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Member since: 2002
Number of posts: 35,773

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Fine Piece On The Importance Of Ensuring The Imperfect ACA Moves Forward


"Even inexperienced physicians like me, still in my residency, have these kinds of stories to tell. They’re tragic. But worse, they’re just so stupid. Notice how, in each instance, the problem still ends up being taken care of, only now it’s emergent, farther along, more risky, and of course, more expensive to treat. This is part of the ludicrous nature of the opposition to health care reform. There is no way to get out of paying for these things. All we do by denying people coverage for necessary medical treatment is guarantee that in a few days, months, or years, they’ll be in the emergency room, only now it will cost ten times as much to fix, at greater risk to the patient. This is also backed up by the international experience of health care. Every other industrialized country has universal coverage, many have far superior care, not to mention superior service (France anyone?) to the United States. Yet every one of the countries pays far less per capita (most less than half) than we do on health care. Data from studies within our own country show it’s cheaper for the state to cover the uninsured than to let them stay uninsured. Because of EMTALA, passed by that notorious socialist Ronald Reagan, everybody gets emergency care whether they are insured or not, and fully 50% of emergency care is uncompensated, costs which get transferred to the insured and the tax payers.

For most of us in the healthcare system we see that universal coverage is necessary (unless you reverse EMTALA which will never happen), although we may disagree on how to accomplish it. If anything, the ACA/Obamacare is more of a free-market reform than many physicians would like. Many in my generation (though certainly not in the older generation) would have preferred single-payer, but for reasons I discussed yesterday this is actually not as important as merely guaranteeing universality. Mixed private/public and government payer/private insurance schemes are, if anything, the norm around the world and they work well while still costing less than 50% of what we pay per capita.

So why so much resistance to what should be obvious? There is no way to avoid paying for this stuff, so why don’t we do it more sensibly? Why don’t we move primary care out of the ER? Why not pay for problems when they’re cheap and not emergent?


In order to oppose a reform so obviously needed, so completely supported by the data from international experience and studies from within our own country, and in the face of the obvious gob-smacking experience of every physician in the country, one ultimately must rely on just lying. Politifact, both before and after the Supreme Court decision, has demonstrated this phenomenon. Many of the claims against the ACA have been so rabidly false as to deserve their “pants-on-fire” designation, including the fully debunked death panels nonsense (2009 lie of the year!), that it’s the largest tax increase ever, it’s rationing, or that it is some kind of Obama socialist plot. See the top five lies here. Immediately after the ruling Romney was apparently tripping over his own feet in order to be the first to lie about his own reform package saying it would increase the deficit by trillions, another lie, and Limbaugh reiterated the lie that it was the largest tax increase ever.


This piece contains some great links that support why reform is needed, why it would save everyone money, why it would be positive for the economy, as well as being the right thing to do (even if there are better solutions that we should have pursued). It also offers links debunking GOP BS on ACA.

I offer this up as a hope that we will fight to keep this moving forward.

Anti-Vaccine Rhetoric: When Pro-Safe Is Pro-Misinformation


The Problem With Dr Bob's Alternative Vaccine Schedule


Yes, not directly on topic, but it addresses many of the concerns.

So your friends add anecdotal evidence to the study's outcomes.

PhDs are meaningless when people can't make an actual risk - benefit analysis.


Vaccines – Too Few, Too Late

Unlike you, I actually read ALL of the literature.

And I understand the scientific process develops out of a consensus. I understand the value and the lack of value of a single study. I don't push a ridiculous agendas based on single lines pulled from single studies. That's not how science works. In fact, it's called cherry picking to fit your agenda.

Vaccine studies: Examine the evidence

New vaccine-scheduling study deals blow to safety fears


Which, of course, begs the question: Why do the more educated among us seem more likely to fall for baseless fear?

Alternative Vaccination Schedules


"it was more common for alternative vaccinators to indicate that they themselves (41%) or a friend (15%) had developed the schedule. Among the 36% of respondents who endorsed the “other” response to this query, several indicated in the free-text section that they had “worked with their child’s physician” to develop the alternative schedule."

Thus, we see how many people think far too much of themselves.

Education and Vaccine Uptake



The study also purports to find that the there was an inverse relationship between education level and vaccine use – college-educated mothers were less likely to vaccinate their children. Further, in the 8 years after the Lancet study this gap increased. This education-gap is also in line with previous research, but needs some explanation. We need to distinguish unvaccinated from undervaccinated, and vaccine non-compliance from vaccine refusal. When looking at the undervaccinated, and specifically those who missed scheduled vaccines, this correlates with lower socioeconomic status and less education. This is in line with a more general pattern – the fewer resources a family has the less likely they are to avail themselves of available health care.

However, if you look at those who refuse or delay vaccines as a deliberate choice, there is a positive correlation with the education level of the parents, especially the mother. This may seem paradoxical at first – higher education leading to bad health care decision making, but actually it makes perfect sense. First, let me say that I am taking as a premise that refusing vaccines is a bad decision. For reference just plug in “vaccine” into the search box on this blog and you can read dozens of articles explaining my position. In short, the evidence overwhelmingly supports the conclusion that vaccines are safe and effective and a net health benefit for the vaccinated. Fears over vaccines causing autism or other neurological damage are based upon soundly refuted pseudoscience. So why, then, the reverse correlation with education?

The typical hypothesis, which is plausible but untested (as far as I know), is that higher education levels leads to greater access to information, specifically on the internet, where vaccine fears have largely been spread. If you are not exposed to misinformation about vaccines then you cannot act on that misinformation.

I also think, however, that this is part of a larger phenomenon – a direct relationship between education level and general acceptance of pseudoscience. Prior surveys have found a correlation between higher levels of education and belief in ghosts, ESP, and alien visitations. Education superficially seems to make us more gullible. However, the interpretation of this result, in light of other psychological research, is different than just gullibility. Access to information is likely part of the reason for the correlation between education and belief. Another factor is likely that as we get smarter we get better at justifying our own beliefs. Having an education can make someone more confident in defending their offbeat beliefs, and better able to defend those beliefs from the skeptics.



If having an "education" meant that you had learned the scientific process in total, that might be a good thing. But, in this world, it does not mean that. Oddly, "education" sometimes makes people think too much of their own knowledge.



Read up to learn about lives saved and hospitalizations avoided via the varicella vaccine.

And to cover the others: http://jama.jamanetwork.com/article.aspx?volume=298&issue=18&page=2155

Please educate yourself. Pushing such a meme seems to be unethical, IMO.
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