Paul Krugman: Health Care Horror Stories

Politics is "supposed to be about changing the country for the better":

Health Care Horror Stories, by Paul Krugman, Commentary, NY Times: Not long ago, a young Ohio woman named Trina Bachtel, who was having health problems while pregnant, tried to get help at a local clinic.

Unfortunately, she had previously sought care at the same clinic while uninsured and had a large unpaid balance. The clinic wouldn’t see her again unless she paid $100 per visit — which she didn’t have.

Eventually, she sought care at a hospital 30 miles away. By then, however, it was too late. Both she and the baby died.

You may think that this was an extreme case, but stories like this are common in America... How can such things happen? “I mean, people have access to health care in America,” President Bush once declared. “After all, you just go to an emergency room.” Not quite.

First..., visits to the emergency room are no substitute for regular care, which can identify ... problems before they get acute. And more than 40 percent of uninsured adults have no regular source of care.

Second, uninsured Americans often postpone medical care, even when they know they need it, because of expense.

Finally, while it’s true that hospitals will treat anyone who arrives in an emergency room with an acute problem — ... hospitals bill patients for emergency-room treatment. And fear of those bills often causes uninsured Americans to hesitate before seeking medical help, even in emergencies...

The end result is that the uninsured receive a lot less care than the insured. And sometimes this lack of care kills them. According to a recent estimate..., lack of health insurance leads to 27,000 preventable deaths in America each year.

But are they really preventable? Yes. Stories like those of Trina Bachtel ... don’t happen in any other rich country — because every other advanced nation has some form of universal health insurance. We should, too.

All of which makes the media circus of a few days ago truly shameful.

Some readers may already have recognized the story of Trina Bachtel. While campaigning in Ohio, Hillary Clinton was told this story, and she took to repeating it, without naming the victim ... as an illustration of ... why we need universal coverage.

Then The Washington Post identified Ms. Bachtel, the hospital where she died claimed that the story was false — and the news media went to town... Instead of being a story about health care, it became a story about the candidate’s supposed problems with the truth.

In fact, Mrs. Clinton was accurately repeating the story... After all the fuss, The Washington Post eventually conceded that “Bachtel’s medical tragedy began with circumstances very close to the essence” of Mrs. Clinton’s account.

And even more important, Mrs. Clinton was making a valid point about the state of health care in this country.

In other words, this was a disgraceful episode. It was particularly sad to see a number of Obama supporters (though not the Obama campaign itself) join enthusiastically in the catcalls against Mrs. Clinton’s good-faith effort to put a human face on the cruelty and injustice of the American health care system.

Look, I know that many progressives have their hearts set on seeing Barack Obama get the Democratic nomination. But politics is supposed to be about more than cheering your team and jeering the other side. It’s supposed to be about changing the country for the better.

And if being a progressive means anything, it means believing that we need universal health care, so that terrible stories like those of ... Trina Bachtel and the thousands of other Americans who die each year from lack of insurance become a thing of the past.

Comments

[Bruce Wilder]

The Democrats are going to have to figure out what to do with the Media.

I was not particularly impressed when Mrs. Clinton sat down with Richard Mellon Scaife, and chose that moment to feed the narrative about Pastor Wright.

I was not initially impressed with how Clinton handled this Ohio story -- it was allowed to become a story about the campaign failing to vett the candidate's stump speech. But, she's getting the story out now, and that's something.

McCain's supporters have been beating up everyone in sight on "100 years in Iraq". Frank Rich, an unapologetic foot soldier in the War against Gore, was criticizing Democrats for using McCain's statement against him.

I've noticed that the groundwork is being laid at the AP and elsewhere for an "arrogant" Obama meme. I hesitate to even imagine what horrors await Clinton.

I cannot pretend to know who would be a better President. I do know that if you are serious about health care reform or any other progressive advance, you'd better be looking very hard at how to get to 60 Democrats in the Senate. There are 23 Republican Senate seat open to contest in November; right now, Democrats look likely to win 5 to 7 of them, which is incredible, but not enough.

The list is intimidating, but Democrats need to find four or five that they can make very competitive.
Alabama
Georgia
Idaho
Kansas
Kentucky
Mississippi (2)
North Carolina
Oklahoma
Tennessee
Texas
Wyoming (2)
If you can use health care or any other issue to at least scare the Republican candidates in 5 of these states, maybe there's a chance.

Otherwise, Clinton's previous experience with health care as an issue is just rehearsing failure.

[Gil]

So Hillary spreads an urban myth of how the medical system has failed and concludes 'this is we need universal coverage'. Aren't righties going to have a field day with this?! There are 27,000 real life versions of this story each year? Piffle! Prove it! Then again didn't Ronald Reagan spread an urban myth about a 'welfare queen' who was raking it in by having upteen multiple identities? Whilst welfare cheats do exist I don't believe any one has shown an individual 'raking it in' as such. Yet does not crackdown on the concept of welfare keep relying on 'welfare queens'. In other words, the 'welfare queen' myth has been disproven but it doesn't hurt the 'let's get rid of welfare' campaign.

[hari]

If the story was repeated, here, in EU it'd have serious juridical implications with the European Court of Justice, In Luxumburg, pounding on state authorities for human rights violation and whatnot....

[reason]

This comment of mine from a dead thread, might be appropriate here:
http://economistsview.typepad.com/economistsview/2008/04/joseph-stiglitz.html#c110171378

[anne]

The story of Trina Bachtel was grossly mis-reported from the beginning, and mis-reported even as slow and grudging correction came, so I am grateful for Paul Krugman being willing to report the story properly. Neither the New York Times nor the Washington Post properly explained the story, which was properly explained by Associated Press. However, I noticed, the Associated Press story was startlingly changed in editing by several papers taking the feed.

[ECONOMISTA NON GRATA]

What Paul says is true. However, if the Clintons didn't have a penchant for embellishing, this would have never happened. That's why she's not effective and it will be very difficult for her to set policies.

So what are you saying Paul.... Hillary got caught telling the truth.....?

Wow.....!

Econolicious

[anne]

http://www.nytimes.com/2008/04/11/opinion/11krugman.html

"And if being a progressive means anything, it means believing that we need universal health care, so that terrible stories like those of Monique White, Trina Bachtel and the thousands of other Americans who die each year from lack of insurance become a thing of the past."

Agreed completely; universal health care is a basic American right, yet to be realized but nonetheless a basic American right that will be fully realized as we come again to understand our heritage.

[anne]

"However, if the -------- didn't have a penchant for embellishing, this would have never happened."

Rubbish, stop the besmirching hate-filled rubbish; all this does is make me more sympathetic to the candidate. Enough hateful rubbish. Stop.

[anne]

"Wow.....!"

Stop being a hatefully destructive; wow, if that is possible, wow, though who can tell with such a penchanct, wow.

[anne]

Paul Krugman has sought to show for months that there is need for a moderation in Barack Obama's approach to health care reform. Obama's approach will not lead to universal insurance and will be excessively costly in being poorly effective. Change in approach would be reasonably and easily developed by a candidate who was either more willing to learn or less sheltered from criticism.

I am worried about an unwillingness of a candidate to flexibly discuss positions, an unwillingness that has been repeatedly noticed but made no difference for being noticed.

[save_the_rustbelt]

I know that part of Ohio very well.

Twenty years ago it would have been very likely the young woman would have had health insurance.

But now most of the manufacturing jobs in that area have been moved overseas and both the patients and the health providers are in tough shape.

[save_the_rustbelt]

Six months ago the conventional wisdom was that the GOP could not win either Ohio or Michigan, and therefore the next President would be a Democrat.

Now, with the infinite primary, and with Obama telling Michigan to go to hell, there is some nervousness among the liberals in this area.

Can the Dems snatch defeat from the jaws of victory?

I hope not.

[bmh]

I started residency in NY before returning to Europe and completing it. There I did one of my first autopsies on a ca. 78 year old male who died from an infection following bypass surgery of the coronary arteries. He was send home little more than a week after this major operation before the wounds had healed. As he lived alone no one would take care of him so the "send them home quicker and sicker" strategy rebounced. The wound got infected, he needed to be readmitted, ailed for weeks including time spend on intensive care and finaly died. Not quiete as dramatic as the above mentioned story but I would guess that quite a lot of similar seamingly unspectacular incidents like this add up to many many missspend dollars in healthcare.

[Real Person from the Real World]

For a few months as the campaigns started and Michael Moore's Sicko film came out, it seemed like we might finally be headed toward universal health care. Since then all the powers against single payer gov't sponsored health care have rallied, and the candidates are slowly adjusting away from this to hybrids and more of the same 'ol same 'ol. I doubt we will get an improved health care system now. Too much money for too many players, even with a recession creeping in. Middlemen don't like being cut out, and don't give a hoot about anyone, just that they get their cut, preferably as big a slab as they can manage to carve out.

[Real Person from the Real World]

One more thing. It will appear elsewhere in these blog pages, how well doctors are compensated here in the US as compared to the rest of the world. As far as doctors, or any profession is concerned, weren't we told in school, and by HR, and marketers to have a "passion" or choose to do what we "love"? BS, ....when you choose what you love money should be less of an issue. All I see, are people aiming for a quick buck, while the HR department screens out based on demonstrating a lack of passion for every piddling job. This society is getting mean and hypocritical. Unfortunately, it will get worse, as the gentler souls all die out, for lack of health insurance, and the wolves and jackals take over.

[anne]

BMH:

"I started residency in NY before returning to Europe and completing it. There I did one of my first autopsies on a ca. 78 year old male who died from an infection following bypass surgery of the coronary arteries. He was send home little more than a week after this major operation before the wounds had healed."

Dramatic enough, to be sure.

[ilsm]

"lack of health insurance leads to 27,000 preventable deaths in America each year."

The Air Force wants $40B for new Airbus jets so that America can "project power" (do power projection???) to another Iraq like graveyard in remote central Asia and the money gets appropriated.

And more money found when the company is inept and cannot do what it promised.

How many trillions to do 'missions' in imaginary wars while each year tens of thousand die needlessly at home.

Is Admiral Mullin's whim of being capable of fighting 'full spectrum' conflicts anything real much less reason for diverting resources from serious domestic issues?

Will anyone hold up the real costs of the wasteful war machine?

It is a matter of conscience.

[ilsm]

"lack of health insurance leads to 27,000 preventable deaths in America each year."

The Air Force wants $40B for new Airbus jets so that America can "project power" (do power projection???) to another Iraq like graveyard in remote central Asia and the money gets appropriated.

And more money found when the company is inept and cannot do what it promised.

How many trillions to do 'missions' in imaginary wars while each year tens of thousand die needlessly at home.

Is Admiral Mullin's whim of being capable of fighting 'full spectrum' conflicts anything real much less reason for diverting resources from serious domestic issues?

Will anyone hold up the real costs of the wasteful war machine?

It is a matter of conscience.

[Patricia Shannon]

When I lived in Huntsville, Al, I knew a member of the staff of the local help line. She said that if a poor person came to the local public hospital with something like early stage cervical cancer, they wouldn't help her because it was an emergency. When she came back when it was an emergency, they would help her because it was too late. And Huntsville was one of the most progressive areas in Alabama.

[evagrius]

"She said that if a poor person came to the local public hospital with something like early stage cervical cancer, they wouldn't help her because it was an emergency. When she came back when it was an emergency, they would help her because it was too late. And Huntsville was one of the most progressive areas in Alabama."

This is the same logic for Social Security Disability approval with regards to cancer.

[jean]

There is a phrase used by Maggie Mahar in the article referenced a few topics back: social solidarity. We are as far from that concept as a herd of cats.

[reason]

Patricia Shannon - Catch 22 is an American book. This has a long tradition.

[anne]

Patricia:

"She said that if a poor person came to the local public hospital with something like early stage cervical cancer, they wouldn't help her because it was an emergency. When she came back when it was an emergency, they would help her because it was too late."

Please edit this important anecdote to see if it is correct; I am not sure I completely understand.

[ken melvin]

ilsm - succinctly. The cold war, the war on terrorism are examples of collective insanity.

[save_the_rustbelt]

I suggest Krugman read the Columbus Dispatch today, where real reporters tracked down all of the details of the story.

Then Krugman can retract.

[save_the_rustbelt]

I suggest Krugman read the Columbus Dispatch today, where real reporters tracked down all of the details of the story.

Then Krugman can retract.

[reason]

Anne - there is in one place the work "not" missing.

Rusty - link? And you mean there are still some real reporters working for the MSM?

[wogie]

Off point of the issue, but reminds of when I was a kid growing up in Chicago. A couple of times each year there would be a newspaper story of a poor young couple with a sick baby taxiing from one hospital to the next looking for help -- only to be refused and the baby died. Also a time when the father of a High School friend was sent home to die because he couldn't afford to live.

For all the current problem we are a cut or two better than back then.

[bmh]

I don't know what impact the income of medical doctors in the USA have on the overall costs of health care. Beeing a medical doctor by profession I sometimes wonder how much more I could be earning had I gone into lawschool or business school. Generally speaking one does need a certain amount of brains and persistence to get either one of those degrees. My impression is that a graduate from lawschool or business school on average had more bang on the bucks over the last 20 years in the US (again not backed by data). If you take a person with a degree from Harvard medschool versus harvard lawschool/ business school I bet the latter will on average make more money given the obscene compensation in the higher levels of corporate america. In addition to the fact that one had to go 4 year to college, at least 4 years to medschool and after that spend on average 4 years as a resident, likely followed by a felloship with long hours of endless nightshifts etc etc one would need to love the job quite a lot to prefer it over a nicely compensated position as say investment banker which could brain and persistencewise have been within reach (apart from the fact that you don^t need to worry about the amount of you malpractice insurance, to become an obsterician these days in the US means having ample of idealism). In other words if you want welltrained responsible doctors you either need to compensate them similar to above mentioned professions or above mentioned professions should be compensated less or you will run out of doctors on the long run or you will have to internally outsource the medical profession to people who accept lower payment(many doctors in the US are from foreign countries allready, especially in public hospitals, I guess one could call this internal outsourcing).
Maybe my views are distorted because I am now working in Europe where compensation for medical doctors is good but on average not overwhelming.

[Noni Mausa]

gil: ...So Hillary spreads an urban myth of how the medical system has failed and concludes 'this is we need universal coverage'.

Phone a Canadian. Grab a Canadian residential number at random and chat for a while. Compare notes. Give it a try, we're friendly. (Mostly)

I am horrified at talking to my US relatives and friends and hearing them say, "I suppose I should go for testing, but I don't have insurance."

gil again: There are 27,000 real life versions of this story each year? Piffle! Prove it! Then again didn't Ronald Reagan spread an urban myth about a 'welfare queen' who was raking it in ... the 'welfare queen' myth has been disproven but it doesn't hurt the 'let's get rid of welfare' campaign.

Interesting argument -- because one candidate told an untrue story, all candidates stories are untrue? I realise the odds are with you on this one, but in this case the story has the advantage of being provable (those dead bodies are so hard to explain away.)

Medscape is Your Friend:

Uninsured Have Higher Rates of Stroke, Death

http://www.medscape.com/viewarticle/555051
Caroline Cassels
April 11, 2007

Using data from 15,792 participants enrolled in the Atherosclerosis Risk in Communities, a longitudinal epidemiologic study, investigators estimated the hazard of MI, stroke, and death associated with insurance status.

At study entry, participants were 45 to 64 years old and were enrolled between 1987 and 1989. Data on cardiovascular risk factors, personal medical histories, socioeconomic status, and family history were collected at baseline. In addition, all study participants underwent physical examination and cardiovascular and laboratory testing. Patients were also asked about their insurance status.

Individuals were then reevaluated using the same tests every 3 years for a total of 4 visits. In addition, annual telephone surveys assessed changes in health status.

[...]

Compared with insured individuals, subjects who reported being uninsured at least once were more likely to be female and nonwhite, with lower education levels and family income.

Uninsured individuals were also more likely to have cardiovascular risk factors, diabetes, hypertension, and higher body mass index and be current smokers.

Number of Uninsured "Alarming"

Within the total study group there were 444 strokes, 968 MIs, and 1,157 deaths. After adjustment for baseline characteristics, a lack of insurance was associated with an increased risk for stroke and all-cause death compared with those who had health insurance...

and another...

Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1992-2002.
Med Care. 2006; 44(3):277-82 (ISSN: 0025-7079)

Baker DW ; Sudano JJ ; Durazo-Arvizu R ; Feinglass J ; Witt WP ; Thompson J

http://www.medscape.com/medline/abstract/16501400?prt=true
BACKGROUND: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time.

OBJECTIVE: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage.

METHODS: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals.

RESULTS: People who were uninsured at baseline had a 35% higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health, but they were equally likely to die. Of the 1512 people who were uninsured at baseline, 220 (14.6%) died; of those who died, only 70 (31.8%) were still uninsured at the HRS interview prior to death.

CONCLUSIONS: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. ,
And finally...

Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States.
Pediatrics. 2006; 118(2):577-85 (ISSN: 1098-4275)
http://www.medscape.com/medline/abstract/16882810?prt=true

Todd J ; Armon C ; Griggs A ; Poole S ; Berman S
Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA. todd.james@tchden.org

BACKGROUND: There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes.

OBJECTIVE: The purpose of this work was to determine whether children with public or no health insurance have differences in hospital admission rates, morbidity, mortality, and/or charges that might be improved if standards of primary care comparable to those of children with private insurance could be achieved.

METHODS: We conducted a retrospective comparison of hospitalization-related outcomes for children If children with public or no health insurance in the United States in 2000 had the same hospitalization outcomes as children with private insurance, $5.3 billion in hospital charges could have been saved.(My emphasis.)

CONCLUSIONS: There is an opportunity to achieve improved health outcomes and decreased hospitalization costs for children with public or no health insurance if private insurance standards of health care could be achieved for all US children.

This latter study compares outcomes between insured and uninsured hospitalized children, in a chart you can view here: http://pediatrics.aappublications.org/cgi/content/full/118/2/577/T2

Of which one useful datum says:

Mortality rate

uninsured or public insurance 14.1 /100k patients
private insurance coverage 7.6 / " "

Hope that helps.

Noni

[BAWDYSCOT]

"But politics is supposed to be about more than cheering your team and jeering the other side. It’s supposed to be about changing the country for the better."

Politics is just that, cheering and jeering. Governance is what changes this country for the better. And sane forward-thinking governance at that.

[save_the_rustbelt]

http://www.dispatchpolitics.com/live/content/national_world/stories/2008/04/11/hilflap.ART_ART_04-11-08_A1_UE9T91B.html?adsec=politics&sid=101

[BAWDYSCOT]

bmh,

I am with you on this one. I daresay most on this site would agree electricity and water are basic human rights right along with healthcare. To this end should we control the compensation of electricians and plumbers? When your electricity or water go out there is hardly anything else as important to you at the time, eh? Anybody here not think the rights of healthcare workers won't get trampled on once we have universal healthcare? And I am not just talking about physicians(anne); what about certified nursing assistants, the low end of the totem pole.

[Joe]

This links to the Columbus Dispatch article:
http://tinyurl.com/49y8ph

The campaign story is still largely correct, Mrs. Clinton retold a story without checking the facts. Coming on top of her Tuzla fiasco, she was bound to get slammed.

That there are many tragic stories of inadequate health care in America should not be in dispute. One should not need to exaggerate or tell fish stories. Everyone should be familiar with the estimate of the Institute of Medicine that 18,000 people a year die because lack of insurance leads to substandard or inadequate or non-existant care. The Urban Institute pumps that up to 27,000. In either case it puts into stark perspective the perverse priorities of our country.

That Krugman continues with the cheap shots towards Obama is unfortunate. We can make a very persuasive case for the need for massive improvements in health care in America without insulting our allies in the endeavor (as Krugman unwisely has done repeatedly).

[anne]

"I suggest Krugman read the Columbus Dispatch today, where real reporters tracked down all of the details of the story."

I suggest there is nothing in the Columbus Dispatch * today that contradicts what the Associated Press already printed and what Krugman wrote today:

http://ap.google.com/article/ALeqM5hCogqAUxS6h4Ib6RQnVPv0j9EdaAD8VTB2QG0

April 7, 2008

Clinton's Tale Part Truth, Part Errors
By Charles Babington - Associated Press

* http://dispatch.com/live/content/national_world/stories/2008/04/11/hilflap.ART_ART_04-11-08_A1_UE9T91B.html?sid=101

[anne]

"That Krugman continues with the cheap shots towards Obama is unfortunate."

This is complete rubbish, and the sadness is such mean-spirited rubbishers are making sure there will be no meaningful approach to universal health care.

Barack Obama's health care plan is quite faulty and the way in which he has chosen to attack the plans of Hillary Clinton and John Edwards will make correcting Obama's plan almost impossible. I will go further and suggest that Obama is making even a quite faulty plan almost impossible to institute by the rest of his economic program.

[Joe]

This detail from the Dispatch story was NOT in the AP story at all and explains the extent to which she might have been receiving care not just her insurance status.

"In 2005, she joined the O'Bleness Health System in Athens, according to Linda Weiss, a spokeswoman for O'Bleness.

During her pregnancy in 2007, Bachtel was under the care of River Rose Obstetrics and Gynecology, which is part of the O'Bleness system and across the parking lot from O'Bleness' hospital in Athens.

According to Jane Broecker, an obstetrician at River Rose, Bachtel made 14 visits between Feb. 8 and July 31. "She came regularly for appointments," Broecker said.

In addition, records made available by O'Bleness show that Bachtel visited the hospital seven times in 2007 on an outpatient basis. Six of those visits took place on the same day she had been at River Rose.

On Aug. 1, Bachtel was admitted to O'Bleness, where her baby boy was stillborn. Two days later, she was transferred to Riverside Hospital in Columbus and finally to Ohio State University Medical Center, where she died Aug. 15."

[ECONOMISTA NON GRATA]

anne:

Easy please.... I'm first in line for universal heath care. However, we won't see it without draconian campaign finance reform. Trina Bachtel's story is the one in a million (s), it's a daily occurrence and I don't need Hillary trying to pull on my emotional strings on this issue.

I believe that heath care should be treated as a constitutional right. No ifs ands or buts. If you have to raise taxes to do it, raise taxes. I'm a firm believer that the whole heath care industry should be nationalized and if you can't persuade the industry, then coercion is our only option.

As for the Cintons, they missed their calling in 2004. They should have been first in line establishing the opposition dialogue, from day one, instead they jumped on the easy street bandwagon. I used to love Hillary, and still do, but she's a broken toy that cant be fixed.

Best regards,

Econolicious

[anne]

"We can make a very persuasive case for the need for massive improvements in health care in America without insulting our allies in the endeavor (as Krugman unwisely has done repeatedly)."

We can insult repeatedly, as just done, and make sure there will be no health care reform, as just done; and be completely sure I have no need at all for such repeatedly insulting rubbishers as allies.

Get it?

[anne]

Econolicious, this is a completely fair criticism.

"Trina Bachtel's story is the one in a million (s), it's [not] a daily occurrence and I don't need Hillary trying to pull on my emotional strings on this issue."

Obama will almost certainly be the nominee, by the way.

[anne]

Econolicious:

"As for the Cintons, they missed their calling in 2004. They should have been first in line establishing the opposition dialogue, from day one, instead they jumped on the easy street bandwagon."

I understand.

[robertdfeinman]

Language police here (again).
Krugman:
Politics is "supposed to be about changing the country for the better"

Is this true? Has it ever been true? Hasn't the history of politics been that it is designed to preserve privilege and that the only time the "people" get a bigger slice of the pie is when the threat of civil disturbance becomes great enough that those at the top decide that tossing a few bones is better than the risk of insurrection?

Just looking at the US we can see that the progressive periods have been few and far between and always in reaction to a major collapse of the economic order. One can start with the Revolutionary War itself, then look at the Civil War, the reaction to the first Gilded Age, the great depression and the current unfolding reaction to the second Gilded Age.

Power or wealth is never given up, except under threat of a worse alternative (true democracy).

[anne]

"Not long ago, a young Ohio woman named Trina Bachtel, who was having health problems while pregnant, tried to get help at a local clinic.

"Unfortunately, she had previously sought care at the same clinic while uninsured and had a large unpaid balance. The clinic wouldn’t see her again unless she paid $100 per visit — which she didn’t have.

"Eventually, she sought care at a hospital 30 miles away. By then, however, it was too late. Both she and the baby died."

http://ap.google.com/article/ALeqM5hCogqAUxS6h4Ib6RQnVPv0j9EdaAD8VTB2QG0

April 7, 2008

Clinton's Tale Part Truth, Part Errors
By Charles Babington

The AP then spoke with Bachtel's aunt, Susie Casto of Middleport, who helped raise the woman. She said Bachtel, who worked at a pizza parlor, did in fact have health insurance when she and her baby died.

But at an earlier time, Casto said, Bachtel lacked health insurance and ran up unpaid bills when treated at a clinic near her home in Middleport. When she returned for treatment when pregnant, the clinic demanded $100 per visit to help retire the outstanding debt, Casto said. Because Bachtel could not afford the fees and found it difficult to travel, her aunt said, she postponed receiving treatment.

Bachtel eventually went to O'Bleness, about 30 miles to the north, for attention....

[me]

Here in Georgia, Bubba Chambliss, one of of lockstep Bushies, is basically unopposed. He is barely at 50% in the polls yet the state of Sam Nunn cannot come up with a credible candidate to oppose him. very sad.

[anne]

Through Joe:

http://dispatch.com/live/content/national_world/stories/2008/04/11/hilflap.ART_ART_04-11-08_A1_UE9T91B.html?sid=101

During her pregnancy in 2007, Bachtel was under the care of River Rose Obstetrics and Gynecology, which is part of the O'Bleness system and across the parking lot from O'Bleness' hospital in Athens.

According to Jane Broecker, an obstetrician at River Rose, Bachtel made 14 visits between Feb. 8 and July 31. "She came regularly for appointments," Broecker said.

In addition, records made available by O'Bleness show that Bachtel visited the hospital seven times in 2007 on an outpatient basis. Six of those visits took place on the same day she had been at River Rose.

On Aug. 1, Bachtel was admitted to O'Bleness, where her baby boy was stillborn. Two days later, she was transferred to Riverside Hospital in Columbus and finally to Ohio State University Medical Center, where she died Aug. 15....

[anne]

Scott:

"Anybody here not think the rights of healthcare workers won't get trampled on once we have universal healthcare? And I am not just talking about physicians; what about certified nursing assistants, the low end of the totem pole."

The last thing I would wish is to lessen the bargaining power of healthcare workers, from technicians to nurses or physicians. Right now healthcare workers are set against private insurance companies or a public insurer such as Medicare and Medicaid or a public employer such as the Veterans Administration. Why would bargaining ability be lessened as ever more people are insured privately and publicly?

Why can't bargaining ability of healthcare workers even be increased? What am I missing?

[Bruce Wilder]

rdf: "Is this true? Has it ever been true?"

Sometimes, yes. Out of the crooked timber of humanity, no straight thing has ever been fashioned, of course. So, all blessings are mixed blessings.

The American Revolution did entail a massive shift to greater egalitarianism, which was reinforced and extended by Jefferson and Jackson in later periods.

The American Civil War was a complete revolution in American politics and economics. The Slavepower plutocracy of the day was put down with great loss of life and property (and "property" -- 4 million slaves were freed).

The Progressive Era and World War I saw some great advances. During the 18 months of government control of the economy in WWI, real wages -- held down for decades -- rose by 50%.

FDR's New Deal and WWII policies changed the country dramatically for the better. LBJ's War on Poverty reduced poverty significantly.

It is true, that today, a relatively small would-be plutocracy is setting up an authoritarian government and squeezing money out of most of the country. Lots of people know that the economy is bad, and they think it's raining, when, in fact, we're being pissed on. So, if you see what's going on, the complacency and naivete is annoying. But, sometimes, the "good guys" do fight and win.

[Andrew]

Collective bargaining coverage in the private sector: 8.1%

Collective bargaining coverage in the public sector: 40.1%

I imagine the lower tier heathcare workers will not be disadvantaged by nationalization of the industry.

[im1dc]

Health care in the USA is a hot button issue for me and therefore I read these econ discussions with great interest.

From many years of reading Editorials and comments I have concluded that the typical American today wants to change the current system of health care delivery to provide for every American.

Most of the comments here are typical of those elsewhere, compassionate, caring and committed to a positive change that improves every Americans health care yet uncertain of the best way to accomplish it.

Our goal ought to be to give every American Health care and reduce our current wasteful and growing spending of 16% of GDP to a sustainable 12%.

The amazing thing, imo, is that will result in healthier Americans, i.e., spend less get healthier.

Why? Simply put medical interventions cause outcomes and a national program can manage outcomes better than our current system.

That is b/c the current system emphasizes maximizing profit per patient/procedure/code/event and not necessarily desirable outcomes.

That's a subtle but pregnant central point that is difficult to 'get' when considered only on a case by case basis instead of a systemic basis.

Too, I rather like the idea of doctors and other medical personnel being put back in charge of health care rather than today's non-medical personnel. Doctors are NOT the problem, though they are forced to play into the current system to survive.

=============================================

PS Hello wogie1,

I hope you are well, happy, busy consulting and no longer limping.

[anne]

The problem with moving to universal insurance will be having the pool of insured complete, either privately or publicly. That will mean making sure private or publicinsurance is inexpensive enough for every person to afford, which will mean subsidies for many but, as with Medicare, asking people who are not otherwise insured to buy insurance that is affordable.

Why should private insurers be harmed as opposed to be made more competitive? Why should healthcare workers have less bargaining ability as opposed to more?

[anne]

Andrew:

"Collective bargaining coverage in the private sector: 8.1%

"Collective bargaining coverage in the public sector: 40.1%"

Please set down a reference when possible.

Also, I would like to have us move to federal-state revenue sharing to allow for lower tuition costs for public colleges and universities.

[Callahan]

There are plenty of horror stories, just read one bill from any hospital, and you WILL be horrified. But if you pay it, you will be broke, beyond broke, like unca sam, you'll have to borrow fum unca china.

[ECONOMISTA NON GRATA]

The thing that I find most amazing is that some of us "progressives" are still evaluating a "free market" system for healthcare, the "SECRET HAND" of healthcare. How long have we been debating this and what hath this "secret hand" done....?

The "secret hand" taketh away. That's all....

Econolicious

[LMP]

"But are they really preventable? Yes. Stories like those of Trina Bachtel ... don’t happen in any other rich country "

Statements like that are ridiculous and untrue. In Canada we get horror stories like these every other week. Granted we don't pay as much for the whole system, it is far from perfect. And ridiculous and preventable deaths happen all the time, but in our case it is usually related to lack of services or capacity. Not long ago, a kid died of an asthma attack in an ambulance after several hours of running around for an hospital to "accomodate" him.

Krugman should know this, there are no free lunches. You want universal coverage, great. Get ready for another wide range of problems.

[bmh]

re Bawdyscot
To make this clear: I am ardently in favour of universial healthcare for reasons having been discussed at length here and elsewhere. I grew up with this system, had the chance to compare it with the US-system and still think it is better. To make it work the income of highly trained healthcare workers should not be dramatically below the avarage income of a person with comparable level of training in a different field.
Another real life experience: We had a guest over from the states, he is in his early sixties and a (tenuered I guess) professor in science. Having a heart condition he had a syncope eg pasted out once after dinner. He was pulsless for half a minute but recovered after we elevated his legs.
From a european point of view this was a clear indication to visit an emergency room to run an EKG and some blood tests as a basic. We had a truly hard time convincing him to go (actually we all but forced him). He obviously was fearing the costs. Later he said that it had cost him less than 1000 Dollar, a sum of which at least 90% would have been covered by insurance for anybody living in Switzerland, as there is obligatory health insurance here.

[save_the_rustbelt]

If Hillary blows up the Democratic Party this conversation will be for nought.

[Andrew]

Please set down a reference when possible.

Enjoy.

[ken melvin]

Some men can't stand a woman that is smarter than they are.

[Patricia Shannon]

jean says...

There is a phrase used by Maggie Mahar in the article referenced a few topics back: social solidarity. We are as far from that concept as a herd of cats.

Or maybe we are farther from that concept than a herd of cats!

http://www.newscientist.com/channel/life/mg19626324.800-female-alley-cats-call-the-shots-at-mealtime.html

Female alley cats call the shots at mealtime
02 December 2007

Cats live independent - some say selfish - lives, but it seems even Rome's streetwise alley cats are chivalrous when it comes to food.

Many social animals have pecking orders in which the largest males tend to dominate. Roberto Bonanni of the University of Parma in Italy and colleagues found that feral cats in a courtyard in Rome also had a pecking order, determined by displays of aggressive or submissive behaviour. When near the food dish, however, females became dominant – the first time this has been documented in mammals. And although the adults treated kittens as low-ranking, the kittens were allowed to eat first (Animal Behaviour, vol 74, p 1369).

[Patricia Shannon]

bmh
How do European countries handle malpractice claims?

[Patricia Shannon]

Thanks, reason. When I was looking for what caused Anne's confusion, I didn't see I had left out a word.

correction:

Patricia Shannon says...

When I lived in Huntsville, Al, I knew a member of the staff of the local help line. She said that if a poor person came to the local public hospital with something like early stage cervical cancer, they wouldn't help her because it was an emergency. When she came back when it was an emergency, they would not help her because it was too late. And Huntsville was one of the most progressive areas in Alabama.

[im1dc]

anne says...

"The problem with moving to universal insurance will be having the pool of insured complete, either privately or publicly."

I don't see the problem, please elaborate.

And, "Why should private insurers be harmed as opposed to be made more competitive? Why should healthcare workers have less bargaining ability as opposed to more??"

Are you confusing private rights with public rights here?

In what way do you assume health care workers bargaining rights are undermined by National Universal coverage versus today's coverage?

I believe they would exactly the same.

Insurers can be ultra competitive but they don't provide health care to anyone, they sit on top of the health care system administering it essentially by approving, denying or limiting health care to enable the insurer to make a profit.

If there is a one sized fits all national universal health insurance plan there is no need for the thousands of individual health insurance contracts we have today or the people to see that they are enforced or the profit needed to pay the executives of the insurers.

The savings there can and will be redirected into providing health care to patients. This aspect is how countries with National Universal health care cover everyone, more goes to the workers in the system not administration.

There is a massive savings to be had there. Yet, there still would be a health insurance industry.
Insurers can come up with plans that cover over and above what the National plans cover like the Medicare Plus plans do now for Medicare recipients.

That is important to understand b/c insurers just pass along costs by raising premiums or restricting what they will pay for and how much they will pay (effectively shifting more costs to patients).

As I see it once health care is National and Universal everyone is covered and providers know they will be paid--at some to be determined reimbursed rate.

In National Universal coverage providers will have to budget so that they make a profit from the number of patients they see (per capita AND health outcomes) RATHER THAN the number of 'interventions per patient' regardless.

They do that now and they can adjust and do it under a National Universal Plan once they know how they are going to be reimbursed and how much.

In essence they will be seeing more patients and will have to become more efficient at doing so to make the same amount of money.

One tried and true way this was accomplished in the past was when doctors participated in open to the public 'clinics' that focused on specific problems, e.g., children or immunizations. No reason why that cannot be done today for heart disease, diabetes, obesity, HBP, eye care, dental, etc.

Clinics are a more efficient way to see more people. I can imagine signs saying 'Wednesday is Cholesterol Clinic Day, get yours checked'. As long as National Universal Health Insurance covers it I imagine someone in the medical community will find a way to profit from providing it so why not stress early intervention over crisis interventions?

That goes to health care coding, which is too complex a subject to discuss here, although most here I assume already are aware that moving to family practitioners and away from the current dependence upon medical specialists will save the system big money, improve overall health outcomes and measures as well as enable everyone to be covered.

Dependence upon medical tests, toys, procedures and the newest pharmaceutical has not commensurately improved Americans health.

Protecting private rights over public rights in health care is like protecting the snake oil salesmen and turning your back to people that die from the poison sold them.

Truly the balance in health care needs to tip in favor of public rights or all we can ever hope for is to be fleeced by providers who promise the moon but deliver early graves.

[im1dc]

Anne,

BBL.

[observer]

"How do European countries handle malpractice claims?"

In part, European countries have less of a problem with malpractice claims because the issue of paying for remedial medical treatment is off the table.

[heckler]

nice article in yesterday's oregon daily emerald.
http://media.www.dailyemerald.com/media/storage/paper859/news/2008/04/10/News/Supply.And.Demand-3316069.shtml

[anne]

"The problem with moving to universal insurance will be having the pool of insured complete, either privately or publicly."

The problem in partial health care insurance coverage becomes a loss of a significant number of the healthiest people who choose to have no insurance thinking they will need to important care or will be able to buy insurance when they do need expensive care or thinking they will be cared for when necessary whether even if they have no insurance.

This predictable problem will signicantly raise the costs for those insured all through, almost certainly worsening public health as such.

[Francois]

"universal health care is a basic American right"

Moreover, it would be a tremendous economic benefit for all, businesses included.

That there are so many Americans unable to fathom this simple fact reminds me of the lapidary comment by J.F. Revel about his compatriots:

"One has the right to wonder by which miracle the average French can think."

[anne]

Patricia and Reason,

"She said that if a poor person came to the local public hospital with something like early stage cervical cancer, they wouldn't help her because it was an emergency. When she came back when it was an emergency, they would [not] help her because it was too late."

I was not sure where the "not" should go; this helps.

There are often anecdotes about health care problems in Canada, but please do keep references so the anecdotes can hopefully be read initially or followed in context, as the story of the problem Trina Bachtel seemingly encountered.

My understanding of the Bachtel story is failure to gain community treatment when ill, which is a problem that can effect veterans as well by the way and possibly the problem of a boy being transported in an ambulance in Canada only to find no treatment. I have no idea at all what the Canadian story might mean.

[anne]

IM1dc,

Point for fine point.

Notice that universal health care insurance can as such limit legal claims-awards, since future health care is systematically provided.

Curious slip, I wrote "boy" not "kid" because I think, before checking, that boys are more likely to have asthma.

"One has the right to wonder by which miracle the average French can think."

Brilliant.

[Icarus]

Ok, I'd like to ask a dangerous question (in this crowd).

We seem to have a consensus that our healthcare industry failed this particular patient.

I wonder if a citizen can fail her society, as well.

Is it problematic to any here, that someone who can't afford $100 in fees, chooses to get pregnant? Isn't this the height of irresponsibility?

This is the exact problem the Right abhors...people making decisions they can't reasonably afford, and then complaining that society isn't covering the gaps.

If you can't afford a $100 bill, how will you raise a child?

[Jay]

"If you can't afford a $100 bill, how will you raise a child?"

Icarus, you COMPASIONLESS CONSERVATIVE! How can you not see that it is Bill Gate's/Any other rich person's responsibility to provide for said women to give birth and any expenses necessary to raise this child. It would be irresponsible of Bill Gate's not to provide such support. And if necessary the government should threaten to put rich people in jail if they do not comply.

[Patricia Shannon]

As usual, Jay & Icarus are making a lot of assumptions about a someone they have never met. There's no use pointing out specifics, because they are not interested in fairness, but in the joy of attacking others. They are pitiful because they don't know the greater joy of empathy, but then they don't know what they're missing.

[mik]

jean says...

There is a phrase used by Maggie Mahar in the article referenced a few topics back: social solidarity. We are as far from that concept as a herd of cats.

You can have multi-cultural society or you can have social solidarity, you cannot have both. Iraq, Yugoslavia and Lebanon are just most recent examples.

An important study by Harvard political scientist Robert Putnam (author of “Bowling Alone”) finds that the more ethnically diverse a community is, the lower the level of trust in the community - even trust between members of the same ethnic group. Putnam is not anti-diversity and notes that immigration is beneficial for countries that send and receive immigrants. However, his study finds that “in the presence of diversity, we hunker down…[w]e act like turtles. The effect of diversity is worse than had been imagined. And it’s not just that we don’t trust people who are not like us. In diverse communities, we don’t trust people who do look like us.”

[anne]

Econolicious, I am sympathetic to a single payer health care insurance system gradually phased in with private insurers offering supplemental whole or partial policies as in Germany. Such a change, however, is not politically possible now.

IM1dc,

Again, I find every suggestion interesting and will wrties myself notes adding to them.

[anne]

As for Trina Bachtel, the need was only to have wished her and her infant all the world.

"Wrties" is really "write," I promise.

[Jay]

"They are pitiful because they don't know the greater joy of empathy, but then they don't know what they're missing."

As usual those that favor the ends justify the means even if it tramples on our freedom to private property make assumptions about a someone they have never met. You can't even begin to imagine how much good has resulted because of my VOLUNTARY charitable donations. But Patricia says that I "don't know the greater joy of empathy". Thanks for telling me something I didn't know about myself.

[Icarus]

It's a sad attempt to silence any discussion. Anyone questioning the decision making process to put oneself in such a dangerous place, is now 'pitiful' and doesn't know 'empathy'????

Sad.

Empathy is important, no doubt...and I don't assume you have any simply because you argue for distributing other people's money.

That said, unless we get to the root cause of these incidents, we'll never evolve into a more considerate society.

The question again...Sure, we can belabor the need for better health care service...even 'free' health care service ad infinitum.

But, what responsibility does the individual have? Can people just get pregnant, without any personal responsibility and financial security attached to that decision, and then expect the social whole to subsidize all basic needs? Who gets this deal? All? Legal? Illegal?

If you can't pay a $100 bill, something is clearly wrong. Having a child is an incredible decision, and requires signficant financial, and non-financial investment. Those who do it beter will raise the next great generation. Those who do it with carelessness are actually the source of cyclical poverty.

So, alongside our contempt of not having better healthcare, why is there not more contempt of irresponsble 'parents'? That contempt rarely comes from the 'free healthcare crowd'...it's as if people can do anything they want, however irresponsible, and it's always the wealthy who screwed them. This mantra gets tiresome, and is losing its hold on the uber-consuming masses. It's probably why class consciousness, in the marxist sense, has rarely taken hold in recent decades.

[Jay]

Icarus: Sometimes I sense these people are really hardcore socialists that hope for all things to be run by central planners. What you do is you implement policy that punishes rational humans and reward the irrational. By doing so you eventually make it rational to be irrational. Then once everyone becomes used to acting irrational we will have no choice but to rely on central planners to survive.
Think about their plan to bail out people that bought overpriced homes in 2005. Next time homes become overpriced I would expect many of those people who rationally rented the past few years to "rationally" buy into the next bubble, anticipating that the government bails them out.

[don]

Yes. And there are other health care stories as well. There are huge allocation problems when you take away (or reduce to a nominal amount) the cost a user bears for a service. As an example, at one time it was a fad in Washington DC for people to call an ambulance merely to get quick transportation from one part of the city to another. So, nurses had to triage ambulance calls. Of course, the inevitable happened, and a patient in dire need of care died, because the nurse couldn't be convinced the call was legitimate. I recall a visit to the GW emergency room (for my wife), and seeing a bouncer manipulating steel balls in his right hand roaming the room. It took me awhile to grasp why he was there. My boss had open heart surgery for less than the charge made on behalf of a friend's mother (who was on medicare) for one night in the hospital as a result of unexplained chest pains.

[billyblog]

ICARUS: Is it problematic to any here, that someone who can't afford $100 in fees, chooses to get pregnant? Isn't this the height of irresponsibility?

ICARUS' MOM: Icky, I wonder why you use the word "chooses" with so much certainty?

ICARUS: You're not suggesting Trina Bachtel was raped? Or that someone's condom was defective?

ICARUS' MOM: No, Icky dear, and I really don't know what went on in this specific case. But I wonder if you have any idea of the asymmetry between men and women when it comes to the matter of pregnancy?

ICARUS: C'mon Mom, in this day and age? With Women's Lib and all the birth control devices we have at our disposal? You could never do a convincing contemporary update on American Tragedy.

ICARUS' MOM: Hmm. I guess you're right, Icky. You're always right, especially about matters involving gender. And besides, I'm sure the father took time out to make sure Ms. Bachtel had taken all her birth control pills and/or had her diaphragm securely in place.

ICARUS: That's right, Mom. So either it was an accident – and no one's to blame – or it was her fault and she really was being irresponsible in getting pregnant if she couldn't afford to pay $100 to consult a doctor.

ICARUS' MOM: Well I think you misread that part of the story, Icky dear. As it turns out, she was actually insured and could in that sense "afford" at least the medical treatment for the pregnancy, since her insurance would cover it. It simply appears that she avoided going to a local clinic where she had previously run up some bills when not insured because she'd have to pay them $100 upfront. Or at least she thought that. Possibly a bit of an hysterical overreaction.

ICARUS: You said it, Mom, not me.

ICARUS' MOM: You're right, Icky dear. And I know that such a thought would never occur to you.

ICARUS: You know me well, Mom.

ICARUS' MOM: But do you think maybe Ms. Bachtel was reluctant to put herself into the embarrassing situation where demands would be made that she pay up even more of her past balance due if she continued to use that local clinic throughout her pregnancy?

ICARUS: Look, Mom, have I ever hesitated to embarrass myself when truth is on the line? I mean, don't you read this blog regularly?

ICARUS' MOM: Who said anything about a frog, Icky?

ICARUS: Blog, Mom, blog. Oh, never mind.

ICARUS' MOM: Uncle Joe used to catch some really big bullfrogs. Remember Icky?

ICARUS: Oh yeah, Uncle Joe, my favorite uncle. Man, when he brought home those bullfrogs, and I put 'em in Suzy's bed ….

ICARUS' MOM: Yes, you were always sensitive with your sister, Icky. Anyway, Ms. Bachtel appears to have decided to go for treatment 30 or so miles away rather than go back to the local clinic where she still would be in the embarrassing situation of owing money.

ICARUS: Thank you for making this point, Mom. Because it just adds to my argument about healthcare insurance.

ICARUS' MOM: How's that, Icky?

ICARUS: Hmm, I see you don't read this blog. Anyway, why should we design a medical system to protect people against their indiscretions, whether they be sexual or financial?

ICARUS' MOM: Funny you should mention indiscretions, Icky. Now that your Uncle Joe is no longer with us, there's something I've always wanted to tell you ….

[halbhh]

The Boston NPR station WBUR reports this evening that in Massachusetts (mandatory health insurance state), that finding a primary care doctor is difficult to impossible now that the Universal Health Care is imposed on us. One doctor commented on the radio: I can't even find one for myself.

Krugman previously made the mistake of saying Universal Health Care would lower costs.

No.

Supply and Demand set costs.

To lower costs you must increase supply vs the level of demand.

With Universal Health Care we raised demand without increasing supply.

[JRossi]

Carroll and Ackerman Ann Int Med April 1 2008 (via the Health Care Blog) state that 59% of physicians surveyed in 2007 favor universal health insurance in the US, up from 49% in 2002.

[Patricia Shannon]

halbhh
There was a shortage of doctors in Huntsville, AL, all of my adult life there, from 1973-1992. I wanted to changed doctors, but all the doctors I called weren't accepting new patients if they already had a doctor, or sometimes not accepting new patients at all. So not having universal health care doesn't ensure that there will be an adequate supply of doctors.

You presented no evidence that Massachusetts had more doctors before Universal Health Care. You presented no evidence that states w/o Universal Health Care fared better than Massachusetts during the same time frame.

An increasing shortage of medical personnel has been predicted for quite awhile, because of the aging of the population. Baby boomer doctors are retiring, and at the same time aging baby boomers need more medical care.

[James Killus]

People who deride compassion are either sure that they will never need it, or sure that they will never receive it. Either way, it's very sad, but then, that's just compassion speaking.

[jeff hoffman]

The original story of Trina Bachtel was as much about access to healthcare in rural America as anything else, a la the Huntsville example of P. Shannon. Now imagine that suddenly the population of patients in Huntsville goes up 25-30 %. Are they going to get more physicians there to accommodate those people? Hardly. Bear in mind also that the physician in Huntsville suddenly is not as tied to that location as previously. Suddenly there's also more access to patients appropriate to his/her business model (paying customers) elsewhere in places with better schools, more culture, shopping, etc. Not to besmirch Huntsville. And certainly the individual physician may have ample personal reasons for living in Huntsville: local family, big backyard, etc. But one of the unspoken attractions of a rural practice is that in underserved communities in which there is less competition, reimbursements from third party payers tend to reflect that. When that financial incentive goes away , some physicians are likely to as well. So I am curious as to what will happen to healthcare in rural America with Universal access. That does not constitute an argument against the appropriateness of Universal Healthcare, mind you. I'm all for it. Those 25-30% are entitled. But I suspect that its detractors will likewise be able to cite a similar such tragedy to Trina Bachtel's at some point in the future if the dynamics of Universal healthcare are unfavorable to parts of the rural environment, ultimately, via physician migration, closing doors to new patients in an already overstressed environment described above etc. One more thing: although PK would like to smooth over the discrepancies in Clinton's telling of this story, if I'm the least bit sophisticated about healthcare and someone tells me a story about an ER verbalizing the refusal of care on reimbursement grounds, my first response is to assert that that is illegal. I'm not saying that everybody knows this, irrespective that it's posted in bold print in English and Spanish in every ER in the U.S. But a highly educated lawyer well versed in healthcare in this country should know this. Instead the patently inaccurate account was promulgated as fact. Not impressive.

[amoney]

Consider a business that sells a set of products, all of which they don't make, along with some value added as to which product is best for a customer. Now consider that for every say, 10 sales, they get stiffed on 1 or 2 by the customers who don't want to or can't pay. What happens to the other 8 or 9 customers who honor their obligations to pay for a product/service? They pay more, possibly a lot more. The business cannot refuse customers, and must somehow makes ends meet or the business will fold. Sound familiar? How many hospitals in border towns, rural locations, and ghettos have shut down in the past 5-10 years? Bottom line, universal health care can't fix this problem, it will just distort it in ways we can't imagine. You take the profit motive out of health care and doctors and nurses will be much harder to find. UHC would require that those who already pay, pay more to cover the rest who don't or won't. I would prefer getting rid of the HMO's and the whole deal where your company pays for part or all of your health care and just directly deal with a doctor, cash on the barrel head - service is better without the overhead nightmare of HMO's processing of payments.

Health care is not a right bestowed upon birth. No government can ever keep that promise as you people envision it.

[Patricia Shannon]

amoney says...

Police and fire protection are not rights bestowed upon birth.
===========================================
And btw, Huntsville, AL is not rural. It has 3 universities, plus branches of several other universities and colleges. It's the home of NASA's Marshall Space Flight Center.

http://en.wikipedia.org/wiki/Huntsville,_Alabama
As of the 2000 census, the population of Huntsville was 164,570. As of 2006 Census estimates the Huntsville Metropolitan Area had a population of 368,661 with the city proper having 168,132 residents.[1] Huntsville, and its cross-river neighbor Decatur, combine their separate metro areas to form the Huntsville-Decatur Combined Statistical Area, which, in 2004, had a total population of 510,088.

[Icarus]

Billybob,

Nice script, but, slingblade it is not.

So, are you saying that pregnancies such as this one always have a 'rational' core, and it's the system which fails people? Who knows for any particular case...

The issue is responsibility. There are irresponsible pregnancies, and both parties are to blame. For every silly script you can write, there's 10 others with a "hey baby" at the beginning, middle, and end of it.

A pregnancy is a horribly important event...it should be treated with the utmost care. When people skip that step, and impregnate one another without proper planning, the cycle of poverty continues.

It seems like many of you confuse compassion with tolerating irresponsibility. These pregnant mothers are not innocent, by any standard. They're purposely risking the next generations life, and daily welfare, with their idiotic decision to become a parent before they can even handle being an adult.
Lets incentivize differently. Government handouts will only further create an underclass of people who are unskilled, quasi-literate, and unable to compete.

[Icarus]

When I was learning chess I recorded a game moves and later showed it to a local Master (who could play 30 games at once and evaluate a situation at a glance). When I asked what to do in this position, his reply was: "you won't be a good player until you realize that you don't understand the problem: it is not what to do in this position. It is how do you avoid getting into this position".

[Icarus]

The above is a quotation...

[Brian]

According to Jake Tapper of ABC, one of the key points of Krugman's column is wrong- that the pregnant Bachtel was refused care unless she paid $100. She had owed thousands of dollars to the clinic from years before for care when uninsured. At that time she had sought more care, and had been told she needed to make a good faith effort on her unpaid balance. Years later, while pregnant, she ASSUMED she would not be treated, and so did not go to the clinic for treatment. But the clinic had a policy to treat certain classes of patients, including pregnant women, regardless of ability to pay. But hey, why let the facts get in the way of a political point.

As Tapper tells it:

First, years ago, Bachtel was told she needed to pay $100 before she would be seen by a doctor not because they wanted the money up front, but because she owed the clinic money.

Second, this did not happen at a hospital, but at a private physicians' clinic. Specifically, Holzer Clinic in Gallipolis, Ohio. Hospitals are legally not permitted to deny care to anyone. The rules are quite different for clinics.

Holzer Clinics Inc. is a private series of clinics (not to be confused with Holzer Hospitals). Holzer Clinic Inc. has nine offices throughout southeastern Ohio and West Virginia. They take in about 500,000 patient visits a year, including more than 100,000 Medicaid patients a year and maybe 25,000 patients with no insurance.

Holzer Clinics Inc. tries to work with patients who accrue medical debts. But there are times when a patient mounts up debts and the clinic system believes he or she needs to make more of an effort.

When that happens, the patient enters an "advanced payment status." Before the doctor will see the patient at this private clinic, he or she is asked to pay $100. If the patient says he cannot pay, he or she is counseled to go to a hospital emergency room.

This is what happened to Trina Bachtel, who at the time had no health insurance.

There are exceptions. Doctors at Holzer Clinics Inc will see patients in "advanced payment status" if, for instance, they have been referred out of an emergency room, if they've since gone onto Medicaid, or if they're receiving workers compensation. Cancer patients in chemotherapy, and pregnant patients will be seen whether or not they pat the $100.

**

Which brings us to the third point: when Bachtel was told she needed to pay the $100 before the visit -- and court records show that she'd owed thousands of dollars to the Holzer System -- she was not pregnant.

Bachtel got pregnant and in 2007 suffered through a difficult pregnancy, suffering from preeclampsia, characterized by high blood pressure and the presence of protein in the urine, effecting 5-8% of all pregnancies.

At that time she had health insurance.

For whatever reason, she thought that she would need to pay Holzer Clinics Inc. $100 and she did not go to the clinic.

"She was told she had to have $100 upfront and that's why she never went there when she got pregnant," one of her family members told me.

Later she went to O’Bleness Memorial Hospital when it was an emergency.

Her son was stillborn there on August 1, 2007. She was airlifted to OSU Medical Center in Columbus, where she died two weeks later.

**

It is all sad. It is all tragic. The family is grieving, and the renewed scrutiny of it all by the media -- prompted by Sen. Clinton using the ancedote -- is bringing them back to those dark days last August.

Those are the facts. A young woman lost her life and the life of her child. But no hospital or clinic denied her coverage as a pregnant woman. She had insurance when she died.

[anne]

There is the typical spate of crazed lying monstrousnessness from the typical crazed lying monsters, and I am trying to understand whether it matters. I think so, because this is what bullying is about and bullying should matter, but the craziness is such that I am not entirely sure.

[anne]

"But hey, why let the facts get in the way of a political point."

But hey, monster, what is the political point?

Please do explain what the political point is, monster, because I am trying to understand the political point monsters find beyond the fact that we each have a right to health care insurance and to health care and tens of millions of us have no health care insurance and have problems with access to health care.

[anne]

I am still waiting for the evidence of a "kid" dying of asthma in an ambulance searching endlessly for a care center that had a single doctor who could treat a kid dying of asthma in Canada. There will be no such evidence. I am waiting for evidence on any of the crazed comments about showing the rottenness of people needing health care and worried about how to afford the care.

[anne]

What is clear to me, through this latest discussion among monsters, is the real problem is that a woman became pregnant, and we know all about the rottenness of women who become pregnant. It is all so sad, all so tragic, all so so so so so....

[billybob]

ICARUS' MOM: Oh, Icky, you really told that Billybob a thing or two.

ICARUS: Aw, shucks, Mom. You're just biased.

IACARUS' MOM: For sure, Icky. And I particularly liked what you said about pregnancy being "a horribly important event."

ICARUS: That it is, Mom, that it is.

ICARUS' MOM: One thing, though, dear. I was wondering what you had in mind when you said: "When people skip that step, and impregnate one another without proper planning ...." Isn't the process asymmetrical?

[anne]

What matters is that we have certain inherent rights among which is the right to health care, but protecting the right to health care for Americans is so questionable for some that for the cost of a mere days in Iraq we were unwilling to insure 3.8 million needy children.

What is interesting here is the progressive maniacal vilifying of a woman, and that we are dealing with a woman is important and that the woman became pregnant is more important and that the woman was poor is even more important in the vilifying.

[anne]

Imagine a poor woman having the astounding nerve to be ill enough to have impossible medical costs, then or still to even become pregnant. The nerve of such a woman, gone though she and infant may be, let us all smash on her, being a smashable woman and all. We are the woman smashers.

[anne]

http://delong.typepad.com/sdj/2007/04/falling_indicat.html

April 23, 2007

Falling Indicators of Human Development in Mississippi
By Brad DeLong

There are 2.8 million people in Mississippi. About 15% of the non-elderly population--make that 350,000--were on Medicaid.

Cut Medicaid enrollments by 50,000, by 1/7.

42,000 babies born in Mississippi each year.

For the share who die to jump from 0.97% to 1.14%... That's a less than 1/3000 chance.

That's worth saying.

[anne]

http://www.nytimes.com/2007/04/22/health/22infant.html?ex=1334894400&en=5d5d40b319346648&ei=5090&partner=rssuserland&emc=rss

April 22, 2007

In Turnabout, Infant Deaths Climb in South
By ERIK ECKHOLM

HOLLANDALE, Miss. — For decades, Mississippi and neighboring states with large black populations and expanses of enduring poverty made steady progress in reducing infant death. But, in what health experts call an ominous portent, progress has stalled and in recent years the death rate has risen in Mississippi and several other states.

The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors....

"I don't think the rise is a fluke, and it's a disturbing trend, not only in Mississippi but throughout the Southeast," said Dr. Christina Glick, a neonatologist in Jackson, Miss., and past president of the National Perinatal Association.

To the shock of Mississippi officials, who in 2004 had seen the infant mortality rate — defined as deaths by the age of 1 year per thousand live births — fall to 9.7, the rate jumped sharply in 2005, to 11.4. The national average in 2003, the last year for which data have been compiled, was 6.9. Smaller rises also occurred in 2005 in Alabama, North Carolina and Tennessee. Louisiana and South Carolina saw rises in 2004 and have not yet reported on 2005.

Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average....