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October 22, 2007
Chronic Disease
If you were asked what the #1 cause of death among the homeless was, what would you answer? Exposure? Crime? Drug overdoses?
It's none of those. The #1 cause of death among the homeless is untreated chronic disease. It's also a major cause of homelessness. The Washington Post tells the story of Vaughn Bell -- he had a solid job at a teen rehab clinic, an apartment, a good life. "The sickness stripped it all away. Everything. Bell fell ill with kidney disease. Because he was sick, he couldn't work and lost the job. Because he lost the job, he lost his apartment and had to go to a homeless shelter. Because he lived in a homeless shelter, he had to take two trains and a bus to get to dialysis treatments. He fell behind, stopped caring for himself, then just stopped caring."
This isn't a policy post, necessarily. I don't know how to holistically end the ravages of chronic disease. A universal health care system could ensure treatment, but it can't keep you from losing your job, or from having to travel too far for care, or from falling into depression and giving up, or from lacking the money to purchase the sort of food your body needs. But it's worth thinking about.
October 22, 2007 | Permalink
Comments
Vaughn Bell story is sad, but with the Hill & Bill Insurance plan at least he'd have been forced to buy health insurance after he lost his job and that's where tax credits really make a difference....not
Posted by: S Brennan | Oct 22, 2007 1:55:30 PM
But it is -- insurance would've probably been free for him. Tax credits aren't fake!
Posted by: Ezra | Oct 22, 2007 1:57:48 PM
Well, one thing single payer could do is promote preventative care, which saves the government money in the long term.
And this is certainly a distinction between single payer and the Republican model of health savings accounts, as well as the Hillary model of making criminals out of those who can't afford insurance. Those plans seem to be based on the idea that we should discourage preventative care to control costs.
Posted by: Dilan Esper | Oct 22, 2007 1:59:24 PM
Ezra,
I have the greatest respect for you [probably unrequited], however your faith in Hill & Bill is misplaced. The end of the 90's look good [is there another tech boom on the horizon?], but Hill & Bill's record really lies in their fecklessness to democratic party principles and their willingness to undermine progressive cause in favor the wealthy elite. And as this past week proves, everybody and their brother in the Democratic party wants try their hand at capitulation...er...um...triangulation.
Shorter Hill & Bill...they want to be liked by those with wealth and power.
Posted by: S Brennan | Oct 22, 2007 2:11:50 PM
I used to work as an RN in a crisis triage center--essentially, a psychiatric emergency room--and I saw this kind of thing all the time. The 2 cases I remember best were a man who'd recently had a heart valve replacement, and a woman with a tooth infection. The man had an intake BP of about 230/120 (dangerously high), was dizzy and seeing spots (potential warning sides of an impending stroke), and admitted he hadn't been taking any of his medication. He obviously had just given up. (I sent him to the ER immediately, but they released him the next day, probably because he wasn't invested in further treatment.) The woman told me she had recently had endocarditis (a severe infection of the heart) as a result of a tooth infection (the bacteria traveled to the heart), and she had a new tooth infection. I made sure she got her antibiotics, but she was homeless and had no money or insurance to get the tooth treated, which was what she needed. Both of these stories are good examples of how lack of ongoing care creates unnecessary, expensive emergencies, but they also reflect the desperate circumstances in which we force some people to live.
Posted by: beckya57 | Oct 22, 2007 2:47:32 PM
without disability, a family or significant other that will help to provide a safety net, the suffering, care and exhaustion of chronic disease can quickly deplete financial and emotional resources.
...good health, safety net,loving family and friends are gifts never to be taken forgranted.
as well as the caring nurses in crisis triage centers.
Posted by: jacqueline | Oct 22, 2007 3:14:24 PM
"The man had an intake BP of about 230/120 (dangerously high), was dizzy and seeing spots (potential warning sides of an impending stroke), and admitted he hadn't been taking any of his medication."
In other words, its his own fucking fault. This shit is going to happen regardless of whether we have socialized medicine or not.
"He obviously had just given up. (I sent him to the ER immediately, but they released him the next day, probably because he wasn't invested in further treatment.)"
What are they supposed to do? I'm sure the docs put him on IV antihypertensives until his BP became WNL. Once that happens, there's no reason to keep him. It would be irresponsible to keep him at that point. Whats the point of keeping somebody in a $5000 per day hotel when he's rock solid stable?
"The woman told me she had recently had endocarditis (a severe infection of the heart) as a result of a tooth infection (the bacteria traveled to the heart), and she had a new tooth infection. I made sure she got her antibiotics, but she was homeless and had no money or insurance to get the tooth treated, which was what she needed."
Ah yes. She obviously needs a dentist. Problem is that dentists refuse to take Medicare, Medicaid, or people without insurance. I dont blame them. Dentists make more money than doctors now, with less training and the reason why is because insurance only penetrates about 40% of their market, compared to 99% of medical care.
Even socialized medicine wont solve the problems with access to dentistry, unless dentists are somehow forced into the network as indentured servants to the government.
Dentists, unlike doctors, are in the position to tell the government to fuck off. They have other options in terms of getting paid.
"Both of these stories are good examples of how lack of ongoing care creates unnecessary, expensive emergencies, but they also reflect the desperate circumstances in which we force some people to live."
Yes but that has nothing to do with socialized medicine. Socialized medicine wont help person #1 because he's an idiot who simply stopped taking his meds and it wont help person #2 because socialized medicine is not going to force dentists to see patients on the government roll.
Posted by: joe blow | Oct 22, 2007 3:32:25 PM
Well, one thing single payer could do is promote preventative care, which saves the government money in the long term. - Dilan Esper
In theory, HMOs were supposed to do the same thing with respect to saving money for privately paid for health insurance, and we all know how that's worked out.
Posted by: DAS | Oct 22, 2007 3:35:54 PM
Joe Blow, re: dentists
Dentists have certain occupational hazards that physicians don't. Much of their work is actually physically quite demanding and many dentists don't have as long of a useful career-span (due to neck injuries and such) as physicians. So it isn't necessarily "wrong" that dentists make the money they do -- they have to save more for a potentially much longer retirement.
Posted by: DAS | Oct 22, 2007 3:39:38 PM
Universal health insurance seems like a side issue here. As someone you linked to pointed out earlier this week (I'm way too lazy to look this up right now), the main benefits of universal health care are not that everyone will necessarily get healthier but that the economy will be less constrained, more flexible. Homelessness is a complex issue that can't be solved by programs really intended for other purposes.
Posted by: Antid Oto | Oct 22, 2007 3:42:39 PM
Based on the description in the article, it doesn't sound like universal health care would have made any difference to Vaughan Bell's situation. His problem wasn't that he couldn't get treatment for his illness, but that he got sick and lost his job and became homeless and basically just gave up.
This story again highlights the fact that the primary costs of serious illness are not medical bills, but all the indirect costs that wouldn't be covered even if we had universal health care, most especially lost income.
Posted by: JasonR | Oct 22, 2007 3:44:41 PM
Well, one thing single payer could do is promote preventative care, which saves the government money in the long term.
There are far more cost-effective ways to prevent illness than universal health care (let alone "single payer" universal health care). I seriously doubt that universal health care would have much impact on the rate of smoking, for example. But a public health program specifically targetted to reduce smoking (higher tobacco taxes, greater restrictions on advertising and sales, stronger anti-smoking education in public schools, etc.) could have a major impact.
Posted by: JasonR | Oct 22, 2007 3:51:39 PM
Of course if there actually were, say, a public health program targetted to reduce smoking, it would be denounced by all the usual suspects exactly as, say, the effort to restrict trans fats has been. Whenever it comes to doing a particular thing, champions of the freedom of others to suffer and die without interfering with the champions' wallets will always object to it and cite some other thing as better. But this is a "jam yesterday and jam tomorrow, never jam today" style of argument. It never translates into practical support for a real policy under serious consideration.
Posted by: Bruce Baugh | Oct 22, 2007 4:06:36 PM
S Brennan -- First, i don't know why you keep implying that I don't like you. It's just not the case. Second, the Clintons did their best to pass a very good universal health care reform in 1994. If it had succeeded, Clinton would be in the pantheon with Johnson and FDR as Presidents who presided over a quantum leap in our social safety net. They failed, and in the face of an overwhelmingly Republican Congress, retreated somewhat. But the genesis here was not a lack of conviction.
Posted by: Ezra | Oct 22, 2007 4:18:20 PM
Where's the beef JasonR?
Statements like this:
"There are far more cost-effective ways to prevent illness than universal health care (let alone "single payer" universal health care" - JasonR
Can only been taken seriously if the person making it has provided an detailed and politically feasible outline in an earlier time frame [not one pulled out of your fanny], otherwise it is just unsupported political hackery.
Where is your "far more cost-effective" plan...and please no right blog links...a specific plan that has already been implemented, not some conjure smoke and mirrors.
FYI, Jason, there 41 other countries spending less money, with better outcomes in medical care, all of those countries, pay doctors, insurance and drug companies less and have centralized government control/regulation of the medical BUSINESS. The US model is a failure in both cost and effect...assuming a positive outcome is a desired outcome.
Posted by: S Brennan | Oct 22, 2007 4:31:10 PM
Ezra,
By 1994 Hill and Bill had lost credibility with the progressives in the Democratic party...uh, yeah and um...many of their congressional seats.
As you know Hill & Bill thought Americans really wanted NAFTA...bad. That's even though Bush could not get enough Republicans to like the plan. NAFTA which makes ADM et. al. in the US richer and drives Mexican peasants off their small farms which were acquired through land reform so that the wealthy could buy their farms at fire sale prices. Making the Rich Richer and the poor peasant poorer. Hmmm...ever wonder why I don't like Hill & Bill? Did I mention Rwanda today?
Hill & Bill came up with a plan that allowed insurers to stay in the game, but insurers, saw Hill & Bill lose big due to their heavy handed efforts for conservative causes and decided they did not have to deal with Hill & Bill. Hill & Bill have done the same again, but this time insurers will go along [they like the government mandate], but will strip out the Medicare/Public competing against private or subsidize private insurers like they did with Medicare...and America will once again be hoodwinked by Hill & Bill.
Ezra, I don't have the quote, but Hill & Bill are sworn to bring about a more conservative government...so far it looks like that will be their legacy.
That said, I can be too hard on you and I presumed it was not appreciated....my bad.
Posted by: S Brennan | Oct 22, 2007 4:53:21 PM
"Joe Blow, re: dentists
Dentists have certain occupational hazards that physicians don't. Much of their work is actually physically quite demanding and many dentists don't have as long of a useful career-span (due to neck injuries and such) as physicians. So it isn't necessarily "wrong" that dentists make the money they do -- they have to save more for a potentially much longer retirement."
WTF? Dentists have career-shortening occupational injuries? LMAO thats pure bullshit.
Posted by: joe blow | Oct 22, 2007 5:34:25 PM
In theory, HMOs were supposed to do the same thing with respect to saving money for privately paid for health insurance, and we all know how that's worked out.
The difference is, the constituents of HMO's (shareholders and employers who pay the premiums) only care about short run cost-custting, and care very little about patient care, especially if the HMO can get away with denying the claim later.
In contrast, if the taxpayers all benefit from the single payer plan, they have an incentive not to scrimp on these things.
Posted by: Dilan Esper | Oct 22, 2007 6:05:10 PM
To DAS
"Dentists have certain occupational hazards that physicians don't. Much of their work is actually physically quite demanding and many dentists don't have as long of a useful career-span (due to neck injuries and such) as physicians. So it isn't necessarily "wrong" that dentists make the money they do -- they have to save more for a potentially much longer retirement."
and Joe Blow:
"WTF? Dentists have career-shortening occupational injuries? LMAO thats pure bullshit."
Dentists I don't know, but bricklayers and Irak soldiers sure.
In both case (market and governement organized), there is a solution where the earnings are not out of whack.
So UHC or not, I am quite confident you can find a solution, if you really want to limit cost of dentist care.
I fo myself believe you really need, I am waiting to see if you want...
Ao a solution
Posted by: French lurker | Oct 22, 2007 6:24:29 PM
S Brennan,
Can only been taken seriously if the person making it has provided an detailed and politically feasible outline in an earlier time frame [not one pulled out of your fanny], otherwise it is just unsupported political hackery.
Then I await your detailed and politically feasible universal health care plan. Otherwise, calling for such a plan is just unsupported political hackery.
Where is your "far more cost-effective" plan...
I don't have a comprehensive anti-smoking plan. I listed three possible policies that could be part of such a plan, and that would be a far more cost-effective way of reducing smoking than universal health care.
FYI, Jason, there 41 other countries spending less money, with better outcomes in medical care, all of those countries, pay doctors, insurance and drug companies less and have centralized government control/regulation of the medical BUSINESS.
This nonsense, yet again. "Better outcomes in medical care?" Prove it. And good luck getting America's doctors to agree to a plan that would cut their income by half or two-thirds. What were you just saying about political feasibility?
Posted by: JasonR | Oct 22, 2007 7:35:00 PM
JasonR,
If you were a typical lazy Republican hack you would have been able to type this entry [ USA ranked 42nd in health care ] into google and get this:
from the Associated Press report:
"Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands. ...
A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.
Or
United States health care system was ranked 37th by overall performance,
http://en.wikipedia.org/wiki/Health_care_in_the_United_States
or
http://apnews.myway.com/article/20070812/D8QVEIRO0.html
But you're a right wing hack so instead doing even a little work, you try to do what every lazy hack does...bluster your way through it.
So again I ask:
Where's the beef JasonR?
Statements like this:
"There are far more cost-effective ways to prevent illness than universal health care (let alone "single payer" universal health care" - JasonR
Can only been taken seriously if the person making it has provided an detailed and politically feasible outline in an earlier time frame [not one pulled out of your fanny], otherwise it is just unsupported political hackery.
Where is your "far more cost-effective" plan...and please no right blog links...a specific plan that has already been implemented, not some conjure smoke and mirrors.
FYI, Jason, there 41 other countries spending less money, with better outcomes in medical care, all of those countries, pay doctors, insurance and drug companies less and have centralized government control/regulation of the medical BUSINESS. The US model is a failure in both cost and effect...assuming a positive outcome is a desired outcome.
Posted by: S Brennan | Oct 22, 2007 4:31:10 PM
Posted by: S Brennan | Oct 22, 2007 9:32:27 PM
S Brennan,
If you were a typical lazy Republican hack
If you weren't such an ignorant fool you might realize that the WHO ranking you refer to does not address "outcomes" of "medical care" at all, and that aggregate health statistics (such as average life expectancy) also do not address "outcomes" of "medical care." The average life expectancy of a national population is determined by many social, political, and environmental factors that vary enormously between different countries, and you cannot infer "medical care outcomes" from such statistics. Costa Ricans live on average almost as long as Americans. That's not because they have better "medical care outcomes" but because far fewer of them smoke, far fewer drive cars (meaning fewer deaths from motor vehicle accidents, and more health-promoting exercise from walking), and they have a much healthier diet.
Posted by: JasonR | Oct 22, 2007 9:57:55 PM
Thanks Jason,
I've always thought life expectancy an outcome of a lifetime of medical care, but of course that wouldn't serve your Republican masters would it? Thanks for bringing up Costa Rica, it doesn't have a standing Army...and certainly not a member of the "coalition of the willing"...which is sure to help their life expectancy.
Costa Rica spends government money on it's people not corporate welfare. Here's a little to get you up to speed on your favorite country:
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Costa Rica is a leader among developing countries in the provision of health care and education facilities. A World Bank report in July 1991 praised Costa Rica for cutting its defense spending and re-allocating resources to social policies. Costa Rica spends 1 per cent of GDP on defense and more than 10 per cent on health and education..
Health services are provided by health insurance and through Ministry of Health units which operate a preventive health program in all parts of the country. Life expectancy in Costa Rica exceeds the average for industrial nations.
The state-owned national insurance institute (INS), founded in 1924, administers the state monopoly on insurance, including all social security insurance. Wage earners and their dependants enjoy disability and retirement pensions, workers' compensation and family assistance.
ARMED FORCES:The Costa Rican constitution contains a clause outlawing the existence of a national army (the military was abolished in 1948). A military force may, however, be convened for the purpose of national defense. Costa Rica is a signatory of the Inter American Mutual Assistance Treaty (TIAR). >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
As tools go JasonR, you're not very sharp.
Now back to your comment towards me
"If you weren't such an ignorant fool you might realize that the WHO ranking you refer to does not address "outcomes" of "medical care" at all" - JasonR
Jason, you're three post into this and you haven't addressed my initial point...at what point do ever laugh at your own Republican hackery?
Who cares if .01% of the population gets acceptable medical care?
I'd better answer that question for you Jason...you're too clueless
Answer: .01% of the population.
What...a...hack.
Posted by: S Brennan | Oct 22, 2007 11:00:27 PM
S Brennan,
I've always thought life expectancy an outcome of a lifetime of medical care, but of course that wouldn't serve your Republican masters would it?
Life expectancy is not completely unrelated to medical care, but the relationship is weak, and other factors swamp the effects of medical care. That is why you cannot draw conclusions about which country has better "medical care outcomes" by comparing statistics on average life expectancy. It's meaningless. If you weren't such a left-wing ideologue, and had taken some time to educate yourself about the issue, you might have realized this.
Posted by: JasonR | Oct 22, 2007 11:16:04 PM
despite all the negativity and negative political fluu talk.. jason alludes to a point that has concerned me. I dont know why everyone constantly tries to address paying for health care and noone will even look at the 10 foot pole, let alone use it to touch addressing the costs of health care.
Health care is unaffordable because its cost has gone up much faster then our incomes. ..why does that mean we need to tax ourselves silly to pay for that increase?
Shouldnt we at least look at the inflation of doctor pay, and at the massive profits being taken by the parma industry among others?
This is concerning because if we dont address these at the same time we look at social medicine we will merely create a superclass of business and professionals that are able to name their price.. much as they do today, except the government will automatically pay it and every citizen will be mandated to pay that fee without choice in the matter.
Posted by: david b | Oct 22, 2007 11:25:20 PM
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