Larry's double standards

Colin:

Quoted message said:

Quoted message said:

Thank goodness for a newsgroup history that shows otherwise that you

said: "American health care is the best in the world, for those
responsible enough to take advantage of it." That was the statement
with racist implications. <<

Firstly, I stand by what I intended the statement to convey. Secondly,
I truly had no idea what you were referring to. What you might have
said is something such as: "Larry, would you care to explain that
statement further? The way that I read it it is that you are saying
that poor African Americans who are not receiving adequate health care
deserve their fate. Is this what you really mean to say?"

And then I could have had the opportunity to see how my words indeed
might have been misconstrued, and I would have proceeded to elaborate
and perhaps to re-state these views in a way in which they would not be
interpreted in the way you have misconstrued them. As it is, what you
did was to try and play some sort of sophomoric "gotcha" game, which
would have been merely annoying had you been content to play the hand
only to portray me as another clueless American. But you went beyond
that. And it was and is [censored].

You wanna play gotcha games?

Quoted message said:

Quoted message said:

I will quote to you just one figure - a very well known one - from that report. The Institute of Health and Welfare notes that Indigenous people have a life expectancy approximately 20 years lower than non-Indigenous Australians. <<

http://www.hreoc.gov.au/speeches/social_justice/searching_for_justice.html

Now, you can continue to debase yourself in an unyielding attempt to
prove your moral superiority, or you can engage me in a perhaps
mutually self-improving exercise in exploring reasons why certain
ethnic groups do not enjoy good health in countries which provide
generally good health care opportunities for their citizens.

- Larry W

email hidden (Larry Weisenthal) said:

Colin:

Quoted message said:

Quoted message said:

Thank goodness for a newsgroup history that shows otherwise that you

said: "American health care is the best in the world, for those
responsible enough to take advantage of it." That was the statement
with racist implications. <<

Firstly, I stand by what I intended the statement to convey. Secondly,
I truly had no idea what you were referring to. What you might have
said is something such as: "Larry, would you care to explain that
statement further? The way that I read it it is that you are saying
that poor African Americans who are not receiving adequate health care
deserve their fate. Is this what you really mean to say?"

And then I could have had the opportunity to see how my words indeed
might have been misconstrued, and I would have proceeded to elaborate
and perhaps to re-state these views in a way in which they would not be
interpreted in the way you have misconstrued them. As it is, what you
did was to try and play some sort of sophomoric "gotcha" game, which
would have been merely annoying had you been content to play the hand
only to portray me as another clueless American. But you went beyond
that. And it was and is [censored].

You wanna play gotcha games?

Quoted message said:

Quoted message said:

I will quote to you just one figure - a very well known one - from that report. The Institute of Health and Welfare notes that Indigenous people have a life expectancy approximately 20 years lower than non-Indigenous Australians. <<

http://www.hreoc.gov.au/speeches/social_justice/searching_for_justice.html

Now, you can continue to debase yourself in an unyielding attempt to
prove your moral superiority, or you can engage me in a perhaps
mutually self-improving exercise in exploring reasons why certain
ethnic groups do not enjoy good health in countries which provide
generally good health care opportunities for their citizens.

- Larry W

Larry,

Thanks for pointing out that we were talking about different things.
That explains much of what has happened.

But my comments are not about America vs Australia, so your link is
not a gotcha. Nor was I trying to play gotcha - I was just frustrated
with the veracity of your replies (or conspicuous lack thereof in many
cases). Some other readers, including at least one who disagreed with
me, had understood what I was writing. For example, Michael Edey took
the time to follow my logic and point out where he thought the logical
links were weak, and where I had missed a alternate line of reasoning.

Indigenous Australians have health and mortality that are at third
world levels. And that is why I would never make a statement about
health care in Australia that would suggest that all residents are
treated equally, fairly or in a manner that gives them what they
deserve or what they choose. I think that if I were to make such a
statement that it would have racist implications. But that is the
point that I was making about your statement that "American health
care is the best in the world, for those responsible enough to take
advantage of it." as it is too broad a statement and has dangerous
implications if taken literally.

Colin

(Larry Weisenthal) said:

Colin:

Quoted message said:

Quoted message said:

Thank goodness for a newsgroup history that shows otherwise that you

said: "American health care is the best in the world, for those
responsible enough to take advantage of it." That was the statement
with racist implications. <<

Firstly, I stand by what I intended the statement to convey. Secondly,
I truly had no idea what you were referring to. What you might have
said is something such as: "Larry, would you care to explain that
statement further? The way that I read it it is that you are saying
that poor African Americans who are not receiving adequate health care
deserve their fate. Is this what you really mean to say?"

And then I could have had the opportunity to see how my words indeed
might have been misconstrued, and I would have proceeded to elaborate
and perhaps to re-state these views in a way in which they would not be
interpreted in the way you have misconstrued them.

You will probably say I am playing a sophomoric gotcha game, but he
didn't misconstrue what you said. What you said is an argument racists
use. This situation is kind of unique. What you call a sophomoric
gotcha game *is* the problem. It is a strong meme that reinforces the
notion Tim Wise calls "white privilege." It is not an easy concept to
fully grasp. I argued with him about once upon a time. I don't argue
anymore. He is right.

There are three kinds of people: those who are conscious of white
privilege and try to eliminate it, those who are conscious of white
privilege and try to maintain it (racists), and the biggest group,
those who are not conscious of white privilege. Your argument,
presented as it is, is an argument used by those who will maintain
white privilege, but you are in the last, larget group.

Quoted message said:

As it is, what you
did was to try and play some sort of sophomoric "gotcha" game, which
would have been merely annoying had you been content to play the hand
only to portray me as another clueless American. But you went beyond
that. And it was and is [censored].

You wanna play gotcha games?

Quoted message said:

Quoted message said:

I will quote to you just one figure - a very well known one - from that report. The Institute of Health and Welfare notes that Indigenous people have a life expectancy approximately 20 years lower than non-Indigenous Australians. <<

http://www.hreoc.gov.au/speeches/social_justice/searching_for_justice.html

Now, you can continue to debase yourself in an unyielding attempt to
prove your moral superiority, or you can engage me in a perhaps
mutually self-improving exercise in exploring reasons why certain
ethnic groups do not enjoy good health in countries which provide
generally good health care opportunities for their citizens.

I think you will find Colin feels the way he does about the African
american situation because of his understanding of the Australian
situation.

Quoted message said:

Firstly, I stand by what I intended the statement to convey. Secondly,
I truly had no idea what you were referring to. What you might have
said is something such as: "Larry, would you care to explain that
statement further? The way that I read it it is that you are saying
that poor African Americans who are not receiving adequate health care
deserve their fate. Is this what you really mean to say?"

Bingo! There's the heart of the argument right there! A person---who is a
reasonable, careful, logical person---simply does not bring "race" into it
without making sure that the original poster INTENDED "racism." It's that
simple! By screaming "racist" or "racist thoughts" or "racist implications"
or "racist tendencies", the person with an agenda tries to bypass logic (and
fairness) and go right to the emotional side of an argument. And why is
that? So that the person with the agenda can "tar" the other person before
the OP has the chance to put up a defense against the racism charge. It IS
a straw man argument: he is saying "I am painting you as a vile racist and
myself as a reasonable man, so everything you now say is only the ranting of
a vile racist and can therefore be dismissed!"

Bottom line: if you can't argue the subject without bringing the "if you
think differently from me you are therefore a racist" charge into it, don't
try to argue the subject. It says more about you than it does the original
poster.

Pat in TX

http://www.usatoday.com/news/health/2006-03-15-mediocre_x.htm

Routine Care is Typically 'Mediocre' for Patients Regardless of Race,
Income Level
Mar 16, 2006
A study in the March 16 New England Journal of Medicine finds that the
quality of routine care for most Americans is "woefully inadequate"
regardless of gender, race, income or insurance status, the Washington
Post reports. For the study, which was funded by the Robert Wood
Johnson
Foundation, researchers from RAND Corporation and the Veterans Affairs
Greater Los Angeles Health Care System conducted random telephone
surveys of 6,712 people in 12 metropolitan areas between October 1998
and August 2000. They constructed aggregate scores based on 439
indicators of care quality for 30 chronic and acute conditions, as well
as for disease prevention, and then estimated the rates at which
members
of various sociodemographic groups received recommended care. The study
found that survey respondents overall received recommended care only
54.9 percent of the time, despite the fact that "recommended care for
these conditions is widely known and accepted." In overall quality
scores, minority patients scored higher than white patients, with
blacks
receiving recommended care 57.6 percent of the time, Hispanics
receiving
recommended care 57.5 percent of the time and whites receiving
recommended care 54.1 percent of the time. Survey respondents with
household incomes greater than $50,000 a year received recommended care
56.6 percent of the time, compared with 53.1 percent of the time among
respondents with incomes lower than $15,000 a year. Lead study author
Steven Asch, M.D., notes that the "small differences" found in care for
different racial and ethnic groups, which contradict a large body of
evidence demonstrating significant disparities in care between minority
and white patients, are "really insignificant compared to the overall
low level of care." Critics say the study failed to examine important
aspects of health care, including access to care and complex procedures
such as cardiac-bypass surgery and kidney dialysis. Health experts add
that the findings could be "skewed" because the researchers did not
survey the "poorest people," including those who never see a physician
and those without telephones. The study authors acknowledge that
disparities, such as being "less likely to see a [physician] in the
first place" and receiving "far less expensive care," persist for
minority and low-income patients but conclude that the findings
indicate
that problems with care quality are "widespread and systemic and
require
a system-wide approach." (Stein, Washington Post, 3/16/06 [registration
required]; http://tinyurl.com/kwj98
Donn, AP/USA Today, 3/15/06; http://tinyurl.com/sxxm6
New England Journal of Medicine, 3/16/06 [subscription required])

Colin Priest said:

Larry doesn't want to be called racist. No one (including me) has said
he is racist. The closest I've got is to say that his arguments are
unintentionally racist (which means that I don't think that he is
racist but that what he says has implications that are racist*).

Yet Larry has no problem labelling me as racist with no justification
provided at all.

That's a double standard if I've ever seen one.

*
1. Larry states that individual Americans get the health care that
they choose.
2. African Americans have poorer health than the USA average (source:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a1.htm )
3. Given 1 and 2, Larry's arguments imply that African Americans have
poorer health because they choose/deserve it.
4. according to msn encarta, racism is "the belief that people of
different races have different qualities"
5.given the definition in 4 and the implication in 3 I would label
Larry's argument as racist - note that this does not mean that Larry
is racist, just that he doesn't think through the implications of what
he says

Pat,

Once again you haven't bothered to get your facts correct. And you are
doing the very thing that are you complaining about - you are accusing
me of something without being "reasonable, careful, logical" first. A
quick read of the original thread will show that when I first raised
the subject, I stated that Larry's statement had racist implications
that he has probably unaware of - i.e. I said exactly what Larry is
now asking me to have said. Yet Larry did not bother to reply to that
post.

Colin

On Mon, 20 Mar 2006 08:32:41 -0600, "Pat in TX" <[email hidden]>

Quoted message said:

Quoted message said:

Firstly, I stand by what I intended the statement to convey. Secondly,
I truly had no idea what you were referring to. What you might have
said is something such as: "Larry, would you care to explain that
statement further? The way that I read it it is that you are saying
that poor African Americans who are not receiving adequate health care
deserve their fate. Is this what you really mean to say?"

Bingo! There's the heart of the argument right there! A person---who is a
reasonable, careful, logical person---simply does not bring "race" into it
without making sure that the original poster INTENDED "racism." It's that
simple! By screaming "racist" or "racist thoughts" or "racist implications"
or "racist tendencies", the person with an agenda tries to bypass logic (and
fairness) and go right to the emotional side of an argument. And why is
that? So that the person with the agenda can "tar" the other person before
the OP has the chance to put up a defense against the racism charge. It IS
a straw man argument: he is saying "I am painting you as a vile racist and
myself as a reasonable man, so everything you now say is only the ranting of
a vile racist and can therefore be dismissed!"

Bottom line: if you can't argue the subject without bringing the "if you
think differently from me you are therefore a racist" charge into it, don't
try to argue the subject. It says more about you than it does the original
poster.

Pat in TX

Thanks to cardarch for moving the discussion from that of Larry's moral
imperfections to the more objective heart of the matter. The cited
NEJM study is quite important in the context of the present discussion.
Here's the most important parts of the study:

__In overall quality scores, minority patients scored higher than white
patients, with
blacks receiving recommended care 57.6 percent of the time, Hispanics
receiving recommended care 57.5 percent of the time and whites
receiving recommended care 54.1 percent of the time.__

__Survey respondents with household incomes greater than $50,000 a year
received recommended care 56.6 percent of the time, compared with 53.1
percent of the time among respondents with incomes lower than $15,000 a
year. Lead study author Steven Asch, M.D., notes that the "small
differences" found in care for different racial and ethnic groups,
which contradict a large body of evidence demonstrating significant
disparities in care between minority and white patients, are "really
insignificant compared to the overall
low level of care." __

Now, my various non-American critics (Colin, Martin, Liz, Olivier) all
make a number of erroneous assumptions, simply because, as I keep
saying, they don't understand the American health care system and what
are its strengths and what are its real weaknesses.

Colin and Martin are race obsessed. They are convinced that American
health care is a rich versus poor issue. They make the following
mistakes:

1. They are aware that African Americans have a lower life expectancy
than white Americans.

2. They are aware that African Americans have lower average incomes
than white Americans.

3. They have the strong bias that in America the "rich" can buy
themselves adequate health care, but the poor cannot.

4. They blame this lower life expectancy for African Americans on the
American health care system being beyond the reach of poor people, who
are disproportionately black.

They consider points 1 - 4 to be so obvious that of course I must have
been perfectly aware of them and my statement that "The US has the best
health care system in the world for those responsible enough to take
advantage of it" must, therefore, have a racist connotation.

The problem is, again, that they don't understand the US health care
system and they don't understand what are its real problems.
Understanding the reality of the problems points the way to the
solutions to these problems.

Now, you need first of all to understand the NEJM study cited by
"cardarch."

This type of study is very popular today. A major effort of clinical
research over the past 10 years has been to define so-called "standard
of care." This means to define how various diseases should be managed,
from prevention to treatment. So what researchers do is to, in effect,
assign a perfect "10" to the ideal standard of care with respect to
various components of standard of care and come up with an overall
score of how well these standards are met. This has been done disease
by disease. The present study is an attempt to assign an overall
global score to health care as a whole. It is a very ambitious effort.
Not surprisingly, health care falls well short of perfection, when
viewed as a global whole. The study in question did not compare the US
with Australia or Norway; so this does not contribute toward settling
the question of "who is number 1?" But it is helpful with respect to
determining how equitably health care is distributed.

As can be seen, the overall quality of health care for African
Americans and Hispanics is, if anything, better than it is for whites.
Without knowing the precise data, I was entirely cognizant of the fact
that disparities in longevity between whites and African Americans have
little to do with health care, per se. And I was aware that -- by far
-- the biggest problem with health care in America is not the
availability of care (it is, in fact, universally available to those
responsible enough to avail themselves of it).

What follows is an "executive summary." I've got good, interesting
citations, links, etc. which I'll try to post in the coming days.
Right now, I'm due home to cook Icelandic haddock for dinner.

1. By far the number one killer of African Americans is cardiovascular
disease and stroke. These conditions are very rare in rural Africa,
somewhat more prevalent in the Caribbean, but explosively prevalent in
the US. This is not because of poverty or lack of access to health
care. It is completely owing to diet, smoking, and lack of exercise.

2. The factor which correlates most strongly with mortality in African
Americans is education level. Once you correct for eduction level,
income doesn't correlate.

3. The employment level among African Americans is very comparable to
the employment level of many Europeans countries. Virtually every
employed American is either provided with health insurance or could
purchase health insurance, were this a priority.

For example, here in California (a relatively "expensive" state) a
person between the age of 20 and 30 can purchase a policy from
California Blue Cross which covers him/herself for less than $100 per
month. For a "single mother" with one child, this would be $120 per
month. For a husband/wife and unlimited children, this would be
$150-175 per month. For an elderly couple such as me and my wife (late
50s) plus two kids who are still students, the cost is a bit under $500
per month.

What does this buy? For starters, the ability to utilize almost every
provider in the state of California when I'm in state and virtually
every provider/hospital elsewhere, when I'm travelling. Next, it buys
me an average discount approaching 50% on most medical services and
procedures. Next, it buys me the right to put up to about $3,000 per
year (I think, per person) into a medical savings account. All of the
money I put into a medical savings account is fully deductible from my
income, even if I don't itemize deductions. In other words, the
government effectly "matches" a percentage of my contribution,
effectively lowering the cost. I can use the money in this medical
saving account to pay for any out of pocket expenses for health care
(e.g. to help me meet my annual deductible).

What's the catch? $3,500 yearly deduction per year per person (up to a
maximum of $10,000 out of pocket costs per year per family for a worst
case scenario). Once the deductible has been met, the plan pretty much
covers 100% of everything. Ranging from those knee replacements for
which Englishmen must wait 3 years to $100,000 treatment for eating
disorders. To a maximum of $5,000,000 in total payouts.

In an average year, the medical expenses for the average
individual/family will be less than $1,000. Let's say a preventive
care doctor visit. Maybe two visits to the ER to sew up lacerations or
work up a case of food poisoning or whatever. Some prescription drugs.
So we pay out of pocket for that. Just like we pay out of pocket for
car repairs or anything else.

In a bad year, this might be $2,000.

In a really bad year, we might need shoulder surgery for a swimmer.
Bingo, $3,500 and then the plan pays for the rest, including a good
allowance for post op physical therapy.

If I can't come up with the dough, everyone involved (hospital to
surgeon) will usually be happy to give me an interest free payment
plan.

Virtually anyone who has a job can afford the above. If they truly
can't afford it (e.g. single mother making minimum wage), then those
cases will ALWAYS be covered by Medicaid or some other form of public
financing. This is exactly why African Americans don't rate lower with
respect to overall quality of health care than whites.

So why is the overall score so low?

It's education and personal priorities and personal choices.

So should we junk a wonderful health care system on the illusion that
medicine is the lone exception to the rule that the private sector does
everything better than the government? Or do we improve the education
to improve personal priorities and personal choices and tweak the
system to make it better, while retaining its underlying structure?

I wish that more Americans were dissatisfied with the state of health
care, so we'd devote more attention to improving it. Alas, most
Americans are reasonably satisfied with their health care, only they
wish that they'd never have to spend any of their own money to get it.

I'll repeat my assertion. American health care is the best in the world
for those responsible (and let my now add the word "educated"😉 enough
to take advantage of it.

- Larry W

Many problems have at their root an incomplete grasp of the thinking
and intentions of others. I think that little is lost by making an
effort to understand if there really is a problem before unleashing
shock and awe.

(Larry Weisenthal) said:

Many problems have at their root an incomplete grasp of the thinking
and intentions of others. I think that little is lost by making an
effort to understand if there really is a problem before unleashing
shock and awe.

Specifically, why are you against extending Medicare to cover
everyone?

(Larry Weisenthal) said:

Thanks to cardarch for moving the discussion from that of Larry's moral
imperfections to the more objective heart of the matter. The cited
NEJM study is quite important in the context of the present discussion.
Here's the most important parts of the study:

Considering your argument, I would have said the most important part
of the study is this bit:

"...the quality of routine care for most Americans is "woefully
inadequate" regardless of gender, race, income or insurance status..."

It directly contradicts the claim you argued for:

Quoted message said:

American health care is the best in the world, for those responsible
enough to take advantage of it.

"best in the world" vs "woefully inadequate"

Quoted message said:

__In overall quality scores, minority patients scored higher than white
patients, with
blacks receiving recommended care 57.6 percent of the time, Hispanics
receiving recommended care 57.5 percent of the time and whites
receiving recommended care 54.1 percent of the time.__

__Survey respondents with household incomes greater than $50,000 a year
received recommended care 56.6 percent of the time, compared with 53.1
percent of the time among respondents with incomes lower than $15,000 a
year. Lead study author Steven Asch, M.D., notes that the "small
differences" found in care for different racial and ethnic groups,
which contradict a large body of evidence demonstrating significant
disparities in care between minority and white patients, are "really
insignificant compared to the overall
low level of care." __

Now, my various non-American critics (Colin, Martin, Liz, Olivier) all
make a number of erroneous assumptions, simply because, as I keep
saying, they don't understand the American health care system and what
are its strengths and what are its real weaknesses.

But this study in the New England Journal of Medicine just confirmed
our understanding, namely that there is a serious problem with the US
health care system. Routine care is woefully inadequate.

And you left out this part:

'Critics say the study failed to examine important aspects of health
care, including access to care and complex procedures such as
cardiac-bypass surgery and kidney dialysis. Health experts add
that the findings could be "skewed" because the researchers did not
survey the "poorest people," including those who never see a physician
and those without telephones. The study authors acknowledge that
disparities, such as being "less likely to see a [physician] in the
first place" and receiving "far less expensive care," persist for
minority and low-income patients but conclude that the findings
indicate that problems with care quality are "widespread and systemic
and require a system-wide approach." '

You don't think those points are important?

Quoted message said:

Colin and Martin are race obsessed. They are convinced that American
health care is a rich versus poor issue.

But if we were race-obsessed, then we would say the health care
problem is an issue of racism, not of financial status. We're not
saying (I'm not, at least) that the US health care system is racist.
We're saying YOUR ARGUMENT, as presented by you, IS OPEN TO a charge
of racism.

Quoted message said:

They make the following mistakes:

1. They are aware that African Americans have a lower life expectancy
than white Americans.

2. They are aware that African Americans have lower average incomes
than white Americans.

3. They have the strong bias that in America the "rich" can buy
themselves adequate health care, but the poor cannot.

4. They blame this lower life expectancy for African Americans on the
American health care system being beyond the reach of poor people, who
are disproportionately black.

Whoa, Larry! 1 and 2 are facts. They are *not* mistakes. You are
saying 1 through 4 are our mistakes? Sorry, 1 and 2 are unquestionably
true.

And, no, 4 is false. We do not blame low African American life
expectancy on restricted access to the health care system. We both
know from observing life in the US and Australia that there are a
number of causes for low life expectancy for blacks in both countries.
Lack of access to health care is one of ,them.

Number 3 is inaccurate as well, but bringing more nuance into the
discussion would just make this problem worse.

Quoted message said:

They consider points 1 - 4 to be so obvious that of course I must have
been perfectly aware of them and my statement that "The US has the best
health care system in the world for those responsible enough to take
advantage of it" must, therefore, have a racist connotation.

Were you not aware of 1 and 2?

Quoted message said:

The problem is, again, that they don't understand the US health care
system and they don't understand what are its real problems.
Understanding the reality of the problems points the way to the
solutions to these problems.

Now, you need first of all to understand the NEJM study cited by
"cardarch."

This type of study is very popular today. A major effort of clinical
research over the past 10 years has been to define so-called "standard
of care." This means to define how various diseases should be managed,
from prevention to treatment. So what researchers do is to, in effect,
assign a perfect "10" to the ideal standard of care with respect to
various components of standard of care and come up with an overall
score of how well these standards are met. This has been done disease
by disease. The present study is an attempt to assign an overall
global score to health care as a whole. It is a very ambitious effort.
Not surprisingly, health care falls well short of perfection, when
viewed as a global whole. The study in question did not compare the US
with Australia or Norway; so this does not contribute toward settling
the question of "who is number 1?" But it is helpful with respect to
determining how equitably health care is distributed.

As can be seen, the overall quality of health care for African
Americans and Hispanics is, if anything, better than it is for whites.

[snip]

I think we're done, Larry. You are making yourself look worse every
time you try to explain your position.

Here is my last, I hope, statement on this subject.

Quoted message said:

American health care is the best in the world, for those responsible
enough to take advantage of it.

This may or may not be a true statement, but I don't think you've ever
actually lived in another country, Larry, so you don't have first hand
knowledge. And your claim is unsupported, so most readers, not having
actual experience, will just take your word for it, I guess. I don't
have to. I've lived in three different countries including the US, and
I've experienced health care in all of them. The health care I have
experienced in all three has always been excellent.

But your statement contains three implications that mark you, whether
you like it or not. First, your statement implies that US health care
is better than health care outside the US. You say US health care is
*the* best in the world. Your statment implies no other country's
health care is as good. My experience says you are wrong, so after
reading your statement, I'm inclined to mark you as a standard,
ignorant American.

Second, your statement implies that all I have to do in the US to get
access to the best health care in the world is "take advantage of it."
All I have to do is go to any hospital and say "I'm here to take
advantage of the best health care in the world," and do you know what,
children? That's exactly what he got. And that's it! But it isn't
really like that, Larry. I've lived there. I know it isn't as simple
as you make it sound. And we have diablo's personal story as evidence
that it isn't that simple.

And third, your statement divides Americans into two groups, just like
George W. Bush did, when he said, "You're either with us, or you're
with the terra-russ." According to you, I am either with the
responsible Americans, who take advantage of the best health care in
the world, or I am with the irresponsible Americans, who don't. There
aren't any other reasons. Diablo is not a responsible American. Well,
he's not an American anyway, of course. But poverty is not a
reason. Ignorance is not a reason. Nobody has any dilemma that can't
be resolved by applying your simple rule. If you make the wrong
decision, you are not a responsible American.

Quoted message said:

The difference is, the individual is responsible for taking care of
him/herself and his/her family. The government doesn't do it for you.

More implications. You imply that Norwegians and Australians are not
responsible for taking care of themselves and their families. They are
irresponsible people. They don't have to make decisions, because the
government makes their decisions for them. Do you really not see the
arrogance you express?

And you appear to think the Norwegian government just prints money to
pay for taking care of all these irresponsible Norwegian families.
I'll bet you think it's oil money. If you do, you're wrong. Norway
doesn't spend its oil money. In particular, Norway does not use the
oil money to subsidize social programs. Norway invests all its oil
money. Quite a lot of it goes to buy US debt, ie Norwegian oil money
indirectly pays to keep the US government afloat.

The point is Norwegians pay for their social programs like health
care. My tax rate is about 45%. I don't know how much of that goes
toward health care. In Australia I did know. The amount of my tax in
Australia that went to pay my share of public health care was less
than it would cost me to buy comprehensive health insurance in the
US. In fact, I was able to add private insurance to supplement the
public system, and even adding private insurance, my total cost was
comparable to what I would pay in the US for comprehensive health care
insurance with a significant deductible.

Quoted message said:

Europe does a better job than the US in caring for the weak. The US
does a better job than Europe in providing opportunities for the
strong.

You have indicated more than once you are against paternalism in
government. You believe it is the American way. It isn't, but let that
pass. Keeping in mind we are discussing health care insurance, your
statement above is paternalistic. You imply that the US health care
system provides opportunities for the strong and doesn't take care of
the weak. I've asked you this before: What opportunities does the US
health care system provide for strong Americans?

And why do you think the American health care system is the best in
the world if it doesn't adequately take care of the weak? If you're
poor you're weak? Poverty is equated to weakness? People who are
unemployed are weak? You don't see implications of paternalism in your
statement? No arrogance?

Quoted message said:

Europe has the [health insurance] system it wants. We have the
system we want.

Who is we? Do you really mean that Americans who can't afford health
insurance have the health care system they want? If you don't mean
that, why write something that implies that you do? What frame of
reference do you expect your reader to be in? Are you only writing for
responsible, strong Americans, or do you mean to include the
irresponsible weak people of Norway?

Quoted message said:

If we don't like it, we can move to Europe.

So that's your proof that irresponsible weak Americans have the health
insurance system they want? If they didn't want it, they would move to
Europe? I assume you have no idea how hard it is to move to another
country.

Do you really not see why your arguments offend? I know when I'm being
an [censored]. I almost always do it on purpose. Apparently you don't.

I have a few home-made solutions to all the problems of the
whole world. I'll skip the obvious ones like strand on an
island Hussein, Bush, Rove, and all the volunteer world
leaders you can find and give them their weapons of choice.
Broadcast the whole reality tv on The Daily Show.

For the matter at hand, I would scrap the involved systems
of H.Clinton and anyone else who wants to provide the
cheapest care for the richest patients before tackling the
problems of the neediest. No comprehensive plan, just start
at the bottom. Open store front clinics in the poorest
areas of the U.S. Develop a Bachelor of Medicine program
similar to Physician Assistant and give one year free
education in exchange for 2 years service in the clinic.
Give practical nurses similar incentives. Have an M.D.
visit once per week. Hire a few locals to aggressively seek
out patients: users, pregnant girls, anyone who's coughing,
bleeding, moaning, starving, whatever. Drag them into the
clinic for free treatment. NO PAPER WORK. No forms of any
kind to fill out. Have some kind of medico/law person (free
ed exchange again) go around to the clinics to make sure no
one is stealing anything like drugs or doing any of the bad
stuff people will do. Station a permanent well-paid cop
nearby.

This isn't pretty medicine, not the sort of thing anyone
would aspire to do, but if you're at all aquainted with
these areas, it's should be obvious it's what is needed. A
sort of Doctors Without Borders but within our borders,
utilizing a lower level of training for all the minor
problems that would make up the majority of cases presented.

rtk

(Larry Weisenthal) said:

Now, my various non-American critics (Colin, Martin, Liz, Olivier) all
make a number of erroneous assumptions, simply because, as I keep
saying, they don't understand the American health care system and what
are its strengths and what are its real weaknesses.

Huh? I have made no criticisms of you or assumptions about the
American health care system.

I asked a number of questions on the thread "Yards ahead of the world"
which were suggested by your contentious statement that Americans who
don't like the system they've got can move to Europe, or vice versa.

I notice that you have not answered any of those questions.

Liz D

On Tue, 21 Mar 2006 12:21:28 +0100, Martin Smith <[email hidden]>

Quoted message said:

(Larry Weisenthal) said:

Thanks to cardarch for moving the discussion from that of Larry's moral
imperfections to the more objective heart of the matter. The cited
NEJM study is quite important in the context of the present discussion.
Here's the most important parts of the study:

Considering your argument, I would have said the most important part
of the study is this bit:

"...the quality of routine care for most Americans is "woefully
inadequate" regardless of gender, race, income or insurance status..."

It directly contradicts the claim you argued for:

Quoted message said:

American health care is the best in the world, for those responsible
enough to take advantage of it.

"best in the world" vs "woefully inadequate"

Quoted message said:

__In overall quality scores, minority patients scored higher than white
patients, with
blacks receiving recommended care 57.6 percent of the time, Hispanics
receiving recommended care 57.5 percent of the time and whites
receiving recommended care 54.1 percent of the time.__

__Survey respondents with household incomes greater than $50,000 a year
received recommended care 56.6 percent of the time, compared with 53.1
percent of the time among respondents with incomes lower than $15,000 a
year. Lead study author Steven Asch, M.D., notes that the "small
differences" found in care for different racial and ethnic groups,
which contradict a large body of evidence demonstrating significant
disparities in care between minority and white patients, are "really
insignificant compared to the overall
low level of care." __

Now, my various non-American critics (Colin, Martin, Liz, Olivier) all
make a number of erroneous assumptions, simply because, as I keep
saying, they don't understand the American health care system and what
are its strengths and what are its real weaknesses.

But this study in the New England Journal of Medicine just confirmed
our understanding, namely that there is a serious problem with the US
health care system. Routine care is woefully inadequate.

And you left out this part:

'Critics say the study failed to examine important aspects of health
care, including access to care and complex procedures such as
cardiac-bypass surgery and kidney dialysis. Health experts add
that the findings could be "skewed" because the researchers did not
survey the "poorest people," including those who never see a physician
and those without telephones. The study authors acknowledge that
disparities, such as being "less likely to see a [physician] in the
first place" and receiving "far less expensive care," persist for
minority and low-income patients but conclude that the findings
indicate that problems with care quality are "widespread and systemic
and require a system-wide approach." '

You don't think those points are important?

Quoted message said:

Colin and Martin are race obsessed. They are convinced that American
health care is a rich versus poor issue.

But if we were race-obsessed, then we would say the health care
problem is an issue of racism, not of financial status. We're not
saying (I'm not, at least) that the US health care system is racist.
We're saying YOUR ARGUMENT, as presented by you, IS OPEN TO a charge
of racism.

That's certainly what I've been saying. And that's all I have been
saying, other than the one point I made to point out that life tables
didn't mean what Larry said they meant.

Quoted message said:

Quoted message said:

They make the following mistakes:

1. They are aware that African Americans have a lower life expectancy
than white Americans.

2. They are aware that African Americans have lower average incomes
than white Americans.

3. They have the strong bias that in America the "rich" can buy
themselves adequate health care, but the poor cannot.

4. They blame this lower life expectancy for African Americans on the
American health care system being beyond the reach of poor people, who
are disproportionately black.

Whoa, Larry! 1 and 2 are facts. They are *not* mistakes. You are
saying 1 through 4 are our mistakes? Sorry, 1 and 2 are unquestionably
true.

And, no, 4 is false. We do not blame low African American life
expectancy on restricted access to the health care system. We both
know from observing life in the US and Australia that there are a
number of causes for low life expectancy for blacks in both countries.
Lack of access to health care is one of ,them.

Number 3 is inaccurate as well, but bringing more nuance into the
discussion would just make this problem worse.

Quoted message said:

They consider points 1 - 4 to be so obvious that of course I must have
been perfectly aware of them and my statement that "The US has the best
health care system in the world for those responsible enough to take
advantage of it" must, therefore, have a racist connotation.

Were you not aware of 1 and 2?

Quoted message said:

The problem is, again, that they don't understand the US health care
system and they don't understand what are its real problems.
Understanding the reality of the problems points the way to the
solutions to these problems.

Now, you need first of all to understand the NEJM study cited by
"cardarch."

This type of study is very popular today. A major effort of clinical
research over the past 10 years has been to define so-called "standard
of care." This means to define how various diseases should be managed,
from prevention to treatment. So what researchers do is to, in effect,
assign a perfect "10" to the ideal standard of care with respect to
various components of standard of care and come up with an overall
score of how well these standards are met. This has been done disease
by disease. The present study is an attempt to assign an overall
global score to health care as a whole. It is a very ambitious effort.
Not surprisingly, health care falls well short of perfection, when
viewed as a global whole. The study in question did not compare the US
with Australia or Norway; so this does not contribute toward settling
the question of "who is number 1?" But it is helpful with respect to
determining how equitably health care is distributed.

As can be seen, the overall quality of health care for African
Americans and Hispanics is, if anything, better than it is for whites.

[snip]

I think we're done, Larry. You are making yourself look worse every
time you try to explain your position.

Here is my last, I hope, statement on this subject.

Quoted message said:

American health care is the best in the world, for those responsible
enough to take advantage of it.

This may or may not be a true statement, but I don't think you've ever
actually lived in another country, Larry, so you don't have first hand
knowledge. And your claim is unsupported, so most readers, not having
actual experience, will just take your word for it, I guess. I don't
have to. I've lived in three different countries including the US, and
I've experienced health care in all of them. The health care I have
experienced in all three has always been excellent.

But your statement contains three implications that mark you, whether
you like it or not. First, your statement implies that US health care
is better than health care outside the US. You say US health care is
*the* best in the world. Your statment implies no other country's
health care is as good. My experience says you are wrong, so after
reading your statement, I'm inclined to mark you as a standard,
ignorant American.

Second, your statement implies that all I have to do in the US to get
access to the best health care in the world is "take advantage of it."
All I have to do is go to any hospital and say "I'm here to take
advantage of the best health care in the world," and do you know what,
children? That's exactly what he got. And that's it! But it isn't
really like that, Larry. I've lived there. I know it isn't as simple
as you make it sound. And we have diablo's personal story as evidence
that it isn't that simple.

And third, your statement divides Americans into two groups, just like
George W. Bush did, when he said, "You're either with us, or you're
with the terra-russ." According to you, I am either with the
responsible Americans, who take advantage of the best health care in
the world, or I am with the irresponsible Americans, who don't. There
aren't any other reasons. Diablo is not a responsible American. Well,
he's not an American anyway, of course. But poverty is not a
reason. Ignorance is not a reason. Nobody has any dilemma that can't
be resolved by applying your simple rule. If you make the wrong
decision, you are not a responsible American.

Quoted message said:

The difference is, the individual is responsible for taking care of
him/herself and his/her family. The government doesn't do it for you.

More implications. You imply that Norwegians and Australians are not
responsible for taking care of themselves and their families. They are
irresponsible people. They don't have to make decisions, because the
government makes their decisions for them. Do you really not see the
arrogance you express?

And you appear to think the Norwegian government just prints money to
pay for taking care of all these irresponsible Norwegian families.
I'll bet you think it's oil money. If you do, you're wrong. Norway
doesn't spend its oil money. In particular, Norway does not use the
oil money to subsidize social programs. Norway invests all its oil
money. Quite a lot of it goes to buy US debt, ie Norwegian oil money
indirectly pays to keep the US government afloat.

The point is Norwegians pay for their social programs like health
care. My tax rate is about 45%. I don't know how much of that goes
toward health care. In Australia I did know. The amount of my tax in
Australia that went to pay my share of public health care was less
than it would cost me to buy comprehensive health insurance in the
US. In fact, I was able to add private insurance to supplement the
public system, and even adding private insurance, my total cost was
comparable to what I would pay in the US for comprehensive health care
insurance with a significant deductible.

Quoted message said:

Europe does a better job than the US in caring for the weak. The US
does a better job than Europe in providing opportunities for the
strong.

You have indicated more than once you are against paternalism in
government. You believe it is the American way. It isn't, but let that
pass. Keeping in mind we are discussing health care insurance, your
statement above is paternalistic. You imply that the US health care
system provides opportunities for the strong and doesn't take care of
the weak. I've asked you this before: What opportunities does the US
health care system provide for strong Americans?

And why do you think the American health care system is the best in
the world if it doesn't adequately take care of the weak? If you're
poor you're weak? Poverty is equated to weakness? People who are
unemployed are weak? You don't see implications of paternalism in your
statement? No arrogance?

Quoted message said:

Europe has the [health insurance] system it wants. We have the
system we want.

Who is we? Do you really mean that Americans who can't afford health
insurance have the health care system they want? If you don't mean
that, why write something that implies that you do? What frame of
reference do you expect your reader to be in? Are you only writing for
responsible, strong Americans, or do you mean to include the
irresponsible weak people of Norway?

Quoted message said:

If we don't like it, we can move to Europe.

So that's your proof that irresponsible weak Americans have the health
insurance system they want? If they didn't want it, they would move to
Europe? I assume you have no idea how hard it is to move to another
country.

Do you really not see why your arguments offend? I know when I'm being
an [censored]. I almost always do it on purpose. Apparently you don't.