"
[email protected] (Larry Weisenthal)" <
[email protected]> wrote:
>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:
>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"
>__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?
>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.
>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.
>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?
>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.
>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.
>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.
>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?
>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?
>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 asshole. I almost always do it on purpose. Apparently you don't.
