The Home of Steven Barnes
Author, Teacher, Screenwriter


Tuesday, September 22, 2009

On This Side of the Line...

My sense about UHC is pretty simple. Please imagine that we as a country are standing in a big room. Draw a line down the middle of the room. Now: everyone who basically believes the WHO report on comparative mortality and life span, on THIS side of the line. Those who do not, on THAT side of the line. I think we simply have to agree to disagree on this: with all due respect and a bit of regret, I consider consider those on THAT side to be somewhat akin to Flat Earthers: I don't understand the world you are seeing. I don't say that about a lot of things, but I'm saying it here, drawing a line in the sand on this one. I am very, very tempted to think you are arguing backwards from the premise that Government can't do anything better than private industry, and cherry-picking the data to shore up the point.

The one argument I kinda like: that by reducing the profit motive, less discovery will result, leading to increased mortality. While utterly speculative (suggesting that profit is a greater motivation than either mortal fear, intellectual curiosity or compassion seems amazingly cynical. I suspect that anyone holding this one might have a very bleak view of human nature), this is actually interesting and worthy of debate.

However, I find it less compelling than the admittedly speculative assumption that an increased social safety network, and preventative care, will decrease obesity, smoking, stress and fatigue-related disease, etc--the things Conservatives often point to, bizarrely, as "evidence" that America has the best care. Why, if those pesky minorities would just get their act together! They're dragging down the curve and making America look bad!

Talk about blaming the mugging victim for being broke. Those using this argument seem to feel that these problems (which do plague minorities to a higher level) have to do with something innate in those people. And you know where THAT argument leads. My conclusion here is that, even if we DID lose some high-end research, we'd save more lives overall.

So I'm going to be EXTREMELY generous and say that these two speculations cancel each other out. But what remains is that on one side of the line are people who think Americans pay more for less--and that they have the numbers to back it up. On the other side are folks who don't believe this is true.

On one side are people who think that there are dozens of role models of people doing health care better than we are, in general (even though we have, by all accounts, the best doctors, hospitals, and trauma care in the world! To me, this implies a GROTESQUE problem in social organization and preventive priorities. How the HELL did we let this happen..?)

I've been around fans most of my life, and have seen a disturbing thought pattern: to abuse their bodies, and then hope some super-science like cryonics or a magic pill or something will come along to rescue them after they have refused to exercise, eat tons of crap, deny themselves proper rest, gloried in power drinking or drugging, and otherwise strip-mined their health. Rescue me! They cry. This is disturbingly similar to the insistence that we don't need to conserve the Earth--the smartest among us will escape to the stars. Blind, short-sighted, and childish. Mommy! Daddy! Superscience! Rescue me from my own folly!

Note that what I'm hoping for is better support in people taking care of themselves, not a last-minute medical extraction of head from ass after a lifetime of intellectually or emotionally justified self-abuse. So the idea that we might lose some high-end research that might benefit the very wealthiest has zero traction with me: the wealthiest, if they are really concerned about those rarefied diseases no one else is afraid of, can fund it themselves. I'll go with the greatest good for the greatest number, thank you. I feel very comfortable on the side of the line that believes statistics, believes we have a social obligation to care for the least of us, believes people are capable of positive change, and believes that it is illogical to believe that the rest of the world is simply wrong about something like this.

And you, apparently, are comfortable on the side that says the WHO is wrong, the rest of the world is wrong, and America has the best health care for everyone. I can live with that.

ᅠᅠ###

In terms of how much UHC will cost--it will be expensive. But by all accounts less expensive than what we're paying now. The funds just need to be allotted differently, with maximum freedom for those who want delux coverage (I would be against making private insurance illegal--but can understand the argument. ) But, yeah, there'll be money out of your pocket, no doubt. That's the biz, kids, the cost of living in a society with other human beings who have a vote. I had to pay for a war I loathed and predicted to be predicated on nonsense--so you asked me to pay money to kill people who had done me no harm. To MURDER soldiers in Iraq who were just protecting their country. Don't you dare try to guilt-trip me about spending money providing life, if you were willing to take my money to kill innocent people. Don't you dare.

##

"Create a definite plan for carrying our your desire, and begin at once to put this plan into action""--Napoleon Hill

What are the preassumptions in this sentence?

1) That you have clarified your wants into a very few definite aims. This is harder than it sounds: most people know what they don't like in their lives, but aren't clear on what they want.

2) Write down your plans. Again, this is hard for most people. They can have vague dreams up the wazoo, but ask them to actually write them down, and they freeze. It is scary to write down our dreams and needs: it involves admitting you really want something, that you actually care. Once you care, you can be hurt if you don't get it. Best to be blase.

3) That you understand the need to maintain sensory acuity, and notice the results you get from your actions. One of the reasons to take action NOW is that as you take actions, you see the results you get. It is the RESULTS OF YOUR ACTIONS that begin to tell you the actual shape of the environment you move through. If you are operating in illusion, your efforts will fall short.

There are more, including the belief that we can affect our own futures, and the implication that we have the right to do so. This single sentence, again, can change your life if taken seriously. "Think and Grow Rich" has thousands of them. I'm enjoying this re-visitation immensely.

27 comments:

Mike Ralls said...

My dad has cancer (in remission).
My step-Mom has cancer (in remission).
My step-sister just got a second type of cancer and is undergoing treatment right now.

Cancer is not a rarefied diseases no one else but the rich is afraid of and US survival rates for cancer are higher than countries that have UHC;

http://www.firstthings.com/blogs/secondhandsmoke/2009/07/21/most-cancer-survival-rates-in-usa-better-than-europe-and-canada/

Under our current system, I am confident that those I love receive the best health care in the world. So I'm going to do what I can to mostly keep our current system and increase the chance that one of my loved ones is not going to die early because they could not receive the best medical care in the world.

Scott said...

"suggesting that profit is a greater motivation than either mortal fear, intellectual curiosity or compassion seems amazingly cynical."

False dilemma: the argument is rather that the product of money, fear, curiosity and compassion is greater than the product of fear, curiosity and compassion.

Scott said...

Oh, and hey:

www.virtuescience.com/think-and-grow-rich.html

Ethiopian_Infidel said...

"So I'm going to do what I can to mostly keep our current system and increase the chance that one of my loved ones is not going to die early because they could not receive the best medical care in the world."

Better still would be to work to enable all Americans to enjoy the quality of medical care that has sustained your loved ones.

"US survival rates for cancer are higher than countries that have UHC"

This seems textbook example of presuming correlation equals causation. Since the USA is consistently at the forefront of medical innovation and a large segment of its citizens can afford quality healthcare, its health demographics predictably show higher cancer survival rates. Countries with UHC but less advanced medical practice predictably show lower cancer survival rates, since certain treatments simply aren't as readily available.

However, consider if America's leading edge in medicine were coupled to a system that distributed it benefits to ALL its citizens.

Mike Ralls said...

>Better still would be to work to enable all Americans to enjoy the quality of medical care that has sustained your loved ones.<

Long term, I beleive that is what I am doing. That is, the health care that the average person will get in 2029 is likely to be better than what my loved ones are getting now, and I do not feel as confident that that will be the case if the system is radically changed (note: I am not 100% sure on this point and am still seeking more data).

In the short term, I do not beleive that everyone receiving the quality of care my loved ones receive is a realistic possibility. Also, as my loved ones are at risk of death in the short term, that is what I care most about.

>if America's leading edge in medicine were coupled to a system that distributed it benefits to ALL its citizens.<

If you are moving resources away from the top 75% to the bottom 25%, the obvious result would be a downgrade in care for the top 75% and a growth in care for the bottom 25%.

My loved ones would be the ones who would risk death in that scenario, so I do not support that.

Dan Moran said...

http://v1.theglobeandmail.com/v5/content/pdf/CONCORD.pdf

Cancer survival rates by country.

The U.S. does well -- not amazingly well, but better than in any other metric you can point to for the U.S. health care system. Given that it's a total disaster in so many other ways, its ability to stand up to the competition in cancer care is worth noting.

The five year survival rates aren't stunning. The Lancet study linked provides five year survival rates for 8 different kinds of cancer; breast cancer for women, prostate for men, and colon, rectum, and colorectum for both. The U.S.'s 5 year survival rate was pretty much a dead wash with Cuba's except for Prostate cancer, where the five year survival rate is about 22 points higher.

But contrast the survival rates for Canada, which, famously, does have UHC:

83·9 VS 82·5
56·1 VS 60·1
58·7 VS 60·1
53·1 VS 56.9
58·7 VS 59·8
55·3 VS 59·1
58·9 VS 60·2
85·1 VS 91·9

The U.S. does better, by about 2 to 6 points, than Canada, in everything except breast cancer, where Canada does better. But except for prostate cancer the differences are tiny.

So ... to be anti-UHC on the basis of these numbers, you have to assert:

1. That cancer survival rates are affected by UHC, rather than, say, wealth.

2. That the relatively small difference in survivability at the 5 year mark for cancer sufferers outweighs the 25K or 45K people per year who die as a result of no health care, and

3. That it also outweighs the tens of thousands of people who die each year in the US due to inferior health care, as opposed to none.

Anyway, short form, it's not an either-or. Australia, Canada, and New Zealand all perform about as well as the U.S., and all have universal health care.

Mike Ralls said...

My Dad underwent months of painful chemotherapy, all to raise his survivability odds by about 5%. When you are facing death, 5% matters a lot.

Shady_Grady said...

At some point I don't think anyone is going to convince anyone else with data points that Universal Health care is good or bad.

But there are some facts about the cancer rate comparisons that do bear mentioning.

http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/

Dan Moran said...

When you are facing death, 5% matters a lot.

Indeed. Now imagine being one of the people with no health insurance. Their odds are something like 40% worse ...

Anonymous said...

"If you are moving resources away from the top 75% to the bottom

25%, the obvious result would be a downgrade in care for the top 75%

and a growth in care for the bottom 25%."

Unless those resources are being inefficiently used.

The more concentrated resources are, the more likely they will be

utilized wastefully; you can see this in all things.

That your loved ones are receiving the best care from the current

system is good fortune, not a function of the system.

How much better care might your loved ones get if that bottom 25%

wasn't stuck draining the resources of hospital system by using

emergency rooms for primary care? How much better care might they

get if their doctors didn't have such a strong incentive to charge

them for tests and procedures they don't need?


-----------------------------
Imagine if all healthcare resouces in the US were directed at a

single individual. That individual would doubtlessly be getting the

absolute best care in the world; yet it's safe to say that 99.99% of

what said system might do for him would be totally pointless.

And yet I can understand why he'd be loathe to make any changes to

the system. What if one tiny sliver of the 99.99% of resources he

doesn't need actually turns out to be the one necessary for his

survival?

Now think: how rapidly, in your esimation, would the rest of us

reach the limits of our sympathy upon hearing his complaints about

changes to the system?

What if it were reversed? If only one person in the US was

denied health coverage, and everyone else had it? Would you go to

that one guy and say, "sorry, it's us who risk lower-quality

care if we extend coverage to you, so I can't support you getting

healthcare"?
I suspect he'd want to very vigorously demonstrate to you the

difference between wanting the best for your loved ones and wishing

suffering and death on someone to his face for no reason.

Now, of course, those are the extreme ends. There are lots of points

along that continuum where fear of diluted care is actually

rational, and it's entirely possible to believe we're at or close to

one of those points.

But at EVERY SINGLE POINT along that continuum YOU ARE ARGUING YOUR FEAR OF DILUTED CARE AGAINST PEOPLE WHO FEAR RISKING DEATH DUE TO HAVING NO HEALTH CARE AT ALL.

As Clyde put it: "I like you, Jimmy, but you're not going to win this."

Pagan Topologist said...

Thanks for that link, Shady_Grady. I have suspected that there were a lot of confounding variables in the cancer survival analysis being discussed here.

Mark Jones said...

"The more concentrated resources are, the more likely they will be utilized wastefully; you can see this in all things."

Especially in anything the government has a hand in.

Steve Perry said...

What I find fascinating when listening to this discussion are the people who allow as how, you know, sure, health care for everybody would be a good thing and all, yeah, right, *someday,* but not this plan.

Or the next one. Or any plan by Obama, who, some of the meaner-spirited among us have said, needs to be stopped, defeated, no matter what he offers up.

Politics and power as usual, and let's be sure the rich keeping getting richer.

Yeah, a plan, long as it lets the insurance companies continue to reap huge profits, kick off anybody they don't like, and pretty much keep things EXACTLY the same as they are now.

Long as it doesn't take money away from those glorious wars we need to throw trillions at.

I imagine such folk to be the spiritual descendants of those men who told the Negroes, hey, slow down, you'll get to be equal eventually. These things take time. Or told the women, yeah, sure, the right to vote, but what's your hurry? Let it evolve naturally.

If God had wanted you to vote, He'd have made you a white man.

People who are against health care for everybody, who'd be happy to stick 'em on an ice floe -- only, those are all melting -- and let God take care of them?

I'm going to break one of the Buddhist precepts on Right Speech here, and be unkind.

Those people are scum. Period. Full stop. If the shoe fits, by all means wear it. If not, then you shouldn't the be least upset, now, should you?

Sure, we all want to take care of our own first, that's the nature of family. But if we judge our society by how well it takes care of the old, the weak, the poor, then we aren't coming off too well. If you think so, hie yourself on down to the optometrist, you need new glasses.

In the Sixties, we had dueling bumper stickers:

America, Love or Leave it!

and

America, Change it or Lose it!

I had the latter one on my car. It still applies. And my opinion of you who prefer the first still applies, too.

Mike Ralls said...

Don't have insurance, or have loved ones who don't have insurance or just think health care is a right and want to switch to a different system? Perfectly understandable. You're not a bad person for wanting that, your interests are just on the opposite side from maximizing the survival of my family. That makes you my enemy (on this issue) but not evil.

Some quick figures:

Three people in my family with cancer, all of which are likely to come back eventually, and multiple times probably. So let's say that over the next 15 years each will get two more relapses. Entirely possible, even probable.

Let's say that their survival rates for each relapse will probably be around a 50% average. It's actually a little higher for some and a little lower for others, but as a rough figure that works.

So if we switch to a different system that cuts the survival rate for my family members from 50% to 45% for each relapse, what does that do to the odds that 15 years from now they will all be alive?

It cuts it in half.

Half.

Everyone here who is in favor of some domestic policy that cuts the odds that three of your family members will all be alive fifteen years from now in HALF raise your hand.

Anyone? If so, you may be a good Bentham utilitarian, but you are a lousy family member. To be unkind, you are a slave to ideology. You are totalitarian-scum and I don't trust you. At all. If you are willing to sacrifice your own family members for some domestic policy, what the hell won't you do to strangers (me and mine) for some other domestic policy?

Anonymous said...

"... everyone who basically believes the WHO report on comparative mortality and life span, on THIS side of the line."

I'm a working biologist. I am very, very wary of any argument about human biology that's supposed to be completely settled by one government study. If we in the worm labs could be that effective at "settling" issues, we'd all have Nobel Prizes.

I'm also skeptical about the WHO study because, when you look at it closely, it's got nontrivial caveats. Which is pretty much my experience with too-simple ideas in biology, generally.


"I consider consider those on THAT side to be somewhat akin to Flat Earthers: I don't understand the world you are seeing."

Well, the incomprehension is somewhat mutual: you really think that having the entire biomedical sector nationalized by stealth is going to give us better medical care, research into new medical therapies, less rationing, and lower costs? If the UHC side wins, I certainly hope you're right, but.....


--Erich Schwarz

Anonymous said...

"I imagine such folk to be the spiritual descendants of those men who told the Negroes, hey, slow down, you'll get to be equal eventually."

Oh, dear, is this the "civility" that the Left has so much of? Or at least demands so much of from the non-Left?

Two reasons, that, if I have any sense, I'll stop posting here for a while:

1. To the degree that I get into flamewars (particularly with people who I, when I know them better, basically like and admire), it's doing nothing for my self-improvement as a human being, which is what made me pay attention to Steve Barnes' ideas in the first place.

2. To the degree that I have to keep reading, again and again, this sort of unimaginative and lazy ad-hominem, I find myself wondering if maybe the U.S. needs and deserves to go through the disaster of trying socialism.

Sheesh, people! Is it so impossible to grok that some of us might be opposed to expanding the already-large role of government in medicine because we actually believe it will generally make people worse off? Whether we're right or we're wrong, is it REALLY so difficult to wrap your brain around that idea?

It's not as if UHC has been some sort of complete slam-dunk success in Britain or Canada; is it really supposed to be something that everybody just Accepts Without Discussion here in the U.S., because apparently we're all now good little left-wing sheep and we're all supposed to "think differently" alike?

And is it really obvious that UHC is even close to being the most important issue in the U.S.? I'd say that it was a long way down the list, with the impending meltdown of the federal budget, our abject inability to produce inexpensive energy through expanded domestic production of any sort (oil shale, coal, offshore oil, nuclear, anything that's not moonbeams and unicorn exhalations), the possibility of Afghanistan and the Middle East unravelling through not-so-benign neglect, and the general uselessness of our current policies on immigration and public education being issues of far greater long-term importance than whether Obama and Pelosi get the dubious "victory" of shoving UHC down Americans' throats.

But that's just me -- just one guy with a Caltech Ph.D. in molecular biology. Why should my concerns have any basis in rationality? Clearly, I'm motivated by raaaaaaaaacism!

So it's time for me to shut up here for a while. I'll still be reading the site for whatever advice Steve has on Lifewriting and the Road of Trials, and I don't mean badly towards anybody here -- I know you all mean well.

But, for crying out loud! Did Hayek write in vain?


--Erich Schwarz

Anonymous said...

"I suspect that anyone holding this one might have a very bleak view of human nature..."

Or he might be somebody who actually has worked in the drug industry for his entire post-grad-school life and who has a lot to say about whether NIH can effectively take over drug development.

Not that Derek Lowe's some infallible guru -- but it'd be pretty silly to blow the guy off. He's actually done drug development. His leftist critics generally haven't.


--Erich

Brother OMi said...

@ Mike Ralls
I know plenty of people in my family and outside of my family who pay for health care (some for a very long time) who learn that it doesn't cover everything.

I know quite a few people who are bankrupt, who have passed away and left their grieving families with huge bills DESPITE the fact that they have health care.

We can go back and forth but we BOTH have to admit (as Barnes has pointed out), that our medical system is flawed.

Folks need to go watch "Sicko".

@Barnes
I am no rabid Anti Obamaphile, but what NO one in the administration and out is talking about is UHC. THey are just discussing a public option.

That's the sad part.

Marty S said...

Now lets see according to Dan's post we have at least a 2% higher rate of cancer survival than Canada. Now there are about 1.6 million incidents a year of cancer in the U.S. so if the differences in health between us and Canada are due to UHC and we slip to Canadian survival rates we can expect 32,000 extra deaths per year from cancer. But wait a moment. The second leading case of death in both countries is heart attacks. Well lets look at the data on heart attacks. According to this article

http://www.webmd.com/heart-disease/news/20040920/us-tops-canada-in-post-heart-attack-care

we also have a 2% higher survival rate for heart attacks. Now there about 1.25 million heart attacks suffered in the U.S. per year. Two percent of heart attack victims equals 25,000 deaths per year. So if going to UHC makes us as good as Canada we can expect an additional 57,000 deaths per year from cancer and heart attacks alone. Last time I looked 57,000 was larger than the 45,000 the pro UHC study estimated among the uninsured. So if number of deaths is your criteria it would seem that those of us who are anti-UHC have a pretty reasonable argument. Oh and that's comparing us to Canada which has better stats than other UHC countries.

Frank said...

Just in case you missed this in the other thread.

A rebuttal to Steve's argument comes from the New York Times (of all places):

The conventional answer to this question has been: anywhere but the United States. With its many uninsured citizens and its relatively low life expectancy, the United States has been relegated to the bottom of international health scorecards.

But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis. . . . Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

As it is, the longevity gap starts at birth and persists through middle age, but then it eventually disappears. If you reach 80 in the United States, your life expectancy is longer than in most other developed countries.


I suggest you read it all...

Marty S said...

Oh one more time on the issue of "believing" studies. The EPA presumably as good an authority on environmental studies as the WHO on health issues put out a recommended procedure for detecting a certain type of pollution in rivers. When this study determined one of our mills was polluting the river it was on I reviewed the procedure and found it to be flawed biased to find pollution even when it wasn't there. My company on my recommendation paid for the Michigan department of environmental affairs to hire their own independent consultant to evaluate the EPA study procedure and my criticisms of it. their expert agreed completely with my criticisms. Together we developed a new unbiased procedure and in a new study using our procedure the pollution went away. The department of environmental affairs recommended to the legislature that EPA procedure which as written into Michigan's environmental laws be removed and replaced by our procedure and the law was changed. So when I criticize studies by groups with "credentials" I am doing this not because I am a "flat earther", but because developing and conducting studies is my area of expertise and I know exactly how dependent they are on the point of view of the person/group doing the study and how they are conducted.

Marty S said...

One more comment, studies conducted in Canada and Switzerland as well as the U.S. show a significant link between education level and life expectancy. So keeping people in school may do more for improving U.S life expectancy than UHC.

Lynn Gazis-Sax said...

If you reach 80 in the United States, your life expectancy is longer than in most other developed countries.

Of course, if you reach 80 in the United States, you're on Medicare. If the longevity gap were entirely due to differences in health care systems, one would expect it to lessen after the age of 65.

Not that a difference in health care systems is the only thing that would cause a longevity gap that goes away by the time you're 80, just that the fact that the longevity gap goes away as you age doesn't, in itself, say that differences in health care systems aren't a significant factor.

Marty S said...

By the way being against UHC doesn't mean you are against helping provide medical care to the poor. There are other models we could use. The U.S has a food stamp program to help provide food to the poor. How about a health stamp program where if you are poor you get health care stamps to buy health insurance.

Steven Barnes said...

"If you are moving resources away from the top 75% to the bottom 25%, the obvious result would be a downgrade in care for the top 75% and a growth in care for the bottom 25%.

My loved ones would be the ones who would risk death in that scenario, so I do not support that."
##
While I disagree with the conclusion, I believe that this is one of the very few actually honest comments about this side of the issue, and I admire it for this reason.

Steve Perry said...

I don't represent the Left, nobody elected me, what I say is my stance.

PhD. are wonderful things -- a measure of effort and accomplishment, and congratulations to those of you who have earned one. If you are going to wave it at us, however, remember that having one in one subject does not automatically qualify you as an expert in a different one. (Or even the same one, given how many Ph.D's in economics somehow missed the coming recession in which we still find ourselves.

Being polite to somebody who wants to do or continue evil? Not my greatest worry.

I didn't call anybody here a racist. I merely pointed out that certain kinds of comments seem to be heir to those folks who were.

Like I said, if that's not you, why all the knee-jerk defensive comments?

It's simple: Reasonable people can disagree. But from where I sit, reasonable people don't let the old and poor die when they can be helped. It's not a good measure of humanity.

Your mileage may vary.

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Source
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