HCE

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Actually, there is no "right to privacy". Here's a great article on the subject:

http://www.law.umkc.edu/faculty/projects/ftrials/conlaw/rightofprivacy.html
I was always under the impression that the Constitution, and in particular the Bill of Rights, was intended to limit the government from infringing on individual rights, whatever they may be. Thus to the extent that there exists a right to privacy, the government cannot infringe on it unless so granted by the Constitution. And I see the Ninth Amendment, cited in the article, as a restatement of that principle.
 

digitlnoize

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I was always under the impression that the Constitution, and in particular the Bill of Rights, was intended to limit the government from infringing on individual rights, whatever they may be. Thus to the extent that there exists a right to privacy, the government cannot infringe on it unless so granted by the Constitution. And I see the Ninth Amendment, cited in the article, as a restatement of that principle.
The 9th Amendment says that the gov't can't use the other, stated rights to infringe on OTHER rights. For example, you can't use the 1st Amendment (freedom of religion) to justify censorship.

The website link is saying that the courts have upheld that the constitution, while it doesn't have a "right to privacy", IMPLIES that people have a right to privacy of beliefs, home, etc.

I actually think the closest we get to this issue is the 4th Amendment (privacy of person and possessions). However the text of the amendment applies to search and seizure, not to some esoteric "right of not counting how much time you spend in a public building."
 

HCE

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I'm not for O-care either. I worry that with our current economic state, adding another trillion dollars will only devalue our dollar even more, raise inflation, skyrocket our deficit, and put us further dependent on China.
I agree and, unless I'm not hearing well these days, so does Obama. At least I know I haven't heard him say he would really like to spend a trillion dollars. I'm not sure where this term "ObamaCare" came from (well, I know the usual suspects). The proposals being put forth are coming from various House and Senate subcommittees, not the Office of the President. I have heard Obama critisize certain parts of these proposals. I do think he has made some general outlines of what he would like to see in a final bill, including universal coverage (are there really doctors, residents and medical students opposed to this?), no "pre-existing conditions" exclusions, a government program added to the mix with insurance companies, etc..

I have not heard national health insurance proposed, or anything like the British or Canadian systems, and yet I hear well-educated people state that this is what Obama is proposing. I did hear Obama say yesterday he is not in favor of taxing health care benifits. But somehow, this proposal becomes part of this mysterious "ObamaCare."

I agree that politicians, in our system, are capable of totally messing up what may be the only chance we have in the foreseeable future to address the mess that healthcare finds itself in. This would be catastrophic not only to the healthcare system, but the economy in general, IMHO.
 
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Fair question.
At least I know I haven't heard him say he would really like to spend a trillion dollars.
How much will the proposed gov plan cost exactly?

Sources differ.

http://www.cnsnews.com/public/Content/Article.aspx?rsrcid=44198
$634 billion for health-care reform to come from tax increases and "savings" in the medical system – money to expand health coverage for Americans currently without health insurance.
However CNS has been criticized as a biased news source.

http://www.factcheck.org/politics/obamas_health_care_claims.html
The president said the estimated $1 trillion cost of his proposals is "less than we are projected to have spent on the war in Iraq." Maybe. But so far, Iraq war costs are around $642 billion.
Now I do recall (and memory is fallible) that the President did say about 1 trillion, and I recall him comparing it to the cost of being in Iraq.

And this is a qoute directly taken from Obama....
Making health care affordable for all Americans will cost somewhere on the order of $1 trillion over the next 10 years
I have not heard national health insurance proposed, or anything like the British or Canadian systems, and yet I hear well-educated people state that this is what Obama is proposing.
Various sources are giving their own opinions. In our society, it is now common practice to take our news from blogs & pundits which are really opinionated commentary, not the actual news itself, on top of the usual distortions that just happen.
 

digitlnoize

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Fair question.


How much will the proposed gov plan cost exactly?

Sources differ.

http://www.cnsnews.com/public/Content/Article.aspx?rsrcid=44198

However CNS has been criticized as a biased news source.

http://www.factcheck.org/politics/obamas_health_care_claims.html

Now I do recall (and memory is fallible) that the President did say about 1 trillion, and I recall him comparing it to the cost of being in Iraq.

And this is a qoute directly taken from Obama....



Various sources are giving their own opinions. In our society, it is now common practice to take our news from blogs & pundits which are really opinionated commentary, not the actual news itself, on top of the usual distortions that just happen.
We spent $7439 per person on healthcare in 2007. (http://www.cms.hhs.gov/NationalHealthExpendData/Downloads/proj2007.pdf)

$7439 * 40,000,000 = ~ $300 billion.

Where's the rest of that 1 trillion going? We should be able to cover 120 million people for 1 trillion dollars!
 

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HCE

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Fair question.


How much will the proposed gov plan cost exactly?
Which proposed plan? The Senate and House in theory will each eventually come up with a plan (each have multiple plans right now), and then the two plans will need to go through the reconciliation process before we reach "the plan." I know its going to cost serious money. I also know that if nothing is done over the next several years, many if not most of the middle class will be priced out of health insurance coverage. It is one tough nut to crack, but I give Obama credit for tackling it rather than continuing the policy of ignoring the problem and hoping it goes away.
 

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digitlnoize

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This post doesn't make sense for a few reasons, but the biggest is that the "1 trillion" is over 10 years, while your calculation accounts for only 1 year.
Oh right. I figured I was messing something up! :D

Well, in that case:

$300 billion per year * 10 years = $3 Trillion.

Now, perhaps we're seeing the true cost of this program? Of course, we're not. Once people have this miracle insurance, they're going to be utilizing services for every sniffle and cough...mostly through the ER.

I'll go out on a limb and estimate the 10 year cost as $5 Trillion. Any takers?

So, at a cost of Trillions, we wind up doing nothing but giving people insurance which will do nothing but give them "access" to an overcrowded ER waiting room...great.
 

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Oh right. I figured I was messing something up! :D

Well, in that case:

$300 billion per year * 10 years = $3 Trillion.

Now, perhaps we're seeing the true cost of this program? Of course, we're not. Once people have this miracle insurance, they're going to be utilizing services for every sniffle and cough...mostly through the ER.

I'll go out on a limb and estimate the 10 year cost as $5 Trillion. Any takers?

So, at a cost of Trillions, we wind up doing nothing but giving people insurance which will do nothing but give them "access" to an overcrowded ER waiting room...great.
You are SERIOUSLY missing the point, my young friend. Right now they DO have access to the crowded waiting room, and that's part of what is breaking the system. The key point, which I've tried to stress above, is that they DON'T have access to insurance which covers the regular primary care and preventative services which will keep them out of the ER.

If we ensured, assured, and insured access to basic health services, I believe we would actually save health costs. This has been the experience in many systems around the US, such as Kaiser, HealthPartners, and the Mayo system, as well as to some extent in the state CHP programs. Take a look at where this is working successfully, before you scream "OMG--Socialism!" and run screaming away.
 

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Since we like to play with anecdotes, I'll never forget the 50 year old guy last year w/ 3 kids and a construction business who hadn't been to the doctor in about 5 years. I'm guessing walking around at 180/110 and with an LDL of 190 on admission may have contributed to the disabling stroke he suffered. His family couldn't understand why they were going to have to sell their 350k house, and were of course angry at their oldest son, who they'd sent to Duke to get a philosophy degree, and who now spent his days in the basement playing XBox Live. They had foregone health insurance because it was expensive, and he was the owner of his small construction company which depended on his labor and expertise as well as administration.

?
what is the point of this story?? Sounds like he could have easily afforded health care over the last 5 years, even if he chose not to pay for health insurance. $1000/yr over the last 5 years should have easily covered the cost of a few doc visits plus generic anti-BP and anti-chol meds.
While I am sure his hospitalization for stroke was expensive, I doubt his family is selling the house soley for this. My guess is that they are selling the house to pay for primarily for living expenses (perhaps your story is meant to illustrate the need for disability insurance?). I also speculate that the cost of the hospitalization is less than 5 years insurance premiums.

So how does this sob story support the need for ObamaCare?????????
 

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So how does this sob story support the need for ObamaCare?????????
It supports the need for universal health insurance by pointing out that the decision to not have health insurance is not a decision people should be allowed to make, because its implications are not limited to the individual. We don't let people walk on the rails of bridges, and we shouldn't let them avoid purchasing health insurance. Either way, public money has to clean up the mess.

And of course he could have afforded health care. But people without insurance don't go to the doctor because they don't have insurance! People don't like paying for the doctor. People don't think they should have to pay for the doctor. They don't go to the doctor when they have to pay for it. All sweeping generalities, of course, but these are generalities that describe American behavior much more clearly than their converses.

Believe me, I'm blaming this guy's lack of responsibility as much as anyone. He and his family are screwed because of his bad decisions. And all they did during the hospital stay was complain about the Mexicans getting free health care in California while they were going to have to sell their house.
 
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LOL the righties' positions are so confusing that they are starting to confuse one another!
all I know is that the system is splitting at the seams, and something has to be done. Its too late for slogans, political posturing and the "Just Say No" position. I'm more than happy to look at LimbaughCare, or whatever the Right wants to call a plan they might devise.
 

digitlnoize

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You are SERIOUSLY missing the point, my young friend. Right now they DO have access to the crowded waiting room, and that's part of what is breaking the system. The key point, which I've tried to stress above, is that they DON'T have access to insurance which covers the regular primary care and preventative services which will keep them out of the ER.

If we ensured, assured, and insured access to basic health services, I believe we would actually save health costs. This has been the experience in many systems around the US, such as Kaiser, HealthPartners, and the Mayo system, as well as to some extent in the state CHP programs. Take a look at where this is working successfully, before you scream "OMG--Socialism!" and run screaming away.
By the same token, we can look at places where it's NOT working. Let's look at the long waiting times in Canada and the UK. Let's look at the exodus of foreign docs trying to come here, to the "land of plenty". Let's look at Mass., where people can't find doctors...Just because something has worked for a few institutions does not mean it will work for the U.S. Government.

I'd also like to point out where most of the world's medical advances come from. The U.S. It will be interesting to see what happens in we start cutting into Big Pharma profits (by madating generics, for instance.)

For the record, it's not "socialism" that I have a problem with. Let's not forget that I'm the one who's fine with the government tracking our purchases or health-related activities. I agree with both the right and the left on varying issues. What I have a problem with is the adoption of idealistic ideas that will not help the American people.

Giving everyone insurance changes nothing. All it will do is encourage more people, who don't need the ER, to use it. There are many people who, currently, do NOT use the ER because they weigh the severity of their symptoms vs. the cost of treatment. People who will wait until Monday to see their pcp for their sore throat. When everyone's covered, this stops.

Currently, we are paying for the people who don't have insurance through increased private insurance rate. They may not have insurance, but they do have treatment. When the gov't starts picking up their tab, all we have done is shift the costs from the private insurance companies to The People, who, by the way, are still paying the Insurance companies the same amount, thus we are getting screwed twice. Doctors, of course, are getting screwed a third time, due to increased taxes on "the wealthy" being used to fund this whole system.

How does this help anyone?
 

billypilgrim37

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For the record, it's not "socialism" that I have a problem with. Let's not forget that I'm the one who's fine with the government tracking our purchases or health-related activities.
You're severely confusing socialism and fascism.



I wish I knew how to quit you, policy thread!
 

michaelrack

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all I know is that the system is splitting at the seams, and something has to be done. Its too late for slogans, political posturing and the "Just Say No" position. I'm more than happy to look at LimbaughCare, or whatever the Right wants to call a plan they might devise.
Well, you asked for it, and here it is:

The right has devised a plan: health/medical savings account combined with catastrophic insurance coverage. Here's a balanced look (but a little outdated) at the plans:

http://www.urban.org/publications/406690.html

Here's a more recent but more center/right view: http://www.ncpa.org/pub/ba465

Here is an even more recent explanation by Senator Grassley:

GRASSLEY: "I'm a strong backer of health savings accounts. And what is the philosophy behind health savings accounts? That you can put money away for the first dollars that are going to be saved, and that's going to be tax free, and it will never be taxed as long as you spend it on health -- on health and medicine. And you do that. But the reason you have to have a catastrophic policy to go with it is that your -- your health savings account is just for the first dollars and have you decide, first of all, incentive to save, and the incentive comes from not being taxed on that money, and then for you to make a decision instead of your insurance company making a decision on what you're going to spend up front. But then when you have a catastrophic situation, that's why you have to have the catastrophic policy to go with it. And the two together give you full insurance."
http://grassley.senate.gov/news/Article.cfm?customel_dataPageID_1502=21895
 

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Giving everyone insurance changes nothing. All it will do is encourage more people, who don't need the ER, to use it. There are many people who, currently, do NOT use the ER because they weigh the severity of their symptoms vs. the cost of treatment. People who will wait until Monday to see their pcp for their sore throat. When everyone's covered, this stops.
<sigh> One more time--maybe you'll get it. If not, maybe after you get to the wards and ER and actually start talking to real patients who struggle with real-world issues, you'll understand.

People with insurance do not use it to go to the ER and get their trivial complaints taken care of. The people who do this have literally nowhere else to go. But when they have insurance they are going to wait until Monday to see their PCP, because that only costs them a $20 co-pay instead of a $200 co-pay for the ER. They will get their colonoscopy at age 50, instead of waiting until they have a blocked colon and terminal cancer. They will get their cholesterol checked and take their generic statin (which carries a lower co-pay than the branded one) instead of waiting until they have crushing 10/10 chest pain radiating to the left arm and jaw. They will start appropriate outpatient management for their diabetes instead of waiting until their ankles swell up and their GFR is 20. They will get a flu shot instead of needing to be intubated for pneumonia. Do you get it yet? I can tell you more... This isn't idealistic airy-fairy stuff. This is how health care works.


Currently, we are paying for the people who don't have insurance through increased private insurance rate. They may not have insurance, but they do have treatment. When the gov't starts picking up their tab, all we have done is shift the costs from the private insurance companies to The People, who, by the way, are still paying the Insurance companies the same amount, thus we are getting screwed twice. Doctors, of course, are getting screwed a third time, due to increased taxes on "the wealthy" being used to fund this whole system.
How does this help anyone?
By getting them effective primary care at lower cost before the hospitals and states are forced to "eat the cost" AT A MUCH HIGHER RATE of their charity ER care.

We're going to be paying anyway. We pay through taxes or through reduced wages, because our employers are paying for our health care instead. I would far rather pay (and I say this as an upper-bracket tax payer in a high income tax state) knowing that we are ensuring a semi-just, somewhat compassionate sytem that covers all, than continue paying so that Cigna, and Aetna, and United Health Care, and Wellpoint, etc. can post better-than-expected quarterly earnings.
 

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all I know is that the system is splitting at the seams, and something has to be done. Its too late for slogans, political posturing and the "Just Say No" position. I'm more than happy to look at LimbaughCare, or whatever the Right wants to call a plan they might devise.
Does that involve unlimited refills on OxyContin, perchance? :laugh:
 

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It supports the need for universal health insurance by pointing out that the decision to not have health insurance is not a decision people should be allowed to make, because its implications are not limited to the individual. We don't let people walk on the rails of bridges, and we shouldn't let them avoid purchasing health insurance. Either way, public money has to clean up the mess.

And of course he could have afforded health care. But people without insurance don't go to the doctor because they don't have insurance! People don't like paying for the doctor. People don't think they should have to pay for the doctor. They don't go to the doctor when they have to pay for it. All sweeping generalities, of course, but these are generalities that describe American behavior much more clearly than their converses.

Believe me, I'm blaming this guy's lack of responsibility as much as anyone. He and his family are screwed because of his bad decisions. And all they did during the hospital stay was complain about the Mexicans getting free health care in California while they were going to have to sell their house.
Thanks for confirming that you are lefty and that the righties are not confusing each other.
 

michaelrack

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It supports the need for universal health insurance by pointing out that the decision to not have health insurance is not a decision people should be allowed to make, because its implications are not limited to the individual. We don't let people walk on the rails of bridges, and we shouldn't let them avoid purchasing health insurance. Either way, public money has to clean up the mess.
.
You seem to be making 2 arguements 1) that lack of insurance can cause even prosperous people to avoid medical care and thereby lead to catastrophic medical problems and 2) when catastrophic medical problems occurr in the uninsured, society often has to pay for the medical care and therefore everyone should be forced to have insurance.

I disagree with arguement # one, but am not going to say more about that right now. Regarding arguement #2, as someone considered rich by Obama, my taxes will increase to pay for health insurance/health care for society's poorer members (I realize that it is not only the poor who lack insurance). Eventually, my health insurance will also decrease in quality under obama care (I currently have "gold-plated" insurance).
Rather than switch to Obamacare, I'd rather have things stay like they are (or switch to a republican alternative). Currently I have good insurance and my high taxes pay for the care of the uninsured who have catastrophic events. Under obamacare, I'll pay higher taxes and have crappier insurance.

I don't expect better medical care from my good insurance than a poor person; what I do expect is to be seen promptly, and to go to a nice office. I don't want to go to some medicaid clinic with long waits. That is what obamacare will lead to after 10-15 years, we will all be treated like medicaid patients/poor patients are currently treated.
 

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It supports the need for universal health insurance by pointing out that the decision to not have health insurance is not a decision people should be allowed to make, because its implications are not limited to the individual. We don't let people walk on the rails of bridges, and we shouldn't let them avoid purchasing health insurance. Either way, public money has to clean up the mess.

And of course he could have afforded health care. But people without insurance don't go to the doctor because they don't have insurance! People don't like paying for the doctor. People don't think they should have to pay for the doctor. They don't go to the doctor when they have to pay for it. All sweeping generalities, of course, but these are generalities that describe American behavior much more clearly than their converses.

Believe me, I'm blaming this guy's lack of responsibility as much as anyone. He and his family are screwed because of his bad decisions. And all they did during the hospital stay was complain about the Mexicans getting free health care in California while they were going to have to sell their house.
Not a decision he should be allowed to make? Whoa! This is the attitude that torques my shorts. Who are you and any one else to tell me and the rest of my country I lack the apptitude to make my own financial decisions? This wreaks of paternalism and impingement on my freedom.

Public money doesn't have to clean up the mess. We passed the laws that currently permit it to be so. We can just as easily reverse it.

People also don't think they should pay for child support, pay their taxes, student loans, credit card bills, and a whole list of other things. That is life. It sucks to have to be a grown up and heaven forbid, be responsible for telling yourself "NO, I can't buy this, I must save for other expenses."

One way or another we are going to end up in a free market medical system. We can all skirt the issue and lie to ourselves now and push through our socialized medical system only to count down the years that it/we/the whole country go bankrupt. Or we can do it right from the get go and hope to avert the impending crisis.

The chinese aren't going to give a damn about our health when they come collecting and you can bet we will be in a pay to play system then.
 

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Not a decision he should be allowed to make? Whoa! This is the attitude that torques my shorts.
Well, then consider your shorts torqued. There are PLENTY of decisions you aren't allowed to make. You aren't allowed to decide that you don't have a fire department or a police department. You aren't allowed to decide your five year old doesn't need some sort of education. You aren't allowed to take the Oreos out of my pantry. And you're not allowed to play loud music in the middle of the night. You can't buy heroin at 7-11, and you can't pump your gas in New Jersey.

So cry me a libertarian river and sop it up with the pages of your ear-marked copy of Atlas Shrugged!
 
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I gotta disengage from this thread. My wife just ripped me apart for spending too much time writing on here the past few days, and this thread is the culprit, so I'm gonna take my little liberal ball home and let you righties play some shirts and skins. Have fun!

Enjoyed it while it lasted.
 

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I gotta disengage from this thread. My wife just ripped me apart for spending too much time writing on here the past few days, and this thread is the culprit, so I'm gonna take my little liberal ball home and let you righties play some shirts and skins. Have fun!

Enjoyed it while it lasted.
Now whose shorts are torqued? :laugh:

Hey--wait a minute!
You're leaving me alone with all these libertarians and social darwinists?
:scared:
 

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First it won't let me post, then it posts my msg 18 times in a row.
 
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I am too lazy to respond to each of you individually, so I'll just ramble until I get bored (yay insomnia!).

First let me say that it's gratifying to see that many of you actually know what libertarians are. For years, I've had to endure being dismissed as a conservative by you bleeding heart hippie socialist dirtbags Reminds me of all the times I've been called the N-word or r**head. Now at least when you insult me, you use the right terminology. Also, billy, I am so thankful I had the foresight to install my spitguard on my keyboard before seeing your atlas shrugged comment. Note: Never read any Rand. have no plans to.

Onto healthcare. Let me start by saying I think the whole problem with the healthcare debate is that we're approaching it as if healthcare is the sum total of health. At the risk of sounding like a hippy myself, health is a much more holistic thing than healthcare. Everything from environmental contaminants (cough bisphenol A, phthalates cough) to how food is grown (higher yield-->poorer nutrition) what food we eat (no further comments) to lifestyle (video games, sedentary lifestyle) to healthy living and prevention research (useless, largely) to medical education with regard to health maintenance (WORSE than useless).

As i've already said in this thread, the best way to reduce healthcare expenditure is to reduce demand for healthcare. Until we take a look at all the societal phenomena behind the rise in healthcare utilization, it is just plain stupid to even think about addressing healthcare itself.

Heinlein once remarked that a people who forget their history have no future. Bioanthropologists (those who study human evolution) have been aware for several decades now that the rise of agriculture, while paving the way for civilization, longer average life expectancies, etc, also began a vicious cycle of trading quantity for quality. Only recently (last couple hundred years) have we re-achieved the stature and brain size that our pre-agricultural ancestors had. That's right, the agricultural period actually heralded shrinking brains and bodies. Things like vitamin deficiencies, tooth decay (not wear) in young adults, etc, are virtually unheard of in the pre-agricultural archaeological record, but commonplace afterward.

And this correlates to today where (leaving aside organic vs. not), modern varieties of fruits and vegetables husbanded specifically for increased yield per acre are actually less nutritious than their less-cultivated counterparts. Grain-fed meat, farmed fish, and caged chicken have high levels of omega-6 fatty acid and low levels of omega-3 fatty acids (causes inflammation=bad).

Moving on to this past century, we have this wonderful experiment with an n of billions on the effects of modern methods of food production and patterns of consumption and their effects on health. It's called Asia. Age-adjusted incidences of obesity, diabetes, dementia, cancer, and almost every chronic, expensive disease we can think of have skyrocketed in the past few generations as they've adopted a more western lifestyle. While obesity is easily explained by sedentary lifestyle and calories, we learn that there is an outrageously strong connection between all these chronic diseases and the change in n-6/n-3 fatty acid ratio (increased) over time. No surprise since almost all of them are linked to generalized inflammation.

Funnily enough, in Asia, the poor and the rural have a lower age-adjusted incidence of chronic disease. Because their food is more likely to be traditionally grown/fed/caught, rather than 'industrialized'.

Much is made of the 'genetics' of health issues like obesity and diabetes. I've never understood this. Lets take a basic evolutionary population genetics model, assuming mendelian inheritance with complete penetrance and apply it to what we know about trends in obesity in the past two generations in the US. Based on this simple model, we can determine that obese people have had twice as many children as non-obese people. Applying it to asia, the obese have had on average 5-10 times as many children as the non-obese each generation. Extrapolating backwards, we can then estimate that a single person onthe mayflower carried the obesity gene. In India and China, the obesity gene popped into being in the 1800s, and then spread like wildfire, as these fatties did the nasty, repeatedly, with absurd reproductive success.

If you assume incomplete penetrance, partial heredity, and multiple gene loci involved (all true), the model actually produces MORE ridiculous figures, as these attenuate the 'strength' of the obesity signal in the genome, thus requiring more absurd reproductive differentials between the obese and non-obese. Not less.

Looking at DM2 specifically, which populations are the most 'at risk' for the disease? Funnily enough, it's the populations in which this disease was almost unheard of 50 or 100 years ago. Strange, that.

Vg +Ve = Vtot Maybe that's the answer???

The NIH spends how much money finding new genes 'for' obesity, how much money studying the intracellular signalling mechanisms and tissue-level pathogenic processes? God knows.

Why? When genetics and cellular-level processes really are quite obviously the smallest part of the obesity epidemic? As made obvious by the basic evolutionary population genetics and the Great Asian Experiment?

As for nutrition, I see studies involving omega-3 acid supplementation with ridiculously puny amounts ranging from 300mg to 1000mg. It's been known for decades that the optimal n-6/n-3 ratio is 2-1 or less, compared to the 8-1 ratio we average. And we also know that seeing health outcome differences require getting under 4-1 at a minimum. With an average daily intake of about 18grams of n-6 fatty acids, and 2-3 n-3 fatty acids from dietary sources, supplementation studies should be using 6g a day at a minimum to see a benefit.http://www.informaworld.com/smpp/content~content=a713479734~db=all~jumptype=rss

More wasted money.

And exercise. Less than 1 in 10 doctors I've polled informally are aware of the best method for increasing BMR, and losing weight (it's not 'cardio', and it's not weight training). Even fewer understand the basics of how to manipulate macronutrient ratios during a dieting phase to prevent bottoming out of BMR and lean mass loss. I didn't even bother with trying to figure out who knew how to spot anterior and posterior pelvic tilt, forward head posture, quad dominance, hip tightness, (all of which can be assessed with nothing more than a hard look) and the numerous other MSK imbalances caused by our sedentary lifestyles and occasionally by our ******ed exercise methods (treadmill *cough*) that are the precursors to cervical and lumbar discopathies, and knee and hip arthritis.

I haven't even touched the huge problem of chemoestrogens because quite frankly I'm tired and I doubt much of this will be read anyway. But if they're strong enough to create intersex fish and frogs, they're probably strong enough to affect us as, even if we're not seeing a huge rise in intersex children.

So why are we wasting sooooo much money in labs studying minutiae and coming up with more pharmaceuticals when we can't even approach optimality with regard to basic lifestyle and health. Why are we so concerned with 'healthcare' when we don't even really concern ourselves with health in the first place.

Before we even think of talking about healthcare reform, I want to see us make progress on health. No more farm subsidies for high-yield crops with poor nutrient density. Direct them at decent produce instead. Tax breaks for grass-fed meats, free range chickens, and non-grain-fed fish. Sales tax on unhealthy foods (including the poorly-raised meats and crops). No sales tax on the healthy stuff. Redirection of NIH money into sensible nutrition and exercise studies. More studies on improving dietary and exercise compliance. A change in medical education. Etc, etc, etc.

Ok I'm done for now.
 

BabyPsychDoc

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Well, then consider your shorts torqued. There are PLENTY of decisions you aren't allowed to make. You aren't allowed to decide that you don't have a fire department or a police department. You aren't allowed to decide your five year old doesn't need some sort of education. You aren't allowed to take the Oreos out of my pantry. And you're not allowed to play loud music in the middle of the night. You can't buy heroin at 7-11, and you can't pump your gas in New Jersey.

So cry me a libertarian river and sop it up with the pages of your ear-marked copy of Atlas Shrugged!
Hey, there is nothing wrong with objectivism. However, I do agree with billy that people must be forced to buy health insurance (but there must be a decent package available to buy for everyone, pre-existing conditions and all that stuff). You don't get to make a decision based purely on your own interests if the negative outcome of that decision affects wider community. Sorry.
 
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TenaciousGirl

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Well, then consider your shorts torqued. There are PLENTY of decisions you aren't allowed to make. You aren't allowed to decide that you don't have a fire department or a police department. You aren't allowed to decide your five year old doesn't need some sort of education. You aren't allowed to take the Oreos out of my pantry. And you're not allowed to play loud music in the middle of the night. You can't buy heroin at 7-11, and you can't pump your gas in New Jersey.

So cry me a libertarian river and sop it up with the pages of your ear-marked copy of Atlas Shrugged!
haha...

priceless.
 

BabyPsychDoc

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And this correlates to today where (leaving aside organic vs. not), modern varieties of fruits and vegetables husbanded specifically for increased yield per acre are actually less nutritious than their less-cultivated counterparts. Grain-fed meat, farmed fish, and caged chicken have high levels of omega-6 fatty acid and low levels of omega-3 fatty acids (causes inflammation=bad).
Curious, what is the evidence?





Much is made of the 'genetics' of health issues like obesity and diabetes. I've never understood this. Lets take a basic evolutionary population genetics model, assuming mendelian inheritance with complete penetrance
This is a brave assumption to make.

If you assume incomplete penetrance, partial heredity, and multiple gene loci involved (all true), the model actually produces MORE ridiculous figures, as these attenuate the 'strength' of the obesity signal in the genome, thus requiring more absurd reproductive differentials between the obese and non-obese. Not less.
Curious, why do you seem to dismiss the concept of epigenetics entirely? Or, am I missing something?

Looking at DM2 specifically, which populations are the most 'at risk' for the disease? Funnily enough, it's the populations in which this disease was almost unheard of 50 or 100 years ago. Strange, that.
Well, it is kind of hard to develop DM2 when you are starving (I assume you are talking about African-Americans and natives of India).




As for nutrition, I see studies involving omega-3 acid supplementation with ridiculously puny amounts ranging from 300mg to 1000mg. It's been known for decades that the optimal n-6/n-3 ratio is 2-1 or less, compared to the 8-1 ratio we average. And we also know that seeing health outcome differences require getting under 4-1 at a minimum. With an average daily intake of about 18grams of n-6 fatty acids, and 2-3 n-3 fatty acids from dietary sources, supplementation studies should be using 6g a day at a minimum to see a benefit.http://www.informaworld.com/smpp/content~content=a713479734~db=all~jumptype=rss
I must say, I am generally very sceptical about this issue, but I did actually try to look up this article (thanks for the link, btw). It is not covered by my Uni's online subscription - if you could pm the article, or at least the results to me, I would be grateful
 

whopper

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Right now they DO have access to the crowded waiting room, and that's part of what is breaking the system. The key point, which I've tried to stress above, is that they DON'T have access to insurance which covers the regular primary care and preventative services which will keep them out of the ER.
Which is a good point.

One argument is the gov pays for the healthcare anyways of people who can't afford private insurance, and that form of healthcare--ER visits is more expensive.

So along the same lines of logic-providing people who can't afford healthcare with a gov sponsored plan will in the long run decrease costs because it'll shift people to a PCP instead of the ER.

I'm for that. However, and this is a problem with the current system, where exactly is the line between the people who are supposed to be given the gov plan and the people who have private insurance? Is it a type of thing such as the UK where everyone automatically has gov insurance unless they pick up a private insurer?

There will also be a sizeable amount of people who even with the gov sponsored healthcare will choose not to go to their PCP.
 

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I am too lazy to respond to each of you individually, so I'll just ramble until I get bored (yay insomnia!).

First let me say that it's gratifying to see that many of you actually know what libertarians are. For years, I've had to endure being dismissed as a conservative by you bleeding heart hippie socialist dirtbags Reminds me of all the times I've been called the N-word or r**head. Now at least when you insult me, you use the right terminology.

VS.

No more farm subsidies for high-yield crops with poor nutrient density. Direct them at decent produce instead. Tax breaks for grass-fed meats, free range chickens, and non-grain-fed fish. Sales tax on unhealthy foods (including the poorly-raised meats and crops). No sales tax on the healthy stuff. Redirection of NIH money into sensible nutrition and exercise studies. More studies on improving dietary and exercise compliance. A change in medical education. Etc, etc, etc.
You had me convinced at first with your defensiveness and name-calling, but reading on, it seems you are awfully hands-on for a "libertarian".
 

HCE

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Well, you asked for it, and here it is:

The right has devised a plan: health/medical savings account combined with catastrophic insurance coverage. Here's a balanced look (but a little outdated) at the plans:

http://www.urban.org/publications/406690.html

Here's a more recent but more center/right view: http://www.ncpa.org/pub/ba465

Here is an even more recent explanation by Senator Grassley:

GRASSLEY: "I'm a strong backer of health savings accounts. And what is the philosophy behind health savings accounts? That you can put money away for the first dollars that are going to be saved, and that's going to be tax free, and it will never be taxed as long as you spend it on health -- on health and medicine. And you do that. But the reason you have to have a catastrophic policy to go with it is that your -- your health savings account is just for the first dollars and have you decide, first of all, incentive to save, and the incentive comes from not being taxed on that money, and then for you to make a decision instead of your insurance company making a decision on what you're going to spend up front. But then when you have a catastrophic situation, that's why you have to have the catastrophic policy to go with it. And the two together give you full insurance."
http://grassley.senate.gov/news/Article.cfm?customel_dataPageID_1502=21895
Thanks for the info. I will in fact read the articles, i.e. I won't "just say no."
 

digitlnoize

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<sigh> One more time--maybe you'll get it. If not, maybe after you get to the wards and ER and actually start talking to real patients who struggle with real-world issues, you'll understand.
I know, I'm just a "young-un", but, being a non-trad, I've seen more of the "real world" than most doctors who've spent their whole lives in training, then in practice. I've BEEN both of these people we're talking about (the insured and uninsured) and I've done all of the things we're discussing.

People with insurance do not use it to go to the ER and get their trivial complaints taken care of. The people who do this have literally nowhere else to go. But when they have insurance they are going to wait until Monday to see their PCP, because that only costs them a $20 co-pay instead of a $200 co-pay for the ER.
Was true at my tertiary care center. Not as true at my community hospitals. There are still PLENTY of people WITH insurance who come to the ER on Friday night or Saturday because their throat hurts. Depends how good their insurance is. Hell, I did this myself once. My office copay was $20, my ER copay was $50 and I felt miserable.

People really hate being sick, especially in our pampered modern age, and they expect it fixed right now. This will only get worse as the next generation gets older. Everyone needs everything right away. Oh, and we all deserve to be Stars.

They will get their colonoscopy at age 50, instead of waiting until they have a blocked colon and terminal cancer.
Well, they would if they weren't afraid of the procedure. My parents, for example, have great insurance and are middle class. Never had a colonoscopy. Dad doesn't go to the doctor ("if it's my time to go, it's my time to go") and Mom is afraid of everything.

I think those of you on the doctor side of the fence would be surprised at how prevalent fear and apathy are among the population.

They will get their cholesterol checked and take their generic statin (which carries a lower co-pay than the branded one) instead of waiting until they have crushing 10/10 chest pain radiating to the left arm and jaw.
They might. If they go to the doctor (see above). But, they'll keep eating McD's everyday, thinking that the medicine will fix everything, and still have the MI.

They will start appropriate outpatient management for their diabetes instead of waiting until their ankles swell up and their GFR is 20.
Because every diabetic with insurance does this...right. These are dream patients you're talking about. Some people will do these things, but not all.

Being insured does not mean you will suddenly start taking care of your medical conditions or seeing a doctor. I know PLENTY of insured people who never go to the doctor.

People hate shots. They hate having their blood drawn. They hate sitting in an office for 2 hours waiting to be seen, then another hour waiting to be seen by the doctor and discharged. They hate people grabbing their junk, and they hate rectal exams. They hate gagging on the popsicle stick. They hate finding out just how sick they actually are. They hate it when you tell them they have to stop eating Coldstone Ice Cream every day. And, they REALLY hate it when you make them pay you to do all this to them.

So, they don't go. Until something goes terribly wrong. Then they come in droves. Giving everyone insurance won't change human nature. Even if having insurance suddenly made everyone WANT to see their doctor, where are all these doctors going to magically come from?

We don't even have enough doctors to see the patients who show up now. Let's add 40 million new patients to the current pcp supply and see how well that works out!

I would far rather pay (and I say this as an upper-bracket tax payer in a high income tax state) knowing that we are ensuring a semi-just, somewhat compassionate sytem that covers all, than continue paying so that Cigna, and Aetna, and United Health Care, and Wellpoint, etc. can post better-than-expected quarterly earnings.
I actually would too. Which is why I do NOT have a problem with government run health care. I have a problem with HOW they are going about it.

No malpractice reform. No patient accountability. No (or little) physician payment reform. Little change in the student loan repayment programs for primary care.

Without these things, we're not going to fix health care. Lack of insurance is only the tip of the iceberg and we're going to sink like the Titanic.
 

masterofmonkeys

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You had me convinced at first with your defensiveness and name-calling, but reading on, it seems you are awfully hands-on for a "libertarian".
the name-calling was a joke. Probably should have used a smilie.

I am not hands-on by choice. But I am a realist. Once you give government power, it rarely hands it back. I can, at least, hope that that power is wielded in the least destructive way. Which is why all of the interventions I spoke of were merely redirections of already extant government presence.
 

masterofmonkeys

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Curious, what is the evidence?
Sorry I don't keep reflists handy for internet arguments, but here's a few from a quick google search.

for decreasing nutrient quality in plants:
http://usfoodpolicy.blogspot.com/2009/01/evidence-on-declining-fruit-and.html
http://www.jacn.org/cgi/content/full/23/6/669
http://www.time.com/time/health/article/0,8599,1880145,00.html
(all same author, sorry)

For grain versus grass-fed beef and fat content and ratios:
http://www.estanciabeef.com/files/Georgia Study.pdf
http://www.texasjbardranch.com/Grass-fedBeefProductsNutrients.pdf

These benefits are also seen in milk and fish but I'm lazy

This is a brave assumption to make.
Again, as I said, this is a conservative assumption (i.e. makes my position that genetics aren't a big deal look worse). As an illustration, if we assume 50% penetrance, the rate at which the obese must have outbred the nonobese doubles.

Curious, why do you seem to dismiss the concept of epigenetics entirely? Or, am I missing something?
Epigenetics is still largely in its infancy. I'm well aware of the thrifty phenotype and readily admit that it plays a part. But just because we find a new gene 'predisposing' you to obesity, or a new epigenetic mechanism, doesn't mean we should drop all inquiry into EVERY OTHER FACTOR.

I was making an illustrative point that given changes in lifestyle, poorer nutrient quality in basic foodstuffs, eating patterns, etc, it's silly to chalk up all (or even most) of the obesity epidemic up to genetics. If you choose to look at the data, it's not hard to see how powerful an effect increasingly sedentary activity, increased total calories, simple carbs, and SFAs, increasing n-6/n-3 ratios, decreasing n-3 content, etc. must be having.


Well, it is kind of hard to develop DM2 when you are starving (I assume you are talking about African-Americans and natives of India).
Because you know, high and low SES people in India alike were starving 50 years ago. Funnily enough, my grandparents generation ate healthy meals high in vegetable and traditionally-husbanded chicken, eggs, and milk. None of them have chronic diseases. Their children do. Despite undergoing gestation in wombs attached to mothers who did, in fact, eat healthy at the time. That's the beauty of the asian experiment.

I must say, I am generally very sceptical about this issue, but I did actually try to look up this article (thanks for the link, btw). It is not covered by my Uni's online subscription - if you could pm the article, or at least the results to me, I would be grateful
I might have been skeptical of the issue myself if I weren't an evolutionary biologist. There's a lot in biology that the traditional medical curriculum fails to expose you to. Like the role of diet in human evolution, and the environment in which our bodies evolved to thrive in. inflammation as a precursor and predisposing factor for chronic disease is a pretty powerful and increasingly well-proven hypothesis. The basic biochemistry of n-6/n-3FAs in the production of pro and anti-inflammatory cellular signaling mechanisms is also well elucidated. We've also got an increasingly large database of longitudinal and cross-sectional

That was actually the first time I'd seen this particular article. Reading anythign by Simopoulos is a good way to start though. Sorry I can't be more helpful.

My overarching point is that there is a lot out there when it comes to environment, lifestyle, and nutrition that has the potential to drastically decrease healthcare expenditures. It doesn't take a rocket scientist to see how large of an effect this all has on the burden of chronic disease in the modern world. It makes sense that attacking these basic societal-level issues that contribute to unhealthiness in the first place is a great way to reduce healthcare costs. It also has the upside of actually reducing disease burden societally and at the individual level. hardly something to be sneezed at.
 

whopper

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Very much agree with you MasterofMonkeys.

We doctors often times just treat sickness & don't promote wellness.

& several doctors don't do anything to promote wellness. They often times just throw pills at a problem.
 

Indryd

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I am not hands-on by choice. But I am a realist. Once you give government power, it rarely hands it back. I can, at least, hope that that power is wielded in the least destructive way. Which is why all of the interventions I spoke of were merely redirections of already extant government presence.
Reasonable enough.

the name-calling was a joke. Probably should have used a smilie.
We know that. My cheeky accusation was just me jabbing back. :)
 

whopper

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Its interesting that the GOP had the White House, had majorities in both houses, yet still did not do much to reform healthcare. They did though increase spending dramatically while claiming to be fiscally "conservative".

All the while, the Democrats criticized them for the increased spending, now the Dems are in power, and they've increased spending through the roof, and now the GOP are criticizing the Democrats.
 

digitlnoize

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Its interesting that the GOP had the White House, had majorities in both houses, yet still did not do much to reform healthcare. They did though increase spending dramatically while claiming to be fiscally "conservative".

All the while, the Democrats criticized them for the increased spending, now the Dems are in power, and they've increased spending through the roof, and now the GOP are criticizing the Democrats.
Of course both parties are spending like crazy. To keep their power, there must be Pork.
 

notdeadyet

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Its interesting that the GOP had the White House, had majorities in both houses, yet still did not do much to reform healthcare. They did though increase spending dramatically while claiming to be fiscally "conservative".

All the while, the Democrats criticized them for the increased spending, now the Dems are in power, and they've increased spending through the roof, and now the GOP are criticizing the Democrats.
Agreed. I'd love it if everyone had to make a proposal. If you're delighted with the current system, that's fine, but no one seems to be. Instead, everyone remains quiet until someone comes up with something and then the opposite side of the fence jumps up to shout it down.

Don't like Obama's proposal? Cool. What's yours? The Republican's response of that two page document without figures attached? Uh-uh. C'mon folks, let's put up or shut up.
 

digitlnoize

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Agreed. I'd love it if everyone had to make a proposal. If you're delighted with the current system, that's fine, but no one seems to be. Instead, everyone remains quiet until someone comes up with something and then the opposite side of the fence jumps up to shout it down.

Don't like Obama's proposal? Cool. What's yours? The Republican's response of that two page document without figures attached? Uh-uh. C'mon folks, let's put up or shut up.
I still don't like the current argument Obama's making. "It's better than what we have now. THAT can't get any worse."

1. It certainly could get worse.
2. Just because it's better than what we have now, does not mean that's the plan we should go with. Why not keep working on it for a few months until it's actually a good plan?

Rome wasn't burned in a day. ;)
 
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