Only a madman would prefer our bizarre hodgepode system.

Cue the madmen...

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

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

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

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.

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.

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?

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

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.

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

or an insurance company executive....

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

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? ;-)

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.

...or insurance company lobbyist

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)

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

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.

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.

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

So who's model should we follow?

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?

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.

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.

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.

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.

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

Or someone who is getting rich off it.

"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?

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...

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.

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?

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.

"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?

"vegan diet"

BOOOOOOOOOOOOOOOOO!!!! BOOOOOOOOOOO!!!!

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

"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.

"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.

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.

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.

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...

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.

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 ?

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).

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?

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.

"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?

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.

Alex and Bud--damn funny!

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

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

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.

vegan = commie

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.

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.

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.

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?

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.

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

opit,

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

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.

"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.

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.

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!)

"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.

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.

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.

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!

LOL on that one craigie.

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. :)

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 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).

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.

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.

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.

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.

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

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.

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.

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?

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.

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

How about meat eaters?

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.

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.

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

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

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.

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.

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.

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.

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'?

"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.

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?

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

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.

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!

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.

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.

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.

"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?

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?

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.

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?

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.

"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.

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.

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.

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.)

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.

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?

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.

"(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.

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.

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?

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.

"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?

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.

"(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.

"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?

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.

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.