many of the students either are bringing junk food for lunch or are not eating at all.

"There are students who are coming to us on empty and leaving on empty. We constantly have to look at creative ways to engage middle and high school students," said Dr. Marilyn Hughes of Atlanta Public Schools' nutrition department.

"That concerns us overall for the obesity rate and for our commitment to academic excellence. We know they never had the opportunity to reach that if they never had proper nourishment," Hughes said.

But Grady's vegetarian line has been a popular cafeteria draw. Originally designed for the 30 students in Archibong's Vegetarian Club, meat-eaters also jumped in line and the cafeteria now serves vegetarian entrees to up to 400 of the school's 1,200 students each day. This past fall, the school district offered the vegetarian option to other schools, although so far there have been no takers.

At Grady, non-vegetarian students who graze in the vegetarian line said they like having better non-meat choices.

"I get the vegetarian meals because they have a decent selection you can choose from," said ninth-grader Jessica Fortney, 15. "Otherwise, I would have to eat the disgusting pizza every day."

Posted by: SecularAnimist on January 10, 2006 at 6:55 PM | PERMALINK
How do you break an addiction? Ultimately, it must come from within, with the addicted actually stopping the behavior.

While certainly the decision to stop is a component, it is generally insufficient on its own; gneerally, to even mostly quit and to manage the almost-inevitable relapse and prevent it from triggering a full return to habitual use requires considerable social support.

Again, you make the mistake of conflating a necessary component of the solution with the whole of the solution, which fits in with your general pattern of failing to recognize that complex problems exist which have more than one contributing factor or necessary component to solution.

When I read people excusing the epidemic of obesity as caused by food advertising, lack of access to healthy food, lack of time, new wider-spread thyroid conditions, what is one to think.

Well, first, you should think about the difference in meaning between the word "explaining" and the word "excusing", and your improper use of the latter to describe what is in fact the former.

Then you should work on your pronoun use and stop shifting from first ("I") to third ("one") person.

Then you should realize that all of those factors are well-documented facts which do, in fact, contribute to the problem at issue, so what you should think is that, oh, these people are right.

These are all lame excuses for the most part.

Whether or not you subjectively believe them to be "lame" (and certainly those explanations are objectively unable to walk), they also are, in fact, true.

Calling facts "lame" or characterizing them as "excuses" will not change them.


The solution to obesity, for most of the obese, is eating less, eating more healthfully, and getting more exercise. Where do I have it wrong?

In your general argument that obesity is not addressed by universal health care, you have it wrong in, even granting, arguendo, that what you claim in this sentence is true for most (i.e., 50%) of the obese, it is still clearly the case that a number of significant contributors to the problem -- including thyroid disease and other medical problems -- are clearly addressable with universal healthcare, and the others -- insofar as social support systems like group counseling are part of "medical" programs addressing, e.g., drug addiction -- are arguably addressable productively through a universal healthcare system, depending on its detailed design.


Posted by: cmdicely on January 10, 2006 at 7:30 PM | PERMALINK

No, cmdicely, you believe it is cheaper to eat unhealthfully, when, in fact, it is not. Now, you are free to believe this if you wish, but it doesn't make it so.

back when i was earning just over four dollars an hour, i chose to buy twenty 20 cent packets of raman or six or seven 60 cent boxes of kraft mac and cheese with that 4 dollars/hr rather than lean meat, milk, eggs, and whole grain bread. i bought a lot of beans and rice too, so my diet wasn't completely horrifying.

yancey, you haven't lived on a limited budget in a long while. i remember what i ate, and my choices were largely based on simple economics. the crappy stuff cost less. i used to take a calculator to the store for shopping because my budget was that tight in those days.

i eat MUCH better now.

Posted by: spacebaby on January 10, 2006 at 8:02 PM | PERMALINK

A lot of back and forth on the reasons for obesity. A typical article on this here, which says the number of obese people has tripled in Britain over the past 20 years. I've heard similar things about the numbers in the U.S.

You can bring a little common sense into this argument. The poverty rate in the U.S. is about half what it was in the 1950s, and has tracked pretty steadily between 10 and 15 percent since 1965. Why hasn't the obesity rate tracked this more closely if it's a major cause?

Also, I seriously doubt three times as many people nowadays have bad thyroid glands as did years ago.

I've just taken a quick look at this, so I'm open to more information, but I think Yancey has some good points, unless somebody else has more figures tracking the numbers on these other presented causes to the perceived rate of obesity.

Posted by: tbrosz on January 10, 2006 at 8:43 PM | PERMALINK

A recent study indicated that Baltimore was the most fit city in the land. Conversely, Chicago was the most fat city. One possible solution would be to move the Chicagoans to Baltimore. The sports teams would improve.

Yancey, don't fall out of a relationship and start gorging chocolate again.

Supermarkets usually stay out of inner cities because of higher insurance costs. In Las Vegas, there are several Smith markets. One of their stores is in one of the poorest areas off the strip. The store charges more across the board and has a higher percentage of food stamp buyers than the Smith stores in the suburbs.

Posted by: stupid git on January 10, 2006 at 9:10 PM | PERMALINK

Oh, yeah, almost forgot. That tripled obesity rate in England? That's a nation with nationalized health care. Apparently that's not a big help.

Posted by: tbrosz on January 10, 2006 at 9:14 PM | PERMALINK

it's still hard to believe that more Democrats aren't willing to put their reputations behind a genuinely sane, comprehensive, modern national healthcare plan.

Why is that hard to believe? "genuinely sane, comprehensive, modern (high tech?) and national" has a great cost in $$$ and regulations that Americans generally end up voting against. Besides, why is it hard to believe something so commonplace as Democrats not living up to your expectations? I am not the only person who regularly points out that the Democratic party isn't all that good -- are you deaf to all criticism of the Democrats?

Canada and several EU nations (and Switzerland) are making their systems more like America's system, by the way.

Posted by: contentious on January 10, 2006 at 9:20 PM | PERMALINK

And what do we get for all that dough? Not much.
-Kevin

You are evaluating private healthcare by looking at the treatment of the poor. Obviously, the whole point of private healthcare is to enable the rich to buy better care.

What you are doing is equivalent to evaluating the food in 3-5 star Los Angeles restaurants by say, looking at the McDonalds.

Posted by: McAristotle on January 10, 2006 at 9:58 PM | PERMALINK

The current healthcare delivery system in the US is unsustainable. Health insurance costs and "free market" labor practices are removing corporate America's support for the system.

Over the next fifteen years, as a large bulge in the population comes to depend on Medicare, the pool of premium payors into private insurance plans will be further reduced. Since Medicare payments don't actually cover the costs to provide treatment, the financial viability of the entire system is at significant risk.

Talk about a death spiral. It costs me, as a self-employed individual, $14,000 + per year to insure a family of five. That's a $2K individual deductible plan. Every premuim notice reflects a 7-27% increase over the previous bill. At some point, even I will stop paying the freight.

How can this system continue?

Posted by: brisa on January 10, 2006 at 11:10 PM | PERMALINK

If the upper class needs to work on shorter lives and larger families.

Posted by: Matt on January 11, 2006 at 12:20 AM | PERMALINK

I see that Ned Flanders is still confusing correlation and causation. I weep for our massively government-subsidized aerospace program....

Posted by: Stefan on January 11, 2006 at 12:44 AM | PERMALINK

Only a madman would prefer our bizarre hodgepode system.

Although I realize Kevin is using hyperbole here, I think his statement is fundamentally incorrect. It might be perfectly rational to support the status quo if one is wealthy, or if one is very comfortably middle class with superior job security and gold-plate insurance, or indeed (in many cases) if one is elderly. America doesn't spread the inferiority of its healthcare system evenly; rather, America manages to give very good (albeit costly) care to a decent percentage of the population even as it shortchanges many millions. Those who receive good care tend to vote in disproportionate numbers. Moreover, Americans on the higher end of the healthcare consumption spectrum tend, because of economic status, to be less adversely effected by the negative economic impact of the system's excessive costs.

I think we're likely in the very early stages of the collapse of the American healthcare system as we know it; but the process could play out in an agonizingly slow fashion because of the political inertia alluded to above. I had always thought that a popular uprising would be necessary to effect real change, but I'm increasingly of the opinion that the more likely scenario is top-down (i.e., corporate-driven) reform.

Posted by: P.B. Almeida on January 11, 2006 at 1:01 AM | PERMALINK
You can bring a little common sense into this argument. The poverty rate in the U.S. is about half what it was in the 1950s, and has tracked pretty steadily between 10 and 15 percent since 1965. Why hasn't the obesity rate tracked this more closely if it's a major cause?

No one I've seen has asserted that poverty per se is a major cause, though some have argued that, among the less well off particularly, the particular pattern of (1) competing demands on time, (2) patterns of food product availability and cost, and (3) patterns of healthcare availability, all combined, contributes to healthcare. Since the prevalence of poverty itself isn't asserted as a major cause, you are merely attempting to knock down a strawman. As is all too typical of your comments here.

Also, I seriously doubt three times as many people nowadays have bad thyroid glands as did years ago.

So? Unless you are holding yourself up as a medical authority and about to present some credentials to justify that, your personal doubt, no matter how serious you assert it is, without any rational basis given for that doubt, isn't even the beginning of a remotely convincing argument.

Given the growth of immigration from places that haven't largely eliminated hypothyroidism through salt iodization, hypothyroidism due to childhood iodine deficiency is certainly likely to be growing ; autoimmune hypothyroidism is also apparently associated with some communicable diseases, including Hepatitis C, which is on the rise. There are a number of other environmental factors which contribute to hypothyroidism which are on the rise; also, as diagnosis and management of hypothyroidism and infertility generally has greatly improved in the last few decades, and it appears to (despite also being caused at times by environmental conditions) have a strong genetic component and be much more prevalent in women and, when not treated, reduce, often greatly, fertility, its quite likely that it is, for that reason, being passed on more, and thus increasing.

So, in summary, I wouldn't give a lot of credence to your casual dismissal, with no reasoning given, of the claim that hypothyroidism had tripled even if it wasn't, once again, just you trying to knock down a strawman. No one claimed it had tripled, it was referred to as one component of the prevalence of obesity.

You seem to be trying to distinguish yourself from your imposters by being even dumber than they usually are.

Posted by: cmdicely on January 11, 2006 at 1:41 AM | PERMALINK

Let's assume we are moving towards a national health care plan given that 60% of American are not privately insured, why are you so reluctant to move forward with mandatory catastrophic care and health savings account as an interim stop gap measure?

Ultimately, I can see a national health care plan which insures the poor, the elderly, the disabled, children* (with emphasis on preventative care and education) and subsidized premiums through tax credits for the working poor. I would prefer to see a State income tax rather than see cost-shifting onto the privately insured through underpayment of services provided by Medicare, Medicaid and VA plans. I would require that carriers who insure an individual or family which developed a chronic disease continue to provide coverage without ratcheding up the premiums. And, I would allow the consumer to purchase coverage provided by out-of-state carriers.

(*An aside, I know someone who insisted her child had ADD until she shifted to an insurance carrier that did not fully reimburse the expense of Ritalin. I know this child, he does not have ADD. She wanted an excuse as to why her 8 year resisted going to bed and doing his homework. Be careful, free health can inadvently encourage poor decisions.)


Posted by: fanny on January 11, 2006 at 8:27 AM | PERMALINK

cmdicely,

In my absence, thank you for providing good info on hypothyroidism.

Posted by: Pale Rider on January 11, 2006 at 9:51 AM | PERMALINK

Medical Bombshell
You can't be fat and healthy

Posted by: popeye on January 11, 2006 at 9:58 AM | PERMALINK

spacebaby,

Well, trying to live in Cambridge on $4/hr leaves one open to starvation, not obesity.

cmdicely,

The original contention was that universal healthcare would allow childhood and adult obesity to be addressed. Nothing you or others have written or linked to really gives much support for this contention. Even the hypothyroidism can even come close to explaining the increases in obesity, nor can poverty. And poverty was explicitly cited by numerous commenters as a prime driver of the increase in obesity. Even if we accept that access to a doctor would help people to lose weight, then why have the privately insured seen explosive growth in obesity? The only conclusion is that obesity is driven by cultural changes in eating habits and activity levels, and that this can only be cured by changes in eating habits and activity levels, and I really don't see how medicine can address this in any significant way.

Posted by: Yancey Ward on January 11, 2006 at 3:41 PM | PERMALINK
The original contention was that universal healthcare would allow childhood and adult obesity to be addressed. Nothing you or others have written or linked to really gives much support for this contention.

Yancey, simply posting bald summaries like this that are inconsistent with the facts rather than attempting to rebut the specific points offered that do, indeed, show large areas where improved healthcare access would allow for progress against obesity is, well, not entirely atypical intellectual dishonesty for you, but at least worse than I would hope for, if not worse than I would expect.

Even the hypothyroidism can even come close to explaining the increases in obesity, nor can poverty.

Strawman, as no one suggested that either of these alone, nor the two combined,
explained, or came close to explaining, the increase in obesity.

And poverty was explicitly cited by numerous commenters as a prime driver of the increase in obesity.

Relative expense of healthy eating was cited as a major source of difficulty in addressing obesity, but no one on the thread pointed to increase in poverty as an explanation for the increase in obesity. Again, you are, as usual, mischaracterizing the points you are responding to. And you have been throughout the entire thread.

Even if we accept that access to a doctor would help people to lose weight, then why have the privately insured seen explosive growth in obesity?

While the driving factor behind the increase may be an interesting independent question, its not directly related to whether increased access to healthcare would help address the problem of obesity.

The only conclusion is that obesity is driven by cultural changes in eating habits and activity levels,

No, its not the only conclusion. It could (in the abstract; I doubt any such ultra-simple explanation is accurate, however) be entirely, for instance, a medical access problem and the patterns of insurance coverage could mean that people that are covered have less access to the benefits relevant to preventing obesity.

and that this can only be cured by changes in eating habits and activity levels,

It is not rational to conclude that eliminating the driver of the increase is the only way to counteract it the increase. For instance, if a stoppered tub is overflowing because the faucet is leaking, its true, you can stop it from overflowing by fixing the leak. You can also stop it from overflowing by removing the stopper.

and I really don't see how medicine can address this in any significant way.

Medicine -- in the sense of drugs -- probably can't. But, just as it is part of the medical treatment for addiction, social support systems for behavior alteration dealing with healthcare are a reasonable component of a healthcare system, and improving access to such services is quite possible within the scope of a universal healthcare system. So, even granting your irrational conclusion about the sole cause and only possible means of addressing obesity, its still within the scope of universal healthcare.


Posted by: cmdicely on January 11, 2006 at 4:52 PM | PERMALINK




 

 

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