A Philosopher's Blog

Is the Emergency Room a Viable Alternative?

Posted in Ethics, Law, Medicine/Health, Philosophy by Michael LaBossiere on August 30, 2013
Typical scene at a local emergency room

 (Photo credit: Wikipedia)

As Obamacare marches onward, its opponents are still endeavoring to stop its advance and send it packing. Of course, the opponents need to provide an alternative system. Interestingly, certain Republicans such as Rick Perry and Jim DeMint have claimed that uninsured Americans are better off relying on the emergency room for treatment. While the battle over Obamacare is largely ideological, the viability of using the emergency room would seem to be an objective matter.

On the positive side, anyone can go to the emergency room and hospitals cannot refuse to treat people with legitimate medical needs—even people who lack insurance or cannot pay.

However, there are numerous problems with the uninsured (or even the insured) relying on the emergency room. The first is the matter of cost. The emergency room is generally more expensive than the non-emergency options. It is certainly more expensive that routine preventative care that can keep a person out of the emergency room. The high costs are problematic because of the burden on the uninsured (medical bills is a leading cause of bankruptcy in America) and also because when the uninsured cannot pay, the cost is passed on to the rest of us (most often in the form of higher health insurance premiums). Thus, relying on the emergency room to treat the uninsured places a heavy burden on everyone and is actually a form of highly inefficient socialism in which those with insurance pay for needlessly expensive treatment for the uninsured. From a purely economic standpoint, if we are going to have medical socialism, we should at least go with the more economically efficient version.

The second is the matter of preventative medicine and ongoing treatments, such as routine checkups and dialysis. The emergency room hardly seems to be set for these medical matters, although people who are unable to avail themselves of them stand a significant chance of ending up in the emergency room, thus taking us back to the first problem. As such, the emergency room option does not seem to be a viable alternative to Obamacare. This is not to say that Obamacare is the only option or even a good option—just that it is better than the emergency-room-for-the-uninsured option.

The third is the matter of compassion. While hospitals cannot deny people necessary medical care, such care is certainly not charity: either the patient must pay or the cost is passed on to the rest of us. As such, relying on the emergency room as a matter of social policy is essentially saying to people that they can get treatment, provided that it is an emergency and that either the patient can pay or the cost can be passed on to everyone else. It is generally agreed that we should collectively protect each other from terrorism, foreign enemies, and our own criminals. This same concern should also extend to protecting each other from disease and injury. After all, whether Sally is dead because of cancer, a criminal’s bullet or a terrorist’s bomb, she is still dead. So, if we can have a huge collective defense against these other threats, we surely can have a developed collective defense against medical threats—one that is better than the emergency room.

 

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  1. unsolicitedtidbits said, on August 30, 2013 at 2:24 pm

    I have wondered why fiscal conservatives argue that the emergency room is the best alternative when it is simply not cost efficient. It puzzles me to no end. I think there needs to be more information put out there about health care options in general. Great post.

    • Michael LaBossiere said, on August 31, 2013 at 1:55 pm

      It might be ignorance of the facts (after all, the politicians get their insurance on our dime, hence they do not see the real cost) or that they are simply going with the talking points passed down. I suspect that some realize that they need to give an alternative to Obamacare and their preferred alternative seems to be things as they are. Interestingly, the nature of conservatism does include the idea that things should stay the same.

  2. Frank Eggers said, on August 30, 2013 at 2:44 pm

    Some of us who have always been adequately insured use an emergency room because of inability to get a timely appointment to see our doctors. For years, here in
    Albuquerque, getting care in an emergency room has been inordinately and dangerously slow.

    A woman received a serious cat bite. At the emergency room, she was told that they were too busy to see her and that she should return later. Finally, 12 hours after she was bitten, she was able to receive treatment in the emergency room but because of the delay, the infection was spreading and she had to be put on an IV. Had she been able to receive prompt treatment, it would have cost far less. That happened four years ago, well before Obamacare.

    It is not unusual to have to wait more than four hours to receive care in an emergency room except in life-threatening situations in which prompt care is generally available. But when urgent care, but not emergency care, is required, there is a serious problem

    Let us suppose that poor people had to use emergency rooms for all their medical needs. That means that if they, or one of their children, required medical care, they would have to take several hours off from work. Assuming they, like most poor people, are paid by the hour, that could be exceedingly costly for them and might even make it impossible for them to buy food for the next meal. Moreover, it could even cause them to be fired from their jobs.

    Back in the early 1970s, I had a coworker who hated his job and hated working for the company, but he could not leave. The reason? He had developed diabetes and if he left, he would not have been able to get medical insurance again since his diabetes would have been considered to be a pre-existing condition.

    I really don’t care whether our medical care system is socialized or private as long as it is fair and everyone can get prompt and adequate medical care when needed. I am greatly disturbed that many people who oppose socialized medical care have inadequate concern for those who are unable to get adequate medical care.

  3. magus71 said, on August 30, 2013 at 3:27 pm

    Lots of charities pay for hospital expenses for those who can’t pay on their own. When I hurt my knee, I used the emergency room.

    “I have wondered why fiscal conservatives argue that the emergency room is the best alternative when it is simply not cost efficient.”

    Best alternative to what? In many cases a poor person will visit the emergency room and pay nothing. How will Obama Care change that?

    • Frank Eggers said, on August 30, 2013 at 3:31 pm

      By making it possible for poor persons to get care without having to visit the emergency room.

      • magus71 said, on August 30, 2013 at 3:33 pm

        What will that change? Won’t they just have to wait, just as you say?

        • Frank Eggers said, on August 30, 2013 at 3:43 pm

          What will change is that they will able to receive non-emergency and non-urgent care by making appointments with physicians instead of going to emergency rooms. That way, emergency rooms will be less busy and wait time will be reduced.

          Also, because chronic conditions will be better controlled by regular visits with doctors, the number of emergencies will be reduced.

          • magus71 said, on August 30, 2013 at 4:08 pm

            I’m skeptical. European and Canadian hospitals and doctor’s offices are notorious for wait times.

            “Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long – sometimes more than a year – to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.[6] All told, 827,429 people are waiting for some type of procedure in Canada.[7] In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.[8]”

            http://www.ncpa.org/pub/ba649

            • Frank Eggers said, on August 30, 2013 at 8:24 pm

              We will have to learn from their mistakes and avoid them. Unless the fact list also includes ways in which people are better off, I would question the objectivity and completeness of the list.

  4. T. J. Babson said, on August 30, 2013 at 3:54 pm

    Let us remember that poor people have medical insurance in the form of Medicaid.

    The people we are talking about here are generally young people who have chosen not to buy health insurance because they would rather spend their money on other things.

    These people are going to have sticker shock when they see the price of the insurance they will be forced to buy, and will choose instead to pay the small tax penalty. At this point Obamacare will “unexpectedly” be found not to be viable economically.

    • Michael LaBossiere said, on August 31, 2013 at 1:52 pm

      The cost of insurance is a major problem, which is linked to the ridiculous cost of medical treatment.

  5. T. J. Babson said, on August 30, 2013 at 3:59 pm

    Also, the idea that preventive care automatically saves money has been disproven again and again and again.

    One big reason why preventive care does not save money, say health economists, is that some of the best-known forms don’t actually improve someone’s health.

    These low- or no-benefit measures include annual physicals for healthy adults. A 2012 analysis of 14 large studies found they do not lower the risk of serious illness or premature death. But about one-third of U.S. adults get them, said Dr. Ateev Mehrota, a primary-care physician and healthcare analyst at RAND, for a cost of about $8 billion a year.

    Similarly, some cancer screenings — including for ovarian cancer and testicular cancer, and for prostate cancer via PSA tests — produce essentially no health benefits, causing the U.S. Preventive Services Task Force to recommend against their routine use. The task force bases its recommendations on medical benefits alone, not costs.

    The second reason preventive care brings so few cost savings is the large number of people who need to receive a particular preventive service in order to avert a single expensive illness.

    “It seems counterintuitive: If you provide care to prevent all these expensive diseases, it should save money,” said Peter Neumann, an expert on health policy and professor of medicine at Tufts University School of Medicine. “But prevention itself costs money, and some preventive measures can be very expensive, especially if you give them to a lot of people who won’t benefit.”

    If preventive care could be provided only to those who are going to get the illness, it would be more cost-effective. “But in the real world, the number needed to screen or to treat in order to prevent one case of illness can be huge,” said BU’s Frakt, who blogs at theincidentaleconomist.com.

    Currently, many people who do not benefit from a preventive service receive it, paying something for nothing. Studies have calculated those numbers, which can be surprisingly high.

    http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129

    • Douglas Moore said, on August 30, 2013 at 4:12 pm

      Regular exercise and keeping carbohydrate intake to 150 grams or less daily= best preventative medicine.

      • Douglas Moore said, on August 30, 2013 at 4:13 pm

        Oh-and moderate amounts of alcohol consumption.

        • Frank Eggers said, on August 30, 2013 at 8:50 pm

          No; encouraging people who don’t already drink to do so would risk increasing the alcoholism rate. Studies that show that ingesting ethanol is beneficial are somewhat questionable.

      • Frank Eggers said, on August 30, 2013 at 8:48 pm

        Few will deny that many medical problems could be prevented by adequate exercise and a good diet. The challenge is to motivate people to get adequate exercise and have a good diet. It may be that better efforts to do so would be effective and would therefore reduce health care costs.

        Simply giving people information usually is not very effective in changing behavior. By the late 1950s, it was common knowledge that smoking was dangerous to one’s health, but that knowledge made little difference in behavior. The ability of most people to think and act rationally is very limited. It took social pressure and restrictive legislation to reduce the smoking rate.

        It has been known for decades that group discussions and group activities are far more effective in changing behavior than simply imparting information. Perhaps if people had to make co-payments for medical appointments unless they regularly took part in group activities designed to motivate people to live more healthful lifestyles, progress could be made. However, before implementing such a program on a national level, there should be pilot projects to evaluate its effectiveness.

    • Frank Eggers said, on August 30, 2013 at 8:38 pm

      It is undeniably true that some traditional preventive methods are not very effective. On the other hand, regular medical care reduces the number of emergency visits by asthmatic patients.

      I myself experienced unnecessary medical expenses, totaling at least $2,000, that were nevertheless fully paid by Medicare and Midigap; I shall herewith elaborate.

      Four years ago, before Obamacare, when I had a bladder infection, I called my primary care doctor and found that I would not be able to see him for a couple weeks. I knew that if I went to emergency I’d have to wait for hours, so I went to an urgent care place that used nurse practitioner. The practitioner confirmed that it was a bladder infection and prescribed a sulfa-based antibiotic. Unfortunately, I experienced highly annoying side effects from the medication, i.e., a moderate headache and dyspepsia; those were known possible side effects of that mediation. The practitioner had me change medications, which was a reasonable thing to do. Then, she gave me an injection for the headache and put me on O2 for half an hour, which were unwarranted expenses. She sent me for a brain MRI to see if the headache could be because of a brain problem, then had a Doppler test done on my carotid arteries to see whether my brain was getting enough blood. Considering that a headache was a known possible side effect of the sulfa-based antibiotic and that I had not previously had a problem with chronic headaches, everything she did except change antibiotics was an expensive waste of funds.

      No doubt considerable money could be saved on our nation’s healthcare bill if these unnecessary tests and procedures were eliminated. They are probably equally likely to occur with either a private of socialized system.

    • Michael LaBossiere said, on August 31, 2013 at 1:51 pm

      I agree that the claim that all (allegedly) preventative care saves money is false. As you note, there are tests that create more costs than benefits. However, this is not a defect in the notion of preventative medicine, but a defect in specific methods. The fix would be to sort out what tests and methods yield cost effective and medically effective results. For example, checking blood pressure is cheap and catching incipient high blood pressure early would be rather helpful. In contrast, expensive and ineffective tests would be a waste of money.

      I’m also a proponent of personal responsibility in this regard: people need to take responsibility for the aspects of their health that are under their control. Exercise, eat as well as possible, avoid unhealthy behavior, and get adequate rest. All that goes a long way.

      • FRE said, on August 31, 2013 at 2:24 pm

        You’re right.

        Expensive tests should be done only in situations where there is a significant benefit. On the other hand, inexpensive tests of proven benefit should be regularly done.

        Surely few would disagree that people should accept responsibility for living healthfully. Even so, it would be good to find effective ways to encourage people to do so and make it convenient for them to do so.

        One of the problems is poor urban planning. Many people live in areas where it is next to impossible to find opportunities for adequate exercise. I discovered that when, for one year, I lived in a Minneapolis suburb where the only thing one could do when leaving an apartment was to get into a car. There are bridges that do not provide for non-motorized traffic; the Coronado Bay Bridge in San Diego is a good example. Some people live in area where it is impossible to buy wholesome food.

        When I was a kid, I either walked to school or rode my bicycle to school. Now many kids have no choice but to take a school bus and many schools are located where the only way to get to them is via motorized transportation.

        There have been complaints that physical education has been removed from schools. In some cases, the complaints may be valid, but my experience with physical education was that it provided too little physical activity to be of significant benefit anyway. Adequate physical activity causes sweating and, unlike the way it was before the late 1970s, kids are so body shy that they will not shower and change if there is even the slightest possibility that they may be seen unclothed. In earlier times, kids with that attitude would have been seen to have problems for which counseling is indicated.

        • Michael LaBossiere said, on August 31, 2013 at 4:23 pm

          True-I actually have picked where I have lived based on access to safe running places. I have visited people in places where running from their place would be likely to result in death. I’m fortunate to have the luxury to pick where I live-and to have the time and money to allow me to exercise properly.

  6. T. J. Babson said, on August 30, 2013 at 9:40 pm

    “Four years ago, before Obamacare, when I had a bladder infection, I called my primary care doctor and found that I would not be able to see him for a couple weeks.”

    Your primary care doctor couldn’t fit you in for a couple of weeks with a bladder infection? Wow.

    • Frank Eggers said, on August 30, 2013 at 9:57 pm

      That is a common problem here in New Mexico. If one has a medical problem which requires prompt attention but is not an emergency and tries to get an appointment to see one’s doctor, one is generally directed to go to emergency.

      About a year ago, I had two basil cell carcinomas removed from my pate (the upper part of the head, for those whose vocabulary is marginal). The same cut was used for both. In the middle of the night, I felt something wet and found that there was bleeding. Fearing that the sutures had failed, I drove to the University of New Mexico emergency room and, upon inquiring, was told that there would be a wait of a few hours. So, I drove to the Presbyterian emergency room. After waiting THREE HOURS and still being unable to tell how much longer it would be, I gave up and drove home. Next, I ‘phoned the nurse emergency line and told her that I had had two basil cell carcinomas removed from my pate and that, because it had started bleeding, feared that the sutures might have failed. She replied, “Sir, are you talking about your penis?” I replied, “I am not talking about my penis! The pate is the upper part of the head!” Even if the nurse did not know what the pate is, it is unclear why she thought that it was the penis. Surely it would be unusual to have basil cell carcinomas there. She told me that I had to go immediately to emergency, whereupon I told her that going to emergency was useless and why. I ended up removing my shirt, leaving over the basin, and removing the dressings, which totally violated the nurses advice, but what else could I do? The stitches were still in place and I was able to stop the bleeding.

      Another time, I had an attack of vertigo. Because I was afraid to drive while dizzy, the widow next door drove me to urgent care at the University of New Mexico. After waiting THREE HOURS, the problem went away just as my name was called.

      Next time I have an urgent medical problem, perhaps I’ll just wait and see what happens and go to emergency only if my life seems to be in danger.

      • T. J. Babson said, on August 30, 2013 at 10:33 pm

        Why is there such a shortage of physicians in New Mexico?

        I can see my primary care physician the same day here in Tennessee. A few days ago I brought my dad to the emergency room and he only had to wait 15 minutes. He was actually giving me a hard time because he thought the wait would have been less at a different emergency room.

        • Frank Eggers said, on August 31, 2013 at 2:03 am

          I don’t know why there is such a shortage of physicians here in NM, but the low per capita income, which is about the lowest in the U.S., may have something to do with it. NM is about like a third-world country. The high school dropout rate is scandalously high and the University of New Mexico has to provide foundation classes because so many high school graduates are not prepared for tertiary level courses.

          It may be that doctors prefer to work where they can make more money. On the other hand, housing costs here tend to be quite low so even if doctors do make less here, they can probably save more than they could if they practiced where they could make more money but where living expenses were higher.

          Everyone here knows about the difficulty of seeing a doctor and getting prompt attention in emergency rooms. It makes me very uneasy. Years ago, when I lived in Fiji, I once had kidney stones. I can imagine what that would be like here. It’s exceedingly painful and requires a high-powered injection, but it is not life-threatening. It would be very bad to have to sit upright in a chair for a few hours in a noisy waiting room. It would be tempting to struggle to the top floor of the parking garage and jump off.

        • Douglas Moore said, on August 31, 2013 at 8:22 am

          TJ, it’s pointless to argue these points anymore. There is a fundamental difference between how one half of America thinks when compared to the other half. One half is comprised of people who want the system to always be there for them, and their elite enablers. Since so many want the system to be there for each individual problem in their life, the system fails, as it has in Greece, Spain, Italy, Ireland et al. None of those countries have much military spending to speak of. And they are much more unified as far as class and ethnicity goes, yet can’t make it work. The other half of the country knows that regardless of mathematical and philosophical computations made by liberal elites, this type of socialism destroys the moral fiber of a nation. People begin to act differently, and the aggregate is not positive. Too much of this thing got us where we are now. More of it cannot cure us. This trend is irreversible until something collapses. “The man who carries a cat by the tail learns a lesson that can be learned in no other way.” ~ Mark Twain.

          Unfortunately, my kids have to grow up in this. They’ll have it worse than I did, despite the free stuff.

          • FRE said, on August 31, 2013 at 1:57 pm

            Why is it unreasonable for people to want the system to be there for them at all times? What would be a reasonable alternative?

            If a child has a broken limb, shouldn’t medical care be available?

            In 1978, when I lived in Minneapolis, I had an emergency appendectomy. Suppose that I’d had no medical care available? Presumably I’d have died after a few days or weeks of suffering. Fortunately I had adequate health insurance, but suppose that because of a pre-existing condition I had been unable to get health insurance? Probably I’d have been able to pay, but the provider would have charged more for the procedure because I, as an individual, could not have bargained the price down the way insurance companies do. But if I had not been able to pay, I’d have been forced into bankruptcy.

            This should not be considered to be a liberal vs conservative matter and has nothing to do with elitism. There are some things that are civilized vs uncivilized.

            • Douglas Moore said, on August 31, 2013 at 2:55 pm

              For one, it assumes the current system does not work. In my opinion, it does work.

              “In 1978, when I lived in Minneapolis, I had an emergency appendectomy. Suppose that I’d had no medical care available? Presumably I’d have died after a few days or weeks of suffering.”

              This is absolutely not the case. I underwent multiple non-emergency surgeries, without private health insurance.

              “There are some things that are civilized vs uncivilized.”

              True. In this case, not wanting federally controlled healthcare does not make one uncivilized. There was no such care before 50 years ago or so. If it were so simple to fix the problems inherent in all the other public healthcare systems, why don’t these other countries do it?

              Even the doctors say it is not good for medicine. Doesn’t there opinion matter?

              “Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”

              http://www.forbes.com/sites/sallypipes/2011/12/26/doctors-say-obamacare-is-no-remedy-for-u-s-health-woes/

        • Douglas Moore said, on September 2, 2013 at 8:26 pm

          Speaking of health TJ, did you ever read “Good Calories, Bad Calories”? Opinions?

          • T. J. Babson said, on September 2, 2013 at 10:43 pm

            Yes. I am convinced Taubes is right about the endocrine system being the key to both weight gain and metabolic syndrome.

            • FRE said, on September 2, 2013 at 11:02 pm

              Strange. Apparently, for unknown reasons, the endocrine system has radically changed within the last 30 years.

            • T. J. Babson said, on September 3, 2013 at 9:30 am

              Not strange at all.

            • Douglas Moore said, on September 3, 2013 at 11:27 am

              I now understand Taubes’ argument. I used to make the thermodynamics argument, too. Then I realized how stupid I was being. Just because something passes through the portal of my mouth, does not mean my body will access the substance’s energy in the same way. Just as a car cannot run on uranium, does not mean the uranium does not hold energy, it simply means the car has no means to initiate the chemical reaction, breaking chemical bonds and releasing energy.

    • Douglas Moore said, on August 31, 2013 at 5:09 am

      biomass….

      • Douglas Moore said, on August 31, 2013 at 5:22 am

        Where are you when we need a balanced view?

      • FRE said, on August 31, 2013 at 4:05 pm

        DM, statistics have shown that people without medical insurance have poorer outcomes when they need treatment. They are more likely to die from various cancers and other life-endangering problems because they are likely to be diagnosed later and receive lower quality care when they are diagnosed. They cannot receive Medicaid until they pauperize themselves which causes problems for the whole family.

        There are multiple reasons for not having medical insurance. A pre-existing condition may make it impossible. Some poor people cannot afford medical insurance as the result of not earning enough money. In fact, some people are poor even though they work long at more than one job, so it’s not just a matter of being lazy. Of course there are irresponsible people who would rather by a more expensive car than buy health insurance. Unfortunately, when they do that, other members of the family can suffer as a result.

        As I have previously stated, I really don’t care whether our medical care system is private or socialized. What I do care about is that adequate care be available to everyone.

  7. Douglas Moore said, on August 31, 2013 at 5:16 am

    Many of Mike’s arguments sound like the arguments made for sub-prime housing loans.

    Here’s Bush, speaking at George Washington University in 2002:

    “I appreciate your attendance to this very important conference. You see, we want everybody in America to own their own home. That’s what we want. This is — an ownership society is a compassionate society.
    More and more people own their homes in America today. Two-thirds of all Americans own their homes, yet we have a problem here in America because few than half of the Hispanics and half the African Americans own the home. That’s a homeownership gap. It’s a — it’s a gap that we’ve got to work together to close for the good of our country, for the sake of a more hopeful future.
    We’ve got to work to knock down the barriers that have created a homeownership gap.
    I set an ambitious goal. It’s one that I believe we can achieve. It’s a clear goal, that by the end of this decade we’ll increase the number of minority homeowners by at least 5.5 million families. (Applause) … And it’s going to require a strong commitment from those of you involved in the housing industry…”

    We all know how this turned out.

    http://autosandeconomics.blogspot.com/2010/12/george-w-bush-2002-speech-on-home.html

    • WTP said, on August 31, 2013 at 11:07 am

      I’d like to get your and TJ’s perspectives on this from Ace of Spades

      http://ace.mu.nu/archives/342960.php

      Most pertinent:
      As Jonah Goldberg argues (I take it– I haven’t read the book), part of the reason for the liberal dominance over the culture and lately politics as well is that it is extremely hard to argue someone out of a proposition he was never argued into in the first place. The public did not decide Barack Obama was extremely intelligent, cultured, articulate, and spiritually uplifting. The public had this word-cloud about Barack Obama drilled into their heads for two years so that when they finally saw the man speak, in all his umming and uhhing glory, there was hardly any space in their minds for their own analytical and impressionistic portrait of Barack Obama. The neurons necessary for storing such electrical wisdom were already all taken up by Extremely Intelligent, Cultured, Articulate, Spiritually Uplifting.

    • FRE said, on August 31, 2013 at 2:06 pm

      Of course home ownership is desirable and important, at least for many people, and it probably contributes to economic stability, but it isn’t really essential. Some people choose to invest their money elsewhere and rent living quarters; there is nothing wrong with that. Some people have jobs that require frequent moving thereby making home ownership impractical. Home ownership can be a real burden if one, for employment reasons, has to move when home prices are depressed and / or when selling is difficult.

      And just how has it been determined that “an ownership society is a compassionate society”? Surely one could conceive of an ownership society that is not compassionate, and a non-ownership society that is compassionate.

      Most definitely I am not knocking home ownership; I’m simply pointing out that the importance of home ownership can be exaggerated.

      Clear thinking is better than sticking to a doctrinaire position regardless of whether it is applicable to the present situation.

      • FRE said, on August 31, 2013 at 2:27 pm

        I’ve been a bit careless with my ID. FRE = Frank (R.) Eggers.

  8. Douglas Moore said, on August 31, 2013 at 3:07 pm

    I still see this as creating a problem out of nothing, and making perfect the enemy of good. It’s practically the same with all socialist programs. It happened with food stamps–1 in 5 in New York City is using food stamps, yet, 71 % of kids are overweight–and the poorest are the most overweight. The Food Stamp Act was signed into law in 1964 by LBJ. Were there starving people everywhere then? What was the obesity rate?

    • FRE said, on August 31, 2013 at 4:15 pm

      Even before food stamps existed, I noticed that poor children were more likely to be obese than children from more prosperous families. However, in the last 30 years, obesity has affected more than poor people. Some parents are even surprised when the doctor tells them that their kids are obese. It’s to the point that to some people, obese looks normal. It has even become more difficult for those of us who are fit to by clothing that fits properly.

      Because I have no need to budget my food purchases, I have not compared the price of healthFUL food with the price of unhealthFUL food, but according to what I’ve read, unhealthFUL food tends to be cheaper. If that it the case, it would explain why poor people tend to be more obese.

      • Michael LaBossiere said, on August 31, 2013 at 4:31 pm

        Yup, cheaper foods tends to be high calorie, low nutrient. More expensive foods, like fresh fruit, lean meats and vegetables, tend to be lower calorie and higher nutrient. This is largely due to subsidies for sugar and corn (which is made into high fructose corn syrup).

        So Doug is right that socialism is a cause of obesity-but it is the socialist state support of the agribusinesses that provide cheap sugar and corn syrup (which is chemically a sugar, but not legally a sugar).

        • FRE said, on August 31, 2013 at 5:20 pm

          Excellent point!!

          There are some people who approve of socialism when it is businesses that benefit but not when it is people who benefit. ADM has very successful lobbies.

          • Douglas Moore said, on August 31, 2013 at 5:31 pm

            I don’t support that kind of socialism either.

            • FRE said, on August 31, 2013 at 6:40 pm

              At least you are consistent.

        • Douglas Moore said, on August 31, 2013 at 5:30 pm

          The Law of Unforeseen Consequences reigns supreme in many of these types of programs. Though I will still argue it’s quite easy to stay thin if you’re (truly) poor. “Healthy” food does not necessarily make us thin.

          We’ve created too many people whom are not really interested in what they can do to make themselves healthy, they’re only interested in what someone else can do for them when they become unhealthy. I posted an article on my blog about how I helped a fellow soldier lose almost 50 lbs and pass the PT test in Afghanistan. People have to take responsibility for their actions. The first level of responsibility is what you put in your mouth.

          This guy ate fast food, three times a say,lost weight and became more healthy.

          http://ts2.mm.bing.net/th?id=V.4522618886555485&pid=2.1&w=186&h=105&c=4&rs=2

          • FRE said, on August 31, 2013 at 6:43 pm

            I agree with you that “We’ve created too many people whom are not really interested in what they can do to make themselves healthy, they’re only interested in what someone else can do for them when they become unhealthy.” However, the correlation between that and income is considerably less than unity.

    • Michael LaBossiere said, on August 31, 2013 at 4:28 pm

      You raise an interesting point here. People are on food stamps, yet obesity is a problem and seems to be linked to poverty. On the face of it, poor people should be leaner because they can afford less food. However, the reality is rather different. Thanks to the socialist subsidies of sugar and corn, high calorie but nutrient low foods are incredibly cheap (compare the cost of a cake mix to the cost of fish or fresh vegetables). So, poor people tend to buy those foods, leading to some folks being obese yet malnourished. Another problem is that poor urban areas tend to lack grocery stores, while having plenty of fast food joints and convenience stores. So, poor people tend to end up eating high calorie low nutrient junk because that is all that is available in walking distance.

      • Douglas Moore said, on August 31, 2013 at 5:37 pm

        The mindset of the new underclass is not sufficient for success and is also related to the types of food they eat. In essence, they don’t care.

        • FRE said, on August 31, 2013 at 6:53 pm

          It’s unfair to say that they don’t care. Many have a defeatist attitude and do not understand the control they have over their lives.

          I’ve known dangerous drivers who were very pious and believed that because God was in control, everything that happened happened because it was the will of God. Therefore, they saw no point in driving safely. The same is sometimes true with diet and exercise. Some people believe that, regardless of what they do, when it is time for them to die they will die.

          There are also people who were raised in poor families which failed to give them the attitudes required for success. They may see themselves as unworthy of success or believe that success is entirely a matter of having wealthy parents.

          Sometimes an exceedingly outstanding teacher is able to get through to students and turn their lives around. We really should be putting more effort into finding out how to help people lift themselves up.

          There are multiple reasons for being poor; the poor are not all alike.

      • Douglas Moore said, on September 1, 2013 at 7:23 am

        Sounds like they are living unexamined lives. Would you agree? Do you think they’re introspective about this, or they just continue doing what’s making them fat? Could this mentality carry over to other areas of their lives?

      • Douglas Moore said, on September 1, 2013 at 12:21 pm

        Mike, suppose you meet and overweight poor person today. And suppose they complain to you about their weight. How will you help them? Will you tell them of government subsidies, or will you tell how to eat and exercise?

        • Michael LaBossiere said, on September 2, 2013 at 11:40 am

          If a poor, overweight person asked me for weight loss advice, I would suggest they work up to a running program (or alternative exercise) and ask the person about his/her diet. However, good food is more expensive, so I would suggest that they get the support they are entitled to, but that they buy good food and not junk.

          When I was in grad school, I was effectively poor (based on my income). Getting proper nutrition was a real challenge that I solved by scavenging academic events that had food and hitting the all you can eat deals.

          Actually, I do think there should be tax breaks for exercise gear. :)

          • Douglas Moore said, on September 2, 2013 at 11:49 am

            So why can’t this be the message fro the Left? You managed, I managed.

            “We cannot reasonably expect the recipients of welfare to refuse their opportunities to claim cash on offer. But it seems somewhere between regrettable and scandalous that so many people holding responsible jobs collude with them.
            For instance, consider those young unmarried mothers who make no attempt to find jobs because they live perfectly comfortably on benefits.
            There are doctors who knowingly sign false sickness claims, and local councillors and officials who fight tooth and nail to cling to every penny of their budgets.
            And at the same time there are always BBC correspondents who peddle repeated half-truths and sometimes outright falsehoods about government cuts.”

            Read more: http://www.dailymail.co.uk/debate/article-2291839/MAX-HASTINGS-Our-coffers-compassion-industry-squeals-money.html#ixzz2dkcCGqJK
            Follow us: @MailOnline on Twitter | DailyMail on Facebook

            • Michael LaBossiere said, on September 2, 2013 at 1:19 pm

              I did manage. But, I went to reasonably good schools paid for by taxes, then went to college with help from my parents and government support (a Pell Grant and student loans). So, I got by with a lot of help.

              Now I’m in the position of being a taxpayer-so I am paying back, many times over, what I was given. I am fine with some of my money being used to help other people get the chance I got.

              Naturally, I do not want to support people who are just lazy and want cheese shoveled from my tax dollars into their cheese ports. But, most people are not like that.

  9. Douglas Moore said, on August 31, 2013 at 7:09 pm

    Here’s a quote from a book review on Amazon.com that succinctly outlines what the new poor are–generally speaking, in America and Britain. This is what I saw as a police officer.

    “Mr Dalrymple shows in essay after essay how the choices the underclass in Britain make determines their destiny. There are countless parallels to American life – the rampant gambling that goes on in casinos and in bingo parlors (and those who cannot stop then blame the casino for their problem!); the spending of needed cash on lottery tickets; the horrible standard of education that graduates illiterate young adults who can barely add in their heads; the ignorance of science, history and math that students display; women who go from one violent man to another, making baby after baby with them and then saying they “love him” and cannot leave him. The stories are pathetic and frustrating because the “victims” are their own hindrance. They live in some sort of parallel universe where they have no more control over their emotions or actions than a squirrel or a worm, and blame their problems on the government, the bureaucracy, their parents, the pubs, the casinos, their teachers… everyone carries the victim’s sin on their own shoulders, because the underclass itself is not responsible for anything.”

    • Douglas Moore said, on August 31, 2013 at 7:14 pm

      Many poor people, and remember, I’m talking about people in America and Europe, ignore a moral imperative that all noble humans must hold to: That we must wake up each day and *try*.

      The lack of this sentiment is encouraged by many of our elites, who simply refuse to tell the underclass what habits they in fact should have. The elites refuse to acknowledge the feedback loops at play; lack of money not only creates the person living outside societal norms and unable to get a job, those living outside societal norms and refusing submission to classic common sense make for themselves a wholly unmarketable persona.

      • Michael LaBossiere said, on September 2, 2013 at 11:45 am

        Plenty of poor people try and try hard. There is a cognitive bias to weigh negative evidence more than the positive, plus the in-group bias in which we see people outside of our group as inferior. Plus other biases as well.

        This is not to say that there are not bad poor people (and very good rich people), just that we should not just emphasize the negative.

        I agree that some people are poor because of their own failures. However, this is not true of all of them. Think about the poor people who work hard at multiple jobs to support their kids.

        • WTP said, on September 2, 2013 at 12:14 pm

          No time to catch up on the rest of this discussion, but this crap about using children as a it’s-not-my/their-fault excuse is obnoxious. People have responsibility for their breeding practices. Especially in the modern world. The methods of birth control available to modern man/woman, via Planned Parenthood web site:

          Abstinence
          Birth Control Implant (Implanon and Nexplanon)
          Birth Control Patch (Ortho Evra)
          Birth Control Pills
          Birth Control Shot (Depo-Provera)
          Birth Control Sponge (Today Sponge)
          Birth Control Vaginal Ring (NuvaRing)
          Breastfeeding as Birth Control
          Cervical Cap (FemCap)
          Condom
          Diaphragm
          Female Condom
          Fertility Awareness-Based Methods (FAMs)
          IUD
          Morning-After Pill (Emergency Contraception)
          Outercourse
          Spermicide
          Sterilization for Women
          Vasectomy
          Withdrawal (Pull Out Method)

          And if all else fails, they even left out legal abortion.

          • FRE said, on September 2, 2013 at 5:06 pm

            Some people, for religious reasons, do not practice family planning. I remember what Mr. Herald Camping said on “Family Radio” on a talk program about family planning. He strongly advised a woman caller to do nothing to limit the number of children she and her husband had. He asserted that doing so would be sinful and that all children are a blessing from God. It was not necessary to educate children beyond high school, and one way for a family to save money was for the wife to have only one dress.

            There are a few churches that officially condemn family planning. Fortunately, most of their members think for themselves and limit their family sizes anyway.

            People who are really down-trodden sometimes think that everything is a matter of fate, that things just happen, and that they have no control over what happens to them.

            It is very difficult for schools to teach the necessity of family planning because very vocal people insist that schools should not be doing so.

            • WTP said, on September 2, 2013 at 5:41 pm

              Schools are not, nor should they be, the Source Of All Knowledge. We can’t be running around organizing people’s lives for them. EVERYONE has a responsibility to think for and take care of themselves. Supporting people with money taken from unwilling third parties with no or very few strings attached is more damaging for the greater number of people in the long run.

            • WTP said, on September 2, 2013 at 5:44 pm

              BTW, I agree with you in the damage hose religions are doing. But they are religions, chosen by the individual via their own free will. Freedom to choose one’s religion or lack there of, a fundamental right.

            • FRE said, on September 2, 2013 at 5:46 pm

              WTP,

              Exactly where are young people supposed to learn about the importance of family planning if neither the schools nor their parents teach them?

            • FRE said, on September 2, 2013 at 5:48 pm

              WTP,

              Surely you are correct that people have a fundamental right to choose their own religion. Unfortunately, some religions brainwash people in such a way that they become incapable of making rational decisions.

            • WTP said, on September 3, 2013 at 6:01 am

              The news media and academia have done an excellent job of brainwashing people also. On a much larger scale across a broader range of issues. Zimmerman is a prime example. What is to be done is reason. Other options come with too many negative side effects.

            • Douglas Moore said, on September 3, 2013 at 7:53 am

              Sorry WTP and FRE. I’m not buying the “religion is causing the family planning disaster”. Sounds like those people have a problem with math, not religion. For one, for the first time in history, America has gone below replacement level births. Europe is dying even faster, well except for Muslims While religion may play a role in some ethnic enclaves in America, such as Catholic Hispanics and Mormons, white America has largely abandoned religion, and is certainly abandoning breeding at replacement levels. Some will argue the underbreeding is a good thing. Without going into the details on necessary replacement of working-age people to sustain modern social welfare states, let’s consider that educated people are not reproducing. It is the fatal seed planted by nature in the Left’s midst. They will simply die off.

              Secondly, it is true that divorcing some classic Christian ideas from others can result in bad things. Paul stated clearly: “He who does not work, will not eat.” I suspect that if many were held to this standard, they would spend more time working and less time breeding. American blacks are among the most religious in America. Let’s take a look at the numbers of families abandoned by black males. Are they following Christian tenets? What does the Bible teach about men whom don’t provide? Blacks don’t have kids because God commands it.

              The failure of black churches to hold its people accountable is a travesty.

            • WTP said, on September 3, 2013 at 3:24 pm

              Magus,
              Religions that do not consider family planning, or more specifically, are hostile to the concept create problems. While I have great respect for many religions, and hard as it may be to believe, even some aspects of Islam, many of them, including Islam, Hindu, Bhuddist, and offshoots of Christianity, don’t know much about others in this regard, seek to create a dependency on their respective religions much like the secular socialists create upon the state. Some of them create problems that they give the impression that only they can solve.

              Any religion that promotes reproduction without any consideration of what the procreating parents can support, without consideration of or hostility toward keeping some degree of separation between pregnancies, is a part of this problem. Now if those religions are willing to take on 100% of the burdens they create, well then OK. But I have yet to see such. As my Democrat-voting wife says, “If you can’t feed ‘em don’t breed ‘em”.

    • FRE said, on August 31, 2013 at 8:10 pm

      We see many of these things in people who are not poor. The appalling ignorance of science is astounding, even among educated people. A former coworker of mine had a masters degree; he took his one month old daughter to a chiropractor for her first adjustment. In spite of shrinking ice caps and glaciers, some well-educated people insist that the earth is cooling off. Surveys have shown that many high school graduates don’t know what country is across the English Channel from France. People from England are asked what language is spoken in England. Many people do not even know the capital of Ethiopia, the sine of a 30 degree angle, or how to define decibel. There is a serious lack of erudition at all levels of education. I could go on and on.

      I don’t doubt for a minute that what Mr. Dalrymple wrote is absolutely true. However, he has cherry-picked his examples. One could easily find examples of people who are trying to do everything right and who are still poor. Sometimes it is a matter of bad luck. David Dunbar Buick, after whom the car was named, died in obscurity and poverty.

      Yes, there is a problem with gambling. Many states encourage gambling because of the tax income from it. They even advertise lotteries and casinos on TV knowing full well the toll that gambling takes on families. Of course gambling is stupid and people should not gamble, but some desperate people irrationally see gambling as their only hope and state governments encourage that hope. Aren’t governments that encourage gambling partly responsible?

      Not all poor people are poor for the same reasons. In the late 1960s, a family of my acquaintance lived in a public housing area of St. Paul, MN. They also had other forms of public assistance. The father had always worked, but his income was insufficient to support eight children. Obviously they had too many children, but try to understand why. The mother had four children by her first husband, then he died. She remarried and had four more children by her second husband. Here is what she told me, condensed and paraphrased: “I hear it’s a great life if you don’t weaken. I’m a fallen-away Catholic. I won’t be having any more children.” For anyone who cannot read between the lines, because of what she was taught by her church, she believed that family planning was a serous sin. Finally, she realized that she had to practice family planning, regardless of the doctrine of her church, and felt horribly guilty about it. Even though they had eight children, their house was always spotless. They kept the children looking neat. However, they were very worried about the influence that the neighborhood was having on their children, but could not afford to move. So, whose fault was their unfortunate plight?

      • Douglas Moore said, on September 1, 2013 at 6:35 am

        Again, I’m speaking generally. The secular elites stay married when compared to the poor, even though marriage is a historically religious phenomena.

        One thing that is proven over and over in studies: Happy marriages and a family staying together keeps adults and children happy. Dalrymple wouldn’t have a problem with a family of 10 who stayed together and whose father worked. I don’t either. Those are not the types I’m talking about.

        I came from an underclass family. When I hung around middle class people and went to their houses, I was in awe at how things worked. I was looking for a male figure whom I could copy. Absent that, I became a petty criminal. I know exactly what comprises the poor in many cases. Not all, but many. I was one of them. What is not happening at many levels today? We no longer teach our kids morality. Hardly a lick of it.

        I am a Christian, and am sympathetic to those in need. I have been helped when I was in need. It takes wisdom to discern true need and when a person needs a kick in the rear. The apostles were poor. But Paul makes it clear i his writings that Christians should not be a burden to anyone.

        The Protestant work ethic made America great. Indoctrination into that ethic should be part of our school curriculum. What happened to Kennedy’s dictum, “Ask not what your country can do for you, ask what you can do for your country?”

        • FRE said, on September 1, 2013 at 3:02 pm

          Usually, when a child from an underclass family does well, it is because someone in his (or her) life has served as a mentor. That person may be a particularly gifted teacher, a relative who has good values, or a good family who takes the child under its wing.

          Probably part of the solution is for our school systems to teach good values. Some say that that cannot be done since it would violate the principal of church – state separation. However, it need not. There is general agreement about what good values are regardless of the religion to which a person is a member, or even if the person is an atheist. These values are beneficial to everyone and will help people to lift themselves out of poverty, although there is no guarantee. A sound and intact family can also help by encouraging an underclass kid.

          However, even people with good values can fall into poverty and find it very difficult to escape. A 16 year old boy may have to drop out of school to help support the family and unless he can find a way to complete high school, he will be put at a serious disadvantage for the rest of his life.

          There can be bad influences at school which only an unusually strong kid can rise above. A good example is a black student’s peers putting him down for “acting white” if he gets good grades. The same thing can happen to white kids who live in a bad neighborhood and attend a school with a lot of poor kids who lack good values.

          • FRE said, on September 1, 2013 at 3:11 pm

            Here is a link to a video that you may find interesting:

            It’s a black man trying to instill good values into other black men. There are other black men using youtube trying to do the same thing. Some of them use language that we might not like, but one has to consider the audience they are addressing.

            It’s unclear how much they can accomplish with youtube videos; probably they are preaching to the choir. I think that a mentoring approach would be more effective. Whites cannot mentor black kids, but there are plenty of white kids who also need mentoring.

          • T. J. Babson said, on September 1, 2013 at 5:53 pm

            The military is a good escape route for many.

        • Michael LaBossiere said, on September 2, 2013 at 11:41 am

          Fortunately gaming saved you from that life of crime. :)

  10. Douglas Moore said, on September 2, 2013 at 11:22 am

    I can always argue that I have a moral right to things from the government. Why is medical care more important than food, or a car for that matter?

    http://www.dailymail.co.uk/debate/article-2291839/MAX-HASTINGS-Our-coffers-compassion-industry-squeals-money.html

    • Douglas Moore said, on September 2, 2013 at 11:22 am

      “We need the imagination and courage to defy kneejerk sentiment about health care, and admit that the resources do not exist to give any hospital or NHS trust the money it wants to do everything modern medical science makes possible for every patient.”

      Read more: http://www.dailymail.co.uk/debate/article-2291839/MAX-HASTINGS-Our-coffers-compassion-industry-squeals-money.html#ixzz2dkVqyyIk
      Follow us: @MailOnline on Twitter | DailyMail on Facebook

      • FRE said, on September 2, 2013 at 5:12 pm

        I certainly agree with that. We simply cannot afford to give everyone who wants one a face lift or to keep them alive on life support for a few months when they are obviously going to die anyway. But surely we can afford to provide cancer treatment for everyone who has a reasonable chance to survive, fix serious injuries, etc.

  11. Douglas Moore said, on September 5, 2013 at 1:44 pm

    Democrats at work: Soccer with no score.

    Quick, unscientific poll: Who’d be more in favor of this, liberals or conservatives?

    I’m never going to be able to retire….there’ll always be a job fighting the hordes of moonbats.

    http://www.thestar.com/sports/soccer/2013/02/16/ontario_youth_soccer_to_stop_keeping_score_standings.html

  12. Douglas Moore said, on September 5, 2013 at 2:58 pm

    Some hard working poor people at work. Hordes of them.


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