« Of Medicare & Medicaid & Whether PIIGS Have Wings | Main | Harry Potter & The Deathly Hallows Pt. 2 »

Saturday, July 16, 2011



I am very thankful for our health insurance, and even more thankful that we found an affordable one through "Penny Health" online. It has been 6 years that they have not increased my premiums. Having health insurance gives us a peace of mind

Donald Pay

There are several problems with your so-called analysis. If you look at one measure, "mortality," especially when you look at it in adults, as these studies did, you are really not using a very powerful statistic. It is far better to look statistics that might actually measure something that health insurance might actually affect. Health insurance is not designed to prevent death, so using adult mortality as a measure is irrelevant. Second, when you say "health insurance" you and these studies are really not defining what is meant. Are you referring just to employer provide health insurance? Are government provided plans included? Third, if you are talking about employer based plans, there are an incredible array of plans with lots of variation in coverages. I don't see any breakdown in these studies regarding the types of coverage versus the health outcomes. Nor do the studies indicate how long someone has been without health coverage. When you use data that is highly variable and not really defined well, you are going to get the sort of statistical result that a poorly designed study would almost always end up with---not statistically significant.

I would think that infant mortality or one of any number of other statistics would be a far better indicator. There are about 30,000 infant deaths in the United States each year. The CDC and National Center for Health Statistics say that infant mortality rate (the risk of death during the first year of life) is related to several factors including the underlying health of the mother, public health practices, socioeconomic conditions, and availability and use of appropriate health care for infants and pregnant women.

Ken Blanchard

So let me see if I get the argument: expanding health insurance saves lives! We heard this over and over again during the recent debate. Opposing expanded government health insurance is in effect killing tens of thousands. Great! Then when I point out that there is no evidence for any of this, Donald says Of course not. "Health insurance isn't designed to prevent death." Besides, better designed studies would show, I think this is Donald's inference, that health insurance does prevent deaths. I suppose, though one cannot tell, that the point of his last paragraph is that infant mortality statistics show that it can prevent deaths.

You'd be great on the Obama team, Donald.

Donald Pay

KB, you've got it wrong. You make strawman arguments are based on using pretty bad statistical analyses.


The researchers in the Oregon study address McArdle's concerns about apparent mortality effects from insurance:

“If you just compare low-income insured people and uninsured people … it can look like health insurance actually is bad for your health... But that’s because people in worse health are more likely to seek out health insurance, not because health insurance makes you sicker.” (http://web.mit.edu/newsoffice/2011/medicaid-study-0708.html)

I will grant that the Oregon study does not directly support my claim that health insurance (and health insurance reform) saves lives. But the positive results demonstrated in the Oregon study offer plenty of motivation for expanding public health insurance that do not require asserting the silly notion that we Dems are really primarily interested in expanding government control.


To be clear, I'm not abandoning the "save lives" claim, but I am taking the Oregon study under serious advisement and will watch my language on that claim. However, Mr. Pay's point finds support in the following link, whose author says that expanded health coverage provides comfort and care that are worthy policy goals. The author also says "we know that poverty is a killer"; if Medicare and Medicaid can reduce financial stresses, maybe that produces an indirect improvement in mortality?


Donald Pay

I did a story about this very issue in the 1990s for the long-defunct Rapid City Reporter. I followed Kathy K., a 30 year old woman who had no children and a health problem that required surgery. Because she was childless, she didn't qualify at that time (not sure about now) for any state or federal welfare program, so medical assistance was not available. She had a job that didn't provide health insurance. Nor did it provide sick leave. The Family Medical Leave Act hadn't been passed at that time. Without the surgery, she would have died within a few months (one of your adult mortalities), but we do live in a society where people don't have to die in the streets. She hoped to have the surgery, and a fast recovery so she would be able to go back to work without too much loss of income.

Rapid City Regional and the doctors provided the surgery, even though they knew she had no insurance and no realistic way of paying the entire bill. She had committed to providing some modest payments each month, but it would have taken her entire life or more to retire the debt. She developed a post-surgery infection that required another set of surgeries. At first the hospital billed her for those surgeries, too, and she went into a depressive episode. Had she had a health insurer, their team of lawyers would more than likely have negotiated a settlement. But she was on her own (just like the Republicans like it). With the post surgery infections and the depression, her recovery time was too long for her employer to hold her job open. Shortly, she lost her apartment because she couldn't pay rent, and became homeless.

When I did the story, the hospital started backing up a bit, knocking down the entire cost of the followup surgeries so they became free to her (probably cost shifted elsewhere) and she applied to the county for medical assistance. The property taxpayers in South Dakota are the payers of last resort for medical bills (at that time), and anything that the hospital and doctors didn't get paid by the taxpayers was shifted to those who could pay (mostly health care plans). Some costs may have been written off, because by this time lawyers were contacting her about suing the hospital. She refused to sue, because she said the hospital and doctors did provide the surgery that saved her life when she had no money to pay, and she didn't feel right about suing them.

So, the taxpayers of Pennington County and South Dakota ended up paying virtually all the hospital and doctor bills that weren't cost shifted onto those that can pay. In addition the added costs of years of this woman's homelessness, and treatment for depression. She had been a productive, if poor, citizen of Rapid City. I last saw her outside the North Rapid hotel where she ended up. She wouldn't admit that she had resorted to prostitution, but it was clear she had lived a hard life after her medical problems. She tried to put on a good face for me. She was ever the optimist, but her eyes were vacant, a victim of Republican health policy.

Dr. Quack

Does law enforcement ensure that laws are enforced? She moved her daughters in with a pedophile. Been dating him for years and is so happy she posted a pic of her and him on her face book page. Feds say that child protection should have removed the children. Not contact law enforcement who ignored the identity theft and child abuse.
Damn now they will have to cut the budget even more.

Sodomy and rape of children under 16 gets you off? In SD it seems to be the norm with deputy sheriff and lawmaker pedophiles.

Ken Blanchard

Cory: you are not abandoning the save lives claim, though you seem to acknowledged that there is no evidence for the claim. Why do you believe it? Because you have believed it for a long time. President Obama began the sales pitch for health care reform by claiming that we needed to do it to reduce heath care costs. This was never plausible and everyone knew it. It will raise the costs. Trying to figure out why we need health care reform is like playing whack a mole. You guys certainly can't figure it out. You believe it because you have always believed it.


Donald, that is an interesting and sad story. But I am sort of curious about a couple of things. You mention cost-shifting. Shifting to someone who can afford it. I think what that really means is the costs were shifted so someone who had insurance was actually paying for it. I think that is why an aspirin can cost $10 in the hospital. Insurance pays for it so some of the excess can go to the indigent, etc.
In your world, just who should pay for people like Kathy? If it is the government health insurance program, it will be taxpayers. Any way you look at it, it is the taxpayer. I am not saying Kathy should not have received help, but we also have to be realistic about what we are doing.

Donald Pay

In my world Kathy would pay into a single payer health insurance system based on her income. I don't think anyone should get free care, but people shouldn't be rationed out of medical care because they can't pay the going price. Kathy's condition may have been caught earlier, and may not have required as invasive medical treatment had she been able to afford regular medical care. She told me she had symptoms for several years, but never went to the doctor because she couldn't pay. Only when the bleeding and pain became very pronounced and didn't subside did she go to the emergency room.


And that single payer health insurance system based upon her income, who subsidizes her payments? Surely she would be unable to afford to pay the total premiums, right? So someone has to pay part of her premium. Will that be the government? Or will it be other people paying more for their health insurance than they normally would? Either way, it is the taxpayers who pay, just like with the status quo. So you really solve nothing with the single payer system. Health care is a product, not a right. If Kathy was unable to afford a doctor visit, how would she be able to afford even a small premium?

Donald Pay

A single payer system gets rid of the leeches skimming multi-million dollars off the top. No more $30 million dollar salaries would be paid to the top execs. That money would go to medical care. A single payer system provides much greater negotiating power with the drug industry, the hospitals and the medical profession. A single payer system would require premiums based on income. The difference between a premium and a tax is a fine one, but if you are going to argue this point then today's health care system amounts to taxation without representation.


I am one of those stories, still living in it. Moved my family here 2 years ago for a job after mine got cut. When we got here, the new employer dropped his health insurance program. We were still trying to sell our house from where we moved, so we couldn't afford the premiums of private insurance. Tried to skate by a few months until we sold our house. Bad move. 5 year old son became ill and spent 10 days in the hospital, and he almost did not make it out of that hospital. It scares me to even think about it, because his pediatrician did not want to admit him, because he knew we didn't have insurance. He wanted to treat him as outpatient. I had to BEG him to admit my son. If he hadn't of, my son would of died.

Fast forward to $80,000 in medical bills later - applied for CHIPS for my son, we made about 2k too much. They wouldn't take into account any of our bills, that showed we actually made -$500/month, because of our house that wouldn't sell. Worked out a lifetime payment plan with the hospital that we couldn't afford. The bills kept coming in and we were much like Kathy in the above story - depressed and hopeless.

Long story short - we struggled 18 months paying our mortgage and this hospital bill before we had to let it all go and file bankruptcy. A collapsed housing market and a hospital bill changed our lives forever.

No, we don't need no reform. WE NEED SINGLE PAYER!


Donald, I really do not know how you come up with a much better negotiating power with the drug industry. Chances are just as good the drug industry will not be so fast to develop new medicines. Or they may decide if they cannot get the kind of return they need/want, they will just not make it any more. Your premium based upon income idea is still making people pay for someone else coverage. And are you going to force people to be part of it? You have a panacea, but I believe the reality would not be what you tell us it would.
Roo, I hate to see anybody struggle like you do and did. Hopefully the new start will be of help to you. I am guessing the bankruptcy got rid of the medical bills. If so, I am guessing the hospital is really enjoying the money they are not getting from you each month.




For what? Just because we go to a Single Payer System doesn't mean you will get the Health Care you think you will get. Care will begin to be serverly rationed for a number of reasons. [SEE CANADA & UK]

Single Payer's strength is in Preventative Medicine, not Treatment and Surgery. Also, choice will be diminished while cost goes up, because the government becomes the insurance company and a massive infrastructure will be put in place offering no incentive to hold down cost. Our tax money will go to feed and grow the bureaucracy just as in any other country that has tried this, with the exception of maybe Germany. And as cost goes up more choice and care is rationed, growth in technology decreases, and the number of qualified people drops......a cycle doomed to failure!

Germany...the inventor of the system...manages their system so well by severely controlling the behavior and size of the population. Immigration is strictly regulated. We can't have our Cake and Eat it....I often hear people who advocate the Single Payer System in the same breath go on and on about how Racist we are for attempting to control the borders and immmigration.

Once we make the final shift to a Single Payer we will cease to be the beacon of free will and individualism.


I lived on the US/Canadian border before moving here (Northern Maine). I worked as a contractor for the federal government. I knew people who had the coveted federal government employee health insurance who married Canadians and went across the border for all of their care. No one came to the US and married a federal employee for the health care.

Single payer can be done correctly. I would gladly transfer the $781/month we paid in premiums after we filed bankruptcy and then could afford insurance to taxes. I paid $781/month for health insurance that was subpar at best. My son has ongoing issues and we pay dearly ONTOP of our premium. I would rather pay it in taxes and receive something like TriCare or VA Health (which I just switched to this month) than the private health care system. It is for profit and profit only. It's insane - we all HAVE to have car insurance, even though you may NEVER get in a car accident and need it. But it's not mandatory to have health insurance when you are guaranteed to get sick and die one day.

Our health should not be a business! Absolutely drug manufacturer's will be dissuaded if they can't make billions off of sick people - and that's why we'll never find cures for anything, too. Take AIDS - will there ever be a cure now that you can take millions of dollars worth of medicine a year?

And not to mention - I have a chronic autoimmune condition that is of no interest to the drug companies - and it turns out its because I have a gluten intolerance. There's no money for them in figuring out WHY you are sick and preventing it. The only money is in maintaining your condition with drugs.

So many illnesses that people are being drugged for by big pharm can be prevented or can be treated simply by changing diet (my condition, and others such as diabetes), by exercising, by taking better care of yourself in general. No money for big pharm in that, though. Did you know that not a single medical school in this country teaches nutrition? It's almost like a conspiracy. Sick Americans are good for business, for A LOT of corporations.


"Once we make the final shift to a Single Payer we will cease to be the beacon of free will and individualism."

Really Jimi? How does "universal health care" deny you from being an independent jackass?

Donald Pay


Let me point out something that became very clear to me when I moved to Madison, WI, a center for development and testing of new medical technology. The cutting edge development of new drugs, medical equipment and procedures occurs in research universities or affiliated hospitals or within very small start up companies associated with academic researchers or university affiliated doctors. Big Pharma may provide some seed money for research to these academy-based researchers, but a good chunk is provided by government. Big Pharma comes in much later, when they buy up the patents and the small companies. So, negotiating better deals with Big Pharma will not hurt medical research at all.

Donald Pay

This recent piece on Wisconsin Technology Network website is instructive about the process the financial leeches use to hollow out the smaller innovative companies by encouraging takeovers by Big Pharma so they can collect fees, etc. Yeah, we don't really need Big Pharma, because all they do is gobble up the innovators, cut the bench scientists doing the research and jack up the price on any innovations that come along with their purchase of the innovators.



"Our health should not be a business" Roo, everything is a business. That is the way the world works. Health care is not a right. Feeding people is a business. We have grocery stores. Should Big Grocer be forced to lower their prices so more people can eat? Housing is not a right. Should apartment owners be forced to lower their rent so more homeless people can move in? There are all kinds of things that humans need in order to survive. However they are not rights, they are businesses. Yes, we have government safety nets to help, but that is charity provided by the government, not a right. You have a right to worship as you see fit. You have a right to speak your mind without fear of arrest. You even have a right to counsel in the event you are arrested. You have many other rights, but if you want to find them, look in the US Constitution. I doubt you are going to find a right to health care, food, or shelter. Those are up to the individual.



"How does "universal health care" deny you from being an independent jackass?"



No, there isn't any plans just for chiropractic care. There are cevirehonspme group and individual plans that do cover chiropractic care along with all other care but it is a full health policy.Be very wary of medical discount cards. They are not regulated by the Department of Insurance nor do the people that sell them need to be licensed. This means you have little recourse when you have problems with the plan. If you are tempted by the low $19.95 per month price and claims of “save up to 80%” be aware that very few doctors actually take these cards. It does you little good if you have to drive 4 hours to find a doctor that will accept the card. Montana couldn’t find any doctors in the whole state that actually took the card and only one dentist who was on probation for unlawful activities so they banned the sale of the card and fined the company. See this link for more information. Many other states are starting to ban these cards as well.Before signing up with any discount plan get a list of doctors. If they won’t give you a list consider it to be a scam. Call the doctors on the list to make sure they’re still taking the card (many don’t even know that they’re listed as a provider) and that they’re accepting new patients.


If you can itemize dendtcious,you can claim it and other medical costs as long as the total medical deduction exceeds 7.5% of your gross income. Medical expenses include hospital,doctor,lab,eye exams and insurance premiums,dental and insurance premiums,prescriptions,transportation costs to medical appointments. Some of these also include any money you spend for other people and are not reimbursed for. So if you pay a Dr. bill for a neighbor and do not get repaid for it,you can claim it on your medical. If you help your parent(s) with the cost of their prescriptions,you can claim those costs as well. You do need to keep records to back up your claims for the deduction. Other tax credits and dendtcious also help lower your tax obligation,but they must also exceed your standard deduction for your filing status.


The reason for hetalh insurance is NOT to cover your injuries unless forced to. That's what they do. Health insurance is not there for your hetalh.Believe me, when you file a claim, they are all over you. They know people do this. They will do ANYTHING not to pay a claim.Our system really stinks! Young people like you have to gamble that they won't break anything; sometimes they lose. Health insurance is a bogus way to handle hetalh care.


Is there a college local to you? Most cllgeoes have counseling on site that will give you free therapy if you qualify for it. I wouldnt trust anything online that you can get for free could be a random person giving you advice. A true therapist would not go online for free.


That hasn't been determined yet.No bills have paessd both houses, and the negotiations are changing so many parts of health care reform that anything on the table right now is irrelevant. If they can remove the public option on a whim, they can change anything.


Most companies will make it eteicffve next day as long as you don't have any ongoing/unresolved health problems. However if your medical situation is more complicated they can push the eteicffve date back till they have answers. The insurance company will most likely ask to view medical records and/or receive an attending physician statement which because of the snail pace in medical records departments can take up to 18 business days in other words about a month. Best advice? Start looking for insurance about 30 days before your current coverage will cease to give the underwriting department for your new company time to handle any snafus.


I don't know where you got your figures, but as snmooee who has had private medical insurance and now am on Medicare, private does much better. Yes, it is higher priced, but Medicare is far from being free either. We pay a monthly premium for it that totally exceeds $150 a month each and the coverage is horrible. I used to be part of an employer based plan where I paid less than that, and got excellent coverage. The only thing I ever had to pay was a small co pay for doctor and prescriptions.I think the best plans are those offered by employers because they are group plans. Medicare SHOULD BE the largest group plan but the group it covers are those who have the biggest health problems so it is a lot of money.Medicare recipients can get better coverage for less money if they take out a private plan where they can become of a group comprised of all ages. That is actually what Obama was attempting to do with the uninsured in the country. The problem is .those uninsured did not have to pay anything for it at all so that only means that the premiums will go up for everyone else to pay for them.I would happily pay my $150 per month to a group plan to get better coverage.


I sell life insurance, and while we're rerqiued to put on your application what your race is (if we ask and you refuse to tell us, we're rerqiued to guess), charging black people more for life insurance would be more than a little illegal. Drive-byes, sickle-cell anemia, increased rates of heart disease and all.Racism still exists, but it cannot be coded into the structure of a business. Imagine the conniption fits Jesse Helms would go into Also, consider this: does your average thug who prowls the streets at night blasting other thugs and trying to avoid getting blasted himself, ever stop and buy life insurance? Seriously, I've never heard that in a DMX track, have you?

The comments to this entry are closed.