Free to choose = free to die?

[John F]

As a lifelong liberal, I have always believed that one of government's essential functions - the essential function, after preventing conquest of our homeland by Nazis and keeping our own criminals at bay - is to provide vital help to citizens who need it and, for reasons beyond their control, can't help themselves. Conservatives - correct me if I'm wrong - sometimes act as if they believe the opposite, that people's lives including their misfortunes are their own problem, and government should stay out.

During Monday's Republican debate, the moderator asked one of the candidates whether someone who chose not to buy health insurance (assuming the mandate in the health care reform law were declared unconstitutional), and then became seriously ill and needed long-term intensive care, should be allowed to die. The candidate, Ron Paul, ducked, as even the most conservative politician would who didn't want to kill his own candidacy then and there. (The audience at the debate was less inhibited; many shouted "Yeah!" You tell 'em, Pittsburgh!) But Paul Krugman, alert as ever to holes in the "enemy's" positions, doesn't let Paul and his fellow conservatives off the hook.

I don't know whether the conservatives among us will read this without having rejected it in advance, considering the source. But this is really too serious for knee-jerks.


September 15, 2011
Free to Die
By PAUL KRUGMAN

Back in 1980, just as America was making its political turn to the right, Milton Friedman lent his voice to the change with the famous TV series “Free to Choose.” In episode after episode, the genial economist identified laissez-faire economics with personal choice and empowerment, an upbeat vision that would be echoed and amplified by Ronald Reagan.

But that was then. Today, “free to choose” has become “free to die.”

I’m referring, as you might guess, to what happened during Monday’s G.O.P. presidential debate. CNN’s Wolf Blitzer asked Representative Ron Paul what we should do if a 30-year-old man who chose not to purchase health insurance suddenly found himself in need of six months of intensive care. Mr. Paul replied, “That’s what freedom is all about — taking your own risks.” Mr. Blitzer pressed him again, asking whether “society should just let him die.”

And the crowd erupted with cheers and shouts of “Yeah!”

The incident highlighted something that I don’t think most political commentators have fully absorbed: at this point, American politics is fundamentally about different moral visions.

Now, there are two things you should know about the Blitzer-Paul exchange. The first is that after the crowd weighed in, Mr. Paul basically tried to evade the question, asserting that warm-hearted doctors and charitable individuals would always make sure that people received the care they needed — or at least they would if they hadn’t been corrupted by the welfare state. Sorry, but that’s a fantasy. People who can’t afford essential medical care often fail to get it, and always have — and sometimes they die as a result.

The second is that very few of those who die from lack of medical care look like Mr. Blitzer’s hypothetical individual who could and should have bought insurance. In reality, most uninsured Americans either have low incomes and cannot afford insurance, or are rejected by insurers because they have chronic conditions.

So would people on the right be willing to let those who are uninsured through no fault of their own die from lack of care? The answer, based on recent history, is a resounding “Yeah!”

Think, in particular, of the children.

The day after the debate, the Census Bureau released its latest estimates on income, poverty and health insurance. The overall picture was terrible: the weak economy continues to wreak havoc on American lives. One relatively bright spot, however, was health care for children: the percentage of children without health coverage was lower in 2010 than before the recession, largely thanks to the 2009 expansion of the State Children’s Health Insurance Program, or S-chip.

And the reason S-chip was expanded in 2009 but not earlier was, of course, that former President George W. Bush blocked earlier attempts to cover more children — to the cheers of many on the right. Did I mention that one in six children in Texas lacks health insurance, the second-highest rate in the nation?

So the freedom to die extends, in practice, to children and the unlucky as well as the improvident. And the right’s embrace of that notion signals an important shift in the nature of American politics.

In the past, conservatives accepted the need for a government-provided safety net on humanitarian grounds. Don’t take it from me, take it from Friedrich Hayek, the conservative intellectual hero, who specifically declared in “The Road to Serfdom” his support for “a comprehensive system of social insurance” to protect citizens against “the common hazards of life,” and singled out health in particular.

Given the agreed-upon desirability of protecting citizens against the worst, the question then became one of costs and benefits — and health care was one of those areas where even conservatives used to be willing to accept government intervention in the name of compassion, given the clear evidence that covering the uninsured would not, in fact, cost very much money. As many observers have pointed out, the Obama health care plan was largely based on past Republican plans, and is virtually identical to Mitt Romney’s health reform in Massachusetts.

Now, however, compassion is out of fashion — indeed, lack of compassion has become a matter of principle, at least among the G.O.P.’s base.

And what this means is that modern conservatism is actually a deeply radical movement, one that is hostile to the kind of society we’ve had for the past three generations — that is, a society that, acting through the government, tries to mitigate some of the “common hazards of life” through such programs as Social Security, unemployment insurance, Medicare and Medicaid.

Are voters ready to embrace such a radical rejection of the kind of America we’ve all grown up in? I guess we’ll find out next year.

[Ricordanza]

Since I'm on the liberal side of the spectrum on economic and domestic issues, I'm not going to take up the challenge posed by John. But I did find the following surprising; it certainly illustrates how far today's right wing has strayed from the principles of their "founding fathers."

In the past, conservatives accepted the need for a government-provided safety net on humanitarian grounds. Don’t take it from me, take it from Friedrich Hayek, the conservative intellectual hero, who specifically declared in “The Road to Serfdom” his support for “a comprehensive system of social insurance” to protect citizens against “the common hazards of life,” and singled out health in particular.

[jbuck919]

That is another good piece by Krugman, but he is playing the children card which, it can be argued, has actually impeded progress in developing a modern social safety net including health care for all. I realize that Krugman himself is not saying "cover only children," but for politicians, advocating programs that cover children has up to now been a politically safe and relatively successful way of getting some needed help from government. However, it has always carried the implication that it is all right if large numbers of people who are not children can remain uninsured with inadequate access to health care. Those people of working age are the backbone of society, and should not be told that if they cannot afford expensive private insurance then they just have to wait until they are seriously ill and then go to the emergency room and hope they are not booted out as charity cases.

[John F]

I disagree. Politicians "play the children card" because it's hard to say "no" to and therefore gets votes, in elections and in Congress. You take what you can get. Saying nothing about children's health wouldn't make it any easier to pass health-care assistance for adults - it never has, has it? Krugman brings up the S-CHIP thing because he thinks it's a hard fact about conservative/Republican priorities, it's shameful, and I'd think it's pretty much unanswerable. (Though one shouldn't underestimate politicians' skill at coming up with spurious arguments and non-facts as needed.)

[lennygoran]

>As a lifelong liberal, I have always believed that one of government's essential functions - the essential function, after preventing conquest of our homeland by Nazis and keeping our own criminals at bay - is to provide vital help to citizens who need it and, for reasons beyond their control, can't help themselves.<

I'm under the impression Medicaid will cover anyone who doesn't get medical help elsewhere from actually dying?

"Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. Unlike the Medicare entitlement program, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. Some people are eligible for both Medicaid and Medicare and are known as Medicare dual eligibles.[8] In 2001, about 6.5 million Americans were enrolled in both Medicare and Medicaid."

I'm trying to think of a case where an actual person would be allowed to die? Regards, Len

[keaggy220]

Sorry, I didn't read the Krugman article, sometimes I can stomach his musings, but after the 9/11 article I need to take a break from him.

However, I can give you a take on how I feel about governments role in helping people. First, the notion that conservatives don't care about those in need is liberal puppet propaganda. I know it's hard to let go of prejudices which are so comfortable to hang on to, but conservatives care deeply about those in need.

On the surface the federal government as a central repository for resources to distribute to those in need is a good idea. However, we would be (and have been) remiss to implement such an undertaking without considering that the quest for power isn't isolated to warmongers and abuse isn't isolated to drug addicts, but also power addicts.

There is no perfect system for helping people, but the one I believe is best suited to help those in need would be at the state and local level. I would love to see a competitive situation where all 50 states, with the help of their localities, bring their best ideas to the table and try to shine as a city on a hill. The main reason I like this model is that I believe it would foster much more involvement of people, reduce ever-increasing rampant bureaucracy, decrease the influence of lobbyists and avoid the one-size-fits-all mentality of centralized control.

Like I said, no model is perfect and we can all easily poke holes in each others arguments with this subject, but this is a model I think many conservatives would favor.

[lennygoran]

>There is no perfect system for helping people, but the one I believe is best suited to help those in need would be at the state and local level.<

The problem is that many states didn't help their people so the Federal Gov't had to step in. Just today on the news--poverty is again on the rise--very disappointing stats produced:

Poverty continues to rise in U.S., now 15.1%

http://www.cbsnews.com/stories/2011/09/ ... 5376.shtml

Regards, Len

[John F]

If you read the rest of the Wikipedia article on Medicaid, you'll see that it doesn't automatically cover all of the poor, and in recent years, those who are covered have had their Medicaid premiums and co-payments significantly increased. The health care reform law of 2009 is meant to increase Medicaid coverage, though it still won't reach 100%. But most of the law's provisions haven't gone into effect yet, the Republicans have sworn to repeal it, and many states (mainly those with Republican governors, I believe) have sued to have it declared unconstitutional.

[keaggy220]

>There is no perfect system for helping people, but the one I believe is best suited to help those in need would be at the state and local level.<

The problem is that many states didn't help their people so the Federal Gov't had to step in. Just today on the news--poverty is again on the rise--very disappointing stats produced:

Poverty continues to rise in U.S., now 15.1%

http://www.cbsnews.com/stories/2011/09/ ... 5376.shtml

Regards, Len

So this tells me the war on poverty is a bust and we were doing better before the feds came to our rescue. Thanks!

[John F]

>There is no perfect system for helping people, but the one I believe is best suited to help those in need would be at the state and local level.<

The problem is that many states didn't help their people so the Federal Gov't had to step in. Just today on the news--poverty is again on the rise--very disappointing stats produced:

Poverty continues to rise in U.S., now 15.1%

The states are obliged by their own constitutions to balance their budgets, and in hard times like these, services are cut - definitely including Medicaid. Meanwhile the number of the poor is rising, as Lenny says, and their health care needs haven't magically dwindled away. Under the circumstances, it's not just irresponsible but, shall we say, disingenuous to try handing off the federal government's responsibility to the states.

[lennygoran]

>If you read the rest of the Wikipedia article on Medicaid, you'll see that it doesn't automatically cover all of the poor,<

But what I'm asking is if there's an example anywhere in the US where someone has actually been allowed to die--maybe there has but I haven't seen it. Many years ago walking the streets of Calcutta you saw people lying dead on the streets with flies swarming over their bodies--does that happen anywhere in the US? Regards, Len

[lennygoran]

>So this tells me the war on poverty is a bust and we were doing better before the feds came to our rescue.<

No, no, no--the Fed programs were working for a while but then you started letting too many millionaires get away without paying their fair share of the taxes! And you didn't monitor the derivatives, you let the bonus boys go free without going to jail and you continue to give the religious institutions these incredible tax exemptions! Regards, Len

[keaggy220]

>So this tells me the war on poverty is a bust and we were doing better before the feds came to our rescue.<

No, no, no--the Fed programs were working for a while but then you started letting too many millionaires get away without paying their fair share of the taxes! And you didn't monitor the derivatives, you let the bonus boys go free without going to jail and you continue to give the religious institutions these incredible tax exemptions! Regards, Len

The reason the fed programs were working is because there was an infusion of cash, which certainly benefits the initial recipients, but also causes inflation so in order to continue equal benefits past the initial recipients an even greater infusion of cash is required and eventually you get to where we are at now. Borrowing huge sums of money to feed a beast which keeps growing.

[lennygoran]

>Borrowing huge sums of money to feed a beast which keeps growing.<

Why bring up the situation in Iraq--that's not part of this thread! Regards, Len [fleeing]

[John F]

what I'm asking is if there's an example anywhere in the US where someone has actually been allowed to die--maybe there has but I haven't seen it.

Do you seriously doubt it? In New York City, death rates are almost 30% higher in the poorest neighborhoods than in the others, according to statistics from the Department of Health. Death certificates do not give the cause of death as "lack of access to health care," so there are no statistics for that, but surely there can be no doubt that this must sometimes be a contributing factor, even the crucial one. Would you claim that it never is?

[lennygoran]

>Would you claim that it never is?<

I'm not claiming that--I was asking if there was an example of a hospital or emergency room not helping a person who was brought in close to death--I believe they would be covered by Medicaid--I believe they would not be turned away. Let's say a neighbor in the south Bronx went out in the hallway and found an old sickly looking person lying in the hallway--I feel that if 911 was called an ambulance would arrive no questions asked--the person would be taken to the hospital and in some manner or form treated--maybe I have that wrong? I'm not saying people living in poverty are not hurting but I thought the discussion was about the rather drastic mention that people are actually allowed to die. I reiterate it may be happening but can you give me any example of one--I just haven't heard of such a case. Regards, Len

[Cosima___J]

The hospital where I work never turns away patients (regardless of ability to pay) from the Emergency Room. Also, my hospital spends a lot of money on indigent care. That's one reason why when a paying patient gets the itemized hospital bill, the charges seem outrageous. But this is one means of transferring costs from the indigent to other patients and their insurers. This goes on all the time.

And as far as the death rates being higher in the poorest neighborhoods, there are a lot of factors that must be considered besides just medical care. Do the people in those poor neighborhoods eat a good, well-balanced diet? Do they try to control their intake of fatty foods and eat more fruits and vegetables? How about smoking and drug use? How about death from gang violence?

[jbuck919]

And as far as the death rates being higher in the poorest neighborhoods, there are a lot of factors that must be considered besides just medical care. Do the people in those poor neighborhoods eat a good, well-balanced diet? Do they try to control their intake of fatty foods and eat more fruits and vegetables? How about smoking and drug use? How about death from gang violence?

Nutrition support and health education programs, additional drug treatment centers, and getting guns out of the inner city as a preferential means over universal health care to reduce the death rate: Now why didn't some Republican think of that already?

[Cosima___J]

Jbuck, I did not claim that changing the factors that I listed was a"preferential means over universal health care to reduce the death rate"!!!! I was just pointing out that other factors enter in when considering death rates.

[John F]

I was asking if there was an example of a hospital or emergency room not helping a person who was brought in close to death--I believe they would be covered by Medicaid--I believe they would not be turned away.

First of all, people have to register for Medicaid and they have to be eligible to register. It's not enough just to walk into a doctor's office or emergency room and say, "I'm poor, help me for free." The Wikipedia article on Medicaid gives an idea of this. Since you've quoted from that article, I don't see how you missed this.

Second, it's not for me to try to research the millions of poor who die in their homes or, if they're homeless, in the street, and try to find out whether they had access to health care - in fact, not just in theory. If you can find statistics about this, you're a better Googler than I am. And I'm certainly not going to argue hypotheticals with you, like that old sickly person who had the luck to be in the right place at the right time to be discovered and saved. But it's a hard fact that the death rate among the poor of New York is 30% higher than that of the not poor. How can this be, if they have equal access to health care? You explain this to me, if you can.

[jbuck919]

Jbuck, I did not claim that changing the factors that I listed was a"preferential means over universal health care to reduce the death rate"!!!! I was just pointing out that other factors enter in when considering death rates.

And all are inadequately addressed, and will be more so if the ascendent Right has its way.

[RebLem]

Here ya go, lenny.

February 11, 2009 2:41 PM

Emergency Room Death Sparks Outrage

New York City hospital officials agreed in court Tuesday to implement reforms at a psychiatric ward where surveillance footage showed a woman falling from her chair, writhing on the floor and dying as workers failed to help for more than an hour.

Esmin Green, 49, had been waiting in the emergency room for nearly 24 hours when she toppled from her seat at 5:32 a.m. on June 19, falling face down on the floor.

She was dead by 6:35, when someone on the medical staff, flagged down by a person in the waiting room, finally approached, nudged Green with her foot, and gently prodded her shoulder, as if to wake her. The staffer then left and returned with someone wearing a white lab coat who examined her and summoned help.

Until the staffer's appearance, Green's collapse barely caused a ripple. Other patients waiting a few feet away didn't react. Security guards and a member of the hospital's staff appeared to notice her prone body at least three times, but made no visible attempt to see if she needed help.

One guard didn't even leave his chair, rolling it around a corner to stare at the body, then rolling away a few moments later.

Green, who had been involuntarily committed the previous morning, and had waited overnight for a bed, stopped moving about half an hour after she collapsed.

The New York City Health and Hospitals Corporation, which runs the hospital, said six people have been fired as a result, including security personnel and members of the medical staff.

The incident in New York recalls a similar situation involving another dying patient last year in Los Angeles, also caught on tape by security cameras, in which a woman collapsed in an emergency room lobby. Edith Isabel Rodriguez writhed on the floor for 45 minutes while hospital personnel stood idly by and a janitor mopped the floor around her, The Los Angeles Times reports. Excerpts of that video were made public after Green's death in Brooklyn shocked New York City this week.

An attorney representing Rodriguez's children, Franklin Casco Jr., said the family had been pressing Los Angles County to view the video before it was sent anonymously to the Times this week.

"My clients and I have been working very hard with the county of Los Angeles to at least view this so they can have some form of closure of their mom's death so they can put this behind them, and the county has refused," he told the newspaper. "The county has refused to provide us with anything. It seems like they're attempting to cover up the whole situation."

The psychiatric unit at Kings County Hospital in Brooklyn had already been a subject of complaints by advocates for the mentally ill.

A state agency, the New York State Mental Hygiene Legal Service, and the New York Civil Liberties Union filed a lawsuit a year ago, calling the psychiatric center "a chamber of filth, decay, indifference and danger."

Both sides in the dispute went before a federal judge Tuesday to jointly file papers in which the hospital system agreed to a series of reforms. Under the agreement, patients in the waiting room will now be checked every 15 minutes.

Over the next four months, the hospital will attempt to shorten the median waiting time to around 10 hours. A judge is scheduled to sign off on the agreement Wednesday. [The fact that the median waiting time before this was more than 10 hours is a pretty good indication that this could not have been an isolated incident, just one that someone decided to make a fuss about. RebLem]

The tape of Green's wait has also been turned over to prosecutors.

Green's medical records raised the possibility that someone might have tried to cover up the circumstances of the death.

One notation said that at 6 a.m., she was "awake, up and about" and had just used the restroom. Another said that at 6:20 a.m., she was sitting quietly in the waiting room, and had a normal blood pressure. During both of those times, Green was either in her death throes or already dead.

Mayor Michael Bloomberg said he was disgusted by the tape, and that the actions of the hospital staff were unacceptable.

"I think what they said is, 'Oh well, people sleep on the floor all the time, and I didn't pay any attention,"' he said. "They shouldn't be sleeping on the floor ... and you should pay attention."

HHC's president, Alan Aviles, said in a statement that he was shocked and distressed by the situation and promised a thorough investigation.

"We are all shocked and distressed by this situation," HHC's president, Alan Aviles, said in a statement. "We express our deep regrets to the patient's family and will ensure a thorough investigation to answer any questions that remain."

Details of the death were disclosed by the hospital on June 20, but the case largely remained unnoticed until the video became public.

According to the lawsuit, patients at the hospital "are subjected to overcrowded and squalid conditions often accompanied by physical abuse and unnecessary and punitive injections of mind-altering drugs."

"From the moment a person steps through the doors," it added, "she is stripped of her freedom and dignity and literally forced to fight for the essentials of life."

The suit was especially critical of the hospital's emergency ward, saying it is so poorly staffed that patients are often marooned there for days while they wait to be evaluated.

Sometimes the unit runs out of chairs, according to the lawsuit, forcing people to wait on foam mats or on the waiting room floor. The suit also claims that bathrooms are filthy and filled with flies, and that patients who complain too loudly are sometimes handcuffed, beaten or injected with psychotropic drugs.

The office of the city's medical examiner said it was still trying to determine why Green died. She had been brought to the hospital suffering from agitation and psychosis, city officials said.

Green was born in Jamaica, and the city has agreed to fly her body home for burial.

Read more: http://www.cbsnews.com/8301-201_162-422 ... z1Y9GYmjMl

[John F]

The hospital where I work never turns away patients (regardless of ability to pay) from the Emergency Room. Also, my hospital spends a lot of money on indigent care. That's one reason why when a paying patient gets the itemized hospital bill, the charges seem outrageous. But this is one means of transferring costs from the indigent to other patients and their insurers. This goes on all the time.

When a poor person suddenly winds up in an emergency room at death's door, this is at least sometimes - I'd guess often, but I've no numbers - because that person hasn't previously been diagnosed and treated for a life-threatening condition, such as cardiovascular disease or diabetes. Admission to the emergency room for the critically ill or injured, especially when it's too late to save them, is not adequate access to health care.

And as far as the death rates being higher in the poorest neighborhoods, there are a lot of factors that must be considered besides just medical care. Do the people in those poor neighborhoods eat a good, well-balanced diet? Do they try to control their intake of fatty foods and eat more fruits and vegetables? How about smoking and drug use?

Bad lifestyle choices aren't the exclusive province of the poor, and besides, people who live unhealthy lives are most in need of access to normal, regular health care - to diagnose conditions resulting from their bad lifestyle, treat those conditions, and counsel them on how to live healthier, longer lives. That's not as dramatic as a race to the ER with sirens screaming, but it's health care too, and surely more life-saving. The health care reform act will make it available to millions more of the poor by broadening health insurance coverage. The Republicans are determined to repeal it.

How about death from gang violence?

Well, how about it? Statistically insignificant, even in the South Bronx.

[HoustonDavid]

It is my understanding that hospitals are mandated to "treat and stabilize" any person
brought to their facility. On-going treatment for patients with the ability to pay is billed
accordingly. My uninsured son was able to sign a statement of indigence and continued to
receive treatment until he was discharged after the resuscitation of his collapsed lung after
a home accident.

Granted, this is anecdotal and may not be true of every case of lack of insurance or indigency,
but there sure were a lot of uninsured people in the emergency ward of a local hospital I visited yesterday with a friend who had fallen and injured her hip.

It is this common occurrence - the lack of insurance or indigency - that points to the need for
the universal health care in this country that will be provided by the Health Care Reform Law
of 2009 when it is fully implemented.

It is utterly appalling that the United States is practically the only country in the entire world
without such universal insurance coverage.

[Cosima___J]

John Francis stated that "Bad lifestyle choices aren't the exclusive province of the poor, and besides, and people who live unhealthy lives are those who most need access to health care - to diagnose conditions resulting from their bad lifestyle, treat those conditions, and counsel them on how to live healthier, longer lives."

John, there are tons of magazine articles, newspaper accounts and TV programs that drive home the health consequences of unhealthy life styles. How can anyone live in our society and not have heard about that? If people don't pay any attention to them, are they going to pay any attention to a doctor counselling them on how to live healthier, longer lives? Probably not.

However, please do not misunderstand and think that I feel that people don't need health care. Of course they do. But everyone, rich or poor, with or without a family physician should at least do what they can to help themselves.

[HoustonDavid]

And the audience watching the debate resoundingly told millions of viewers that those
very people should be ignored and allowed to die. Which side of the Republican vision
of health care do you agree with, Cosi?

[John F]

John Francis stated that "Bad lifestyle choices aren't the exclusive province of the poor, and besides, and people who live unhealthy lives are those who most need access to health care - to diagnose conditions resulting from their bad lifestyle, treat those conditions, and counsel them on how to live healthier, longer lives."

John, there are tons of magazine articles, newspaper accounts and TV programs that drive home the health consequences of unhealthy life styles. How can anyone live in our society and not have heard about that?

In the real world, millions upon millions of them. You and I read magazines and newspapers and watch serious TV programs, but we're not typical. Americans are notoriously ill-informed or uninformed about the most basic facts of life, things we take for granted, and many can't distinguish between well-attested fact and whatever their friends may take it into their heads to say. Leave them to the tender mercies of the media, and who knows what they might believe or not believe?

If people don't pay any attention to them, are they going to pay any attention to a doctor counselling them on how to live healthier, longer lives? Probably not.

You must be wrong. Random articles in magazines and newspapers, and factoids on TV are easily ignored (if you've even heard them in the first place), but you go to a doctor because you believe he's an expert on health - your health - and you wouldn't be seeing him if you weren't predisposed to believe what he tells you. When I say you, I mean you, and me, and we're much more well-read than the poor. How much more likely that when a poor person goes to see an expert, and pays for it (even Medicaid has co-payments), she will take the expert's advice seriously.

However, please do not misunderstand and think that I feel that people don't need health care. Of course they do. But everyone, rich or poor, with or without a family physician should at least do what they can to help themselves.

We certainly agree about that. Do we also agree that everyone should at least have access to a family physician? Because without Medicaid or insurance, millions of poverty-stricken Americans don't.

[lennygoran]

>How can this be, if they have equal access to health care? You explain this to me, if you can.<

No you're still a better googler than me! I never said the health care was equal--I'm just saying no one is left to die as far as I can tell--if you know of any cases please produce them. Regards, Len

[John F]

>How can this be, if they have equal access to health care? You explain this to me, if you can.<

No you're still a better googler than me! I never said the health care was equal--I'm just saying no one is left to die as far as I can tell--if you know of any cases please produce them. Regards, Len

I'm not asking you to Google anything. Nor is there anything for me to Google. As I pointed out, it's in the nature of deaths among the faceless and nameless poor that they don't get individually reported in the media or show up on Google. But just because something isn't publicized, or reported, doesn't mean it never happens. We have to use such evidence as we have, and our capacity for reasoning, to find as good an answer as the evidence allows.

If the poor had as full access to medical care as you and I do, their death rate couldn't possibly be 30% higher. Of course there are other causes too, but you can't eliminate this one. After all, health care is what allows us to stay healthy and alive longer; when a life-threatening disease hits us, early diagnosis and treatment is often crucial to survival. "Access to health care" is about getting regular checkups by your doctor, visiting specialists when there's a health problem, and undergoing medication or other remedies which can be very expensive. Lacking health insurance, all these services have to be paid for out of your own pocket; I had to do it once, years ago, and a doctor's visit just for a checkup cost me more than $100. I could afford it, but if you're poor, and struggling just to keep a roof over your family's head and food on the table, where's the money to come from? Even Medicaid requires co-payments, some states even charge premiums, and not all poor are eligible for Medicaid anyway. And what doctors and specialists, and pharmacies, will give you the medical care you and your family need, if you walk in and can't pay? You know the answer as well as I do.

It may be that when someone turns up in an emergency room in critical condition with no money and no insurance, the hospital won't turn her away. But by then some are so far gone that they can't be saved even by heroic measures, and others are dead on arrival. These are the cases you asked for, Lenny, even if they don't make the papers or the 5:00 local news. And many of these sad cases wouldn't have come to the emergency room at all, or at least not so much sooner than the likes of you and me, with proper medical care to prevent their condition, or diagnose and treat it in time. What kills them is lack of medical care, just as surely as if the hospital slammed the ER door in their faces.

Paul Krugman assumes that everybody knows people die from lack of medical care, the uninsured poor among them. He doesn't try to prove it, he shouldn't have to, and neither should I; he merely reminds us of it and points out its significance. If you want to deny it, no one can stop you, but denial doesn't make a problem go away, and certainly doesn't solve it.

[RebLem]

>How can this be, if they have equal access to health care? You explain this to me, if you can.<

No you're still a better googler than me! I never said the health care was equal--I'm just saying no one is left to die as far as I can tell--if you know of any cases please produce them. Regards, Len

I already did, earlier in this thread. READ IT !!!!!!!!

[lennygoran]

>If the poor had as full access to medical care as you and I do, their death rate couldn't possibly be 30% higher. <

You don't seem to get what I'm saying-I'm for a universal health plan here in the US--I have brought up the PBS show several times where they show how happy people are with it in other countries. However imo you've taken your eye off the ball--my responses are directed to Paul and the crowd--again no one is left to die as a policy in this country as far as I know:

Here's Krugman's article again:

"But that was then. Today, “free to choose” has become “free to die.”
I’m referring, as you might guess, to what happened during Monday’s G.O.P. presidential debate. CNN’s Wolf Blitzer asked Representative Ron Paul what we should do if a 30-year-old man who chose not to purchase health insurance suddenly found himself in need of six months of intensive care. Mr. Paul replied, “That’s what freedom is all about — taking your own risks.” Mr. Blitzer pressed him again, asking whether “society should just let him die.”
And the crowd erupted with cheers and shouts of “Yeah!”

My response to you and Krugman is as a policy no one is allowed to die in the manner that ugly crowd responded to --right now people don't get equal care as I've said several times to you already--to the extent that a Donald Trump can pay more and get better medical care than me and I have to use Medicare and then first my plan and then Sue's the country is letting me die!

"Paul Krugman assumes that everybody knows people die from lack of medical care, the uninsured poor among them."

Oh so you've spoken with him--send him my best! Regards, Len

[lennygoran]

>I already did, earlier in this thread. READ IT !!!!!!!!<

I read it and of course that incompetence was terrible but as far as I can see that's not the policy of the US right now that the crowd on that show were advocating. Regards, Len