Myth Diagnosis

[alienlovechild 75]

Part of the trouble with reports like the one from the Urban Institute is that they cannot do the kind of thing we do to test drugs or medical procedures: divide people randomly into groups that do and don’t have health insurance, and see which group fares better. Experimental studies like this would be tremendously expensive, and it’s hard to imagine that they’d attract sufficient volunteers. Moreover, they might well violate the ethical standards of doctors who believed they were condemning the uninsured patients to a life nasty, brutish, and short.

So instead, researchers usually do what are called “observational studies”: they take data sets that include both insured and uninsured people, and compare their health outcomes—usually mortality rates, because these are unequivocal and easy to measure. For a long time, two of the best studies were Sorlie et al. (1994), which used a large sample of census data from 1982 to 1985; and Franks, Clancy, and Gold (1993), which examined a smaller but richer data set from the National Health and Nutrition Examination Survey, and its follow-up studies, between 1971 and 1987. The Institute of Medicine used the math behind these two studies to produce a 2002 report on an increase in illness and death from lack of insurance; the Urban Institute, in turn, updated those numbers to produce the figure that became the gold standard during the debate over health-care reform.

The first thing one notices is that the original studies are a trifle elderly. Medicine has changed since 1987; presumably, so has the riskiness of going without health insurance. Moreover, the question of who had insurance is particularly dodgy: the studies counted as “uninsured” anyone who lacked insurance in the initial interview. But of course, not all of those people would have stayed uninsured—a separate study suggests that only about a third of those who reported being uninsured over a two-year time frame lacked coverage for the entire period. Most of the “uninsured” people probably got insurance relatively quickly, while some of the “insured” probably lost theirs. The effect of this churn could bias your results either way; the inability to control for it makes the statistics less accurate.

The bigger problem is that the uninsured generally have more health risks than the rest of the population. They are poorer, more likely to smoke, less educated, more likely to be unemployed, more likely to be obese, and so forth. All these things are known to increase your risk of dying, independent of your insurance status.

There are also factors we can’t analyze. It’s widely believed that health improves with social status, a quality that’s hard to measure. Risk-seekers are probably more likely to end up uninsured, and also to end up dying in a car crash—but their predilection for thrills will not end up in our statistics. People who are suspicious of doctors probably don’t pursue either generous health insurance or early treatment. Those who score low on measures of conscientiousness often have trouble keeping jobs with good health insurance—or following complicated treatment protocols. And so on.

The studies relied upon by the Institute of Medicine and the Urban Institute tried to control for some of these factors. But Sorlie et al.—the larger study—lacked data on things like smoking habits and could control for only a few factors, while Franks, Clancy, and Gold, which had better controls but a smaller sample, could not, as an observational study, categorically exclude the possibility that lack of insurance has no effect on mortality at all.

The possibility that no one risks death by going without health insurance may be startling, but some research supports it. Richard Kronick of the University of California at San Diego’s Department of Family and Preventive Medicine, an adviser to the Clinton administration, recently published the results of what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality. He used a sample of more than 600,000, and controlled not only for the standard factors, but for how long the subjects went without insurance, whether their disease was particularly amenable to early intervention, and even whether they lived in a mobile home. In test after test, he found no significantly elevated risk of death among the uninsured.

This result is not, perhaps, as shocking as it seems. Health care heals, but it also kills. Someone who lacked insurance over the past few decades might have missed taking their Lipitor, but also their Vioxx or Fen-Phen. According to one estimate, 80,000 people a year are killed just by “nosocomial infections”—infections that arise as a result of medical treatment. The only truly experimental study on health insurance, a randomized study of almost 4,000 subjects done by Rand and concluded in 1982, found that increasing the generosity of people’s health insurance caused them to use more health care, but made almost no difference in their health status.

If gaining insurance has a large effect on people’s health, we should see outcomes improve dramatically between one’s early and late 60s. Yet like the Kronick and Rand studies, analyses of the effect of Medicare, which becomes available to virtually everyone in America at the age of 65, show little benefit. In a recent review of the literature, Helen Levy of the University of Michigan and David Meltzer of the University of Chicago noted that the latest studies of this question “paint a surprisingly consistent picture: Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.”

Of course, that might be an indictment of programs like Medicare and Medicaid. Indeed, given the uncertainties about their impact on mortality rates—uncertainties that the results from Sorlie et al. don’t resolve—it’s possible that, by blocking the proposed expansion of health care through Medicare, Senator Lieberman, rather than committing the industrial-scale slaughter Klein fears, might not have harmed anyone at all. We cannot use one study to “prove” that having government insurance is riskier than having none. But we also cannot use a flawed and conflicting literature to “prove” that Lieberman was willing to risk the deaths of hundreds of thousands. Government insurance should have some effect, but if that effect is not large enough to be unequivocally evident in the data we have, it must be small.

Even if we did agree that insurance rarely confers significant health benefits, that would not necessarily undermine the case for a national health-care program. The academics who question the mass benefits of expanding coverage still think that doing so improves outcomes among certain vulnerable subgroups, like infants and patients with HIV. Besides, a national health program has nonmedical benefits. Leaving tens of millions of Americans without health insurance violates our sense of equity—and leaves those millions exposed to the risk of mind-boggling medical bills.

http://www.theatlantic.com/doc/201003/insu...erage-mortality

[one...two...tree 2,762]

Leaving tens of millions of Americans without health insurance violates our sense of equity—and leaves those millions exposed to the risk of mind-boggling medical bills.

Yep.

[Ali G. 37]

Even if we did agree that insurance rarely confers significant health benefits, that would not necessarily undermine the case for a national health-care program. The academics who question the mass benefits of expanding coverage still think that doing so improves outcomes among certain vulnerable subgroups, like infants and patients with HIV. Besides, a national health program has nonmedical benefits. Leaving tens of millions of Americans without health insurance violates our sense of equity—and leaves those millions exposed to the risk of mind-boggling medical bills.

Rubbish, just posted today:

The two things to look at in particular are the interactive map regarding America's waistline and the option illustrating how the US compares to others around the world. For example. The US spends over ~$7,200 per capita vs Australia's $3,100 or Japan's $2,300, yet life expectancy for Americans' is just 78.1 vs 81.6 and 82.1 respectively.

http://money.cnn.com/magazines/fortune/sto...nt/flyp_ibm_07/

The success of foreign medical systems is the skeleton in the closet, however, those aware of it use a powerful weapon against it; American absentmindedness and ethnocentrism. They basically resort to the stock standard 'we are the best in the world' rhetoric, with squat evidence of it, to divert attention from this reality. The uneducated and misinformed masses then buy this #######, hook, line and sinker.

Edited February 21, 2010 by Booyah

[Ali G. 37]

Anyone trying to bring light to this reality about the rest of the world is quickly branded a socialist or a communist. And we all know how powerful and negative such labels are in the US.

Edited February 21, 2010 by Booyah

[one...two...tree 2,762]

Anyone trying to bring light to this reality about the rest of the world is quickly branded a socialist or a communist. And we all know how powerful and negative such labels are in the US.

I hope you can see now that the Right Wing of the Republican Party has a very rigid viewpoint that government is incapable of solving any problems and it's only true role is to stay clear out of the way of the private sector. There is no real middle ground coming from the Right right now. Even after 8 years of failed policies, they haven't fessed up to the failures of their rigid ideology....that we do in fact need robust regulations on financial institutions, that allowing mega-corporations to continuously absorb other, smaller corporations is a recipe for economic disaster...

[Ali G. 37]

I hope you can see now that the Right Wing of the Republican Party has a very rigid viewpoint that government is incapable of solving any problems and it's only true role is to stay clear out of the way of the private sector. There is no real middle ground coming from the Right right now. Even after 8 years of failed policies, they haven't fessed up to the failures of their rigid ideology....that we do in fact need robust regulations on financial institutions, that allowing mega-corporations to continuously absorb other, smaller corporations is a recipe for economic disaster...

I saw that when Obama propose things that Repubs have been beating on about for years get booed by these same folks. Those sort of shenanigans are disingenuous and also shows me that they are playing a game with these filibusters to screw the president, at the expense of the country of course. It's basically a win at all cost strategy. Shame on anyone who does not see this or catch them out on this unpatriotic behavior.

Danno in another thread brought up monopolies in a negative manner. Strange how he refuses to apply this logic to corporations. Apparently monopolistic markets or duopolies are just businesses good at what they do.

Edited February 21, 2010 by Booyah

[one...two...tree 2,762]

I saw that when Obama propose things that Repubs have been beating on about for years get booed by these same folks. Those sort of shenanigans are disingenuous and also shows me that they are playing a game with these filibusters to screw the president, at the expense of the country of course. It's basically a win at all cost strategy. Shame on anyone who does not see this or catch them out on this unpatriotic behavior.

Danno in another thread brought up monopolies in a negative manner. Strange how he refuses to apply this logic to corporations. Apparently monopolistic markets or duopolies are just businesses good at what they do.

Yep.

[alienlovechild 75]

The same two posters backslapping each other without addressing anything in the article. Why I'm I not surprised. Nearly all about politics and very little about the effectiveness of healthcare.

Shame on anyone who does not see this or catch them out on this unpatriotic behavior.

Is there ever a day when some poster doesn't throw the unpatriotic label to win over people? It never works but usually only liberals do it on this forum.

Edited February 21, 2010 by alienlovechild

[scandal 951]

Is there ever a day when some poster doesn't throw the unpatriotic label to win over people? It never works but usually only liberals do it on this forum.

"I don't know that atheists should be considered citizens, nor should they be considered patriots. This is one nation under God." GHW Bush

[alienlovechild 75]

"I don't know that atheists should be considered citizens, nor should they be considered patriots. This is one nation under God." GHW Bush

I didn't know Bush Sr. posted that much here.

[one...two...tree 2,762]

The same two posters backslapping each other without addressing anything in the article. Why I'm I not surprised. Nearly all about politics and very little about the effectiveness of healthcare.

Sorry ALC, for responding to BY's post that was off the topic. He didn't earn his name, wild tangent, for nothing.

Back to topic: The article you posted on healthcare really doesn't lend itself to much of a discussion unless anyone here wants to argue over those studies. I personally don't need a study to understand that preventive healthcare is beneficial. Just the other night, there was a program on the awareness of colon cancer. If detected early, a person has a 90 percent chance of beating it. The scary part is that most who have it, won't experience any detectable symptoms, so the only way to catch is to have a screening, which is recommended for everyone who when they turn 50. Breast cancer for women and prostate cancer for men are also beatable when detected early through routine screening. So I question whether these studies were flawed in how they were conducted. A good study would look at how many lives were saved from early cancer screening, for example.

[Ali G. 37]

The same two posters backslapping each other without addressing anything in the article. Why I'm I not surprised. Nearly all about politics and very little about the effectiveness of healthcare.

Is there ever a day when some poster doesn't throw the unpatriotic label to win over people? It never works but usually only liberals do it on this forum.

Read the article and it was silly on a number of points. It's akin to wasting time debating with a 9/11 denier.

Are you for real? Labeling someone who doesn't agree with you unpatriotic is the centerpiece of Republican strategy. The difference between Republicans to I is that I am labeling their actual actions unpatriotic, which they are, rather than just shooting out some label.

Edited February 21, 2010 by Booyah

[alienlovechild 75]

Back to topic: The article you posted on healthcare really doesn't lend itself to much of a discussion unless anyone here wants to argue over those studies. I personally don't need a study to understand that preventive healthcare is beneficial. Just the other night, there was a program on the awareness of colon cancer. If detected early, a person has a 90 percent chance of beating it. The scary part is that most who have it, won't experience any detectable symptoms, so the only way to catch is to have a screening, which is recommended for everyone who when they turn 50. Breast cancer for women and prostate cancer for men are also beatable when detected early through routine screening. So I question whether these studies were flawed in how they were conducted. A good study would look at how many lives were saved from early cancer screening, for example.

There was nothing saying lack of health insurance means lack of healthcare. In fact, it challenged one the basics of the healthcare claiming that no insurance= high mortality. People pay for it or go to emergency rooms and can substract the 1,000s who die from hospital infections and adverse reactions to legal drugs. Americans are subjected to more medical tests than practically anyone else in the world but it doesn't lead to us having the lowest mortality.

Are you for real? Labeling someone who doesn't agree with you unpatriotic is the centerpiece of Republican strategy. The difference between Republicans to I is that I am labeling their actual actions unpatriotic, which they are, rather than just shooting out some label.

I'm talking about people on this forum. What's patriotic about healthcare anyway? Are the sick more patriotic because they'll use more government healthcare? Wait til it begins as people line up there's supposedly a huge pent up demand for services. Forget about going to hospital for quite a while unless you really enjoy waiting rooms. There also better be better malpractice protection for doctors and hospitals once the lawyers get in the deep pockets of the government.

One other thing, why would you care about the healthcare system in the U.S. as I could care less about the state of healthcare in Australia? It's a national issue rather than an international one?