8 ms·

Obama (almost) fixed this. The Affordable Care Act extended Medicaid coverage from the absolute indigent, to those making up to 133% of the poverty line in thei

Obama (almost) fixed this. The Affordable Care Act extended Medicaid coverage from the absolute indigent, to those making up to 133% of the poverty line in their state, something around $16,000 per year. The group that is in a bad spot are those right above that number, as even though their premiums are subsidized, deductibles are anywhere from 2400 to 6400 per annum. That said, you are right the dead are everywhere. Poverty kills. It deteriorates every system of the body, and it's first target is the brain. The status quo is an evil waste of humanity, and poverty is grossly expensive and inefficient. UBI can't come fast enough.

maxerickson 10y ago
2016 deductibles can be $6,850 for an individual and $13,700 for a family. Of course the Medicaid limit is higher for the family.
yummyfajitas 10y ago
Western-style poverty (i.e. little work + wealth transfers adding up to approx $15-20k/year) doesn't kill. We have various randomized control trials which demonstrate this. Giving poor people money doesn't significantly affect health: http://m.qje.oxfordjournals.org/content/131/2/687 http://m.qje.oxfordjournals.org/content/131/2/687 The medicaid expansion similarly had no statistically significant effect on health, though it does make people feel better: https://www.nber.org/oregon/ https://www.nber.org/oregon/ The RAND experiment back in the day had similar results based on variation in coinsurance levels: http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html Why do you keep spreading myths? Now, you may have discovered some correlations between poverty and bad health. As correlation is not causation, and an RCT is the best way to check. So apparently the correlation is caused by something else - i.e., some third factor which makes people both poor and unhealthy.
- willholloway 10y ago
  Have you lived in Western style poverty? Have you mingled with those who patronize pawn shops and payday lenders? Please cite the various randomized control trials, and I would say it is far too early to draw conclusions on the effects of the medicaid expansion as it has only been two full years since rollout. I speak from experience, as someone from a wealthy family and a wealthy area that shunned the family business and went out with nothing to seek startup fortune. I had a good start in 2009 with a success in affiliate marketing, when that dried up I put all that I had made into another venture that limped along at sub-ramen levels for a while and then I pulled the plug. The fallout was not fun, and the effects not benign. It was pre medicaid expansion and there was no healthcare to be had, and almost no safety net to be found whatsoever. I could have gone home and had everything I needed but I wanted to make it on my own. I had been living in Boulder, Colorado and thought a move to Austin would lower expenses and extend the runway for the company. That was ill-advised, and another story, but it added another dimension to my troubles at the time. Was it a stupid risk? It was but I was young and felt invincible, and in 2010 with a liberal arts education there weren't a ton of jobs waiting for me. The wealth transfers you speak of are not easy to get. I'm not even sure where you get the 15-20k number. What else is there for a low earning single male besides SNAP, and now Medicaid. In that time, as someone who found themselves with no assets and no income the only benefit I seemed to have qualified for was about $160 a month that could be spent at the grocery store. Feeling a tremendous amount of shame I applied for SNAP benefits, even though I knew that they were really a subsidy for American farmers, ideology had trained me that subsidies for corporations are virtuous, while subsidies for basic human needs are shameful. Even though I qualified, the overworked staff denied my valid claim. It took them over a month to tell me this. It would have taken another month to apply again and maybe they would get it right that time. I gave up and having good credit financed my nutrition via credit card. I hadn't coded since elementary school, but I was able to pick up django web dev and find a high paying job in a couple months. But that happy ending is not typical. There is no way that the stress from that period didn't shave a little bit of time off my life. And the lack of liquidity prolonged the period by a good bit. I spent so much time doing this or that to get $200 for the rent, it was tremendously inefficient and stressful. Bad terrible memories, a place I never want to go back to. I was sad during all of this. It broke up the relationship I was in with someone I really loved. I spent a lot of time with those who ride the bus, with those who pawn. Their lives are very different than the lives of the families from my coastal home town. Their lives do kill them slowly, which is why life expectancy is a full dozen years longer for the wealthy. I have since moved back to the wealthy coastal town I grew up in. Life is so easy here, because there is wealth here. You can get a nice boat for almost nothing because someone just doesn't want it anymore. Someone I knew was just gifted a boat for $1 because the owner was just happy it was going to stay on the island. No one ever gives my former bus riding compatriots anything. The thing is the people that live here are no different genetically than the people at the pawn shops back in Texas. The only difference is the presence of wealth, and the virtuous effects that has when it's sustained for a few generations.
  - maxerickson 10y ago
    The Oregon thing started in 2008. It has mostly benefited the recipients financially rather than medically.
    - willholloway 10y ago
      Oregon is just one program, why is life expectancy for wealthy rising, and falling for the poor? Why is the gap around a full dozen years?
      - maxerickson 10y ago
        I don't know. But if I understand correctly, the point of bringing up the Oregon study was that access to medical care doesn't seem to have a lot to do with it. At least not the incrementally better access provided by Medicaid programs. I would certainly speculate that there is a bundle of ideas that contribute to it. Ideas about personal decisions being impactful, leading to things like less smoking and better diet, and even better life situations (which can presumably lead to a different relationship with stress).
      - yummyfajitas 10y ago
        Probably because the poor behave differently from the rich - they tend to overeat more, exercise less, smoke more and drink more. Also any disabled person (who probably has other health problems that reduce life expectancy) is by definition poor (poverty is defined as low market income).
        facetube 10y ago
        All of the behaviors you cite could be caused by extreme stress, poverty, or threats to safety/well-being (rather than being a cause of poverty). I've felt it, and I've done it.
        willholloway 10y ago
        It is poverty itself that creates short term thinking that leads to those choices. This is why poverty is expensive for society, and investment by society to eliminate it would be paid back and much more.
- facetube 10y ago
  The RCT you cite examines the effects of "wealth shocks" (read: unexpected winnings) in a population of Swedish lottery winners on mortality and health care utilization, in a country that already has access to taxpayer-funded universal health care. The state pays 97% of all medical costs there [1]. Using this to support your claim borders on intellectual dishonesty IMO. Re: Medicaid, it's difficult to find high-quality health care in the US as a Medicaid patient, mostly because practices are free to turn you away simply because you're a Medicaid patient. "We don't take Medicaid". That's it. One of the major academic health systems here (in Oregon) systematically directed all Medicaid and Medicare patients to a single low-resource clinic across town by policy, citing inadequate reimbursement rates. The result is long wait times and inadequate care. [1] Glenngard, A., Hjalte, F., Svennson, M., Anell, A., & Bankauskaite, V. (2005). Health Systems in Transition: Sweden. WHO Regional Office for Europe, 2005
  - yummyfajitas 10y ago
    The state provides health care, yet there are still disparities between rich and poor. This confirms my second and third studies which show health care doesn't help. This study also shows that (as postulated by folks down thread) that money doesn't change health behaviors. That's the point - health disparities are mostly not caused by either health care or wealth. They are caused by something else (e.g.diet, exercise, genetics).
    - facetube 10y ago
      The US absolutely does not have a universal health care system; roughly 33 million remain uninsured, and a large number of those who are insured do not have adequate savings to pay their high deductible (which can be as high as $6,000 per person per year in-network, and twice that out of network).
      - yummyfajitas 10y ago
        Read all three studies. Rand and Oregon show more health care doesn't improve health. Sweden shows more money doesn't. What, exactly, are you disputing here?

maxerickson 10y ago

2016 deductibles can be $6,850 for an individual and $13,700 for a family. Of course the Medicaid limit is higher for the family.

yummyfajitas 10y ago

Western-style poverty (i.e. little work + wealth transfers adding up to approx $15-20k/year) doesn't kill. We have various randomized control trials which demonstrate this. Giving poor people money doesn't significantly affect health: http://m.qje.oxfordjournals.org/content/131/2/687 http://m.qje.oxfordjournals.org/content/131/2/687 The medicaid expansion similarly had no statistically significant effect on health, though it does make people feel better: https://www.nber.org/oregon/ https://www.nber.org/oregon/ The RAND experiment back in the day had similar results based on variation in coinsurance levels: http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html Why do you keep spreading myths? Now, you may have discovered some correlations between poverty and bad health. As correlation is not causation, and an RCT is the best way to check. So apparently the correlation is caused by something else - i.e., some third factor which makes people both poor and unhealthy.

willholloway 10y ago
Have you lived in Western style poverty? Have you mingled with those who patronize pawn shops and payday lenders? Please cite the various randomized control trials, and I would say it is far too early to draw conclusions on the effects of the medicaid expansion as it has only been two full years since rollout. I speak from experience, as someone from a wealthy family and a wealthy area that shunned the family business and went out with nothing to seek startup fortune. I had a good start in 2009 with a success in affiliate marketing, when that dried up I put all that I had made into another venture that limped along at sub-ramen levels for a while and then I pulled the plug. The fallout was not fun, and the effects not benign. It was pre medicaid expansion and there was no healthcare to be had, and almost no safety net to be found whatsoever. I could have gone home and had everything I needed but I wanted to make it on my own. I had been living in Boulder, Colorado and thought a move to Austin would lower expenses and extend the runway for the company. That was ill-advised, and another story, but it added another dimension to my troubles at the time. Was it a stupid risk? It was but I was young and felt invincible, and in 2010 with a liberal arts education there weren't a ton of jobs waiting for me. The wealth transfers you speak of are not easy to get. I'm not even sure where you get the 15-20k number. What else is there for a low earning single male besides SNAP, and now Medicaid. In that time, as someone who found themselves with no assets and no income the only benefit I seemed to have qualified for was about $160 a month that could be spent at the grocery store. Feeling a tremendous amount of shame I applied for SNAP benefits, even though I knew that they were really a subsidy for American farmers, ideology had trained me that subsidies for corporations are virtuous, while subsidies for basic human needs are shameful. Even though I qualified, the overworked staff denied my valid claim. It took them over a month to tell me this. It would have taken another month to apply again and maybe they would get it right that time. I gave up and having good credit financed my nutrition via credit card. I hadn't coded since elementary school, but I was able to pick up django web dev and find a high paying job in a couple months. But that happy ending is not typical. There is no way that the stress from that period didn't shave a little bit of time off my life. And the lack of liquidity prolonged the period by a good bit. I spent so much time doing this or that to get $200 for the rent, it was tremendously inefficient and stressful. Bad terrible memories, a place I never want to go back to. I was sad during all of this. It broke up the relationship I was in with someone I really loved. I spent a lot of time with those who ride the bus, with those who pawn. Their lives are very different than the lives of the families from my coastal home town. Their lives do kill them slowly, which is why life expectancy is a full dozen years longer for the wealthy. I have since moved back to the wealthy coastal town I grew up in. Life is so easy here, because there is wealth here. You can get a nice boat for almost nothing because someone just doesn't want it anymore. Someone I knew was just gifted a boat for $1 because the owner was just happy it was going to stay on the island. No one ever gives my former bus riding compatriots anything. The thing is the people that live here are no different genetically than the people at the pawn shops back in Texas. The only difference is the presence of wealth, and the virtuous effects that has when it's sustained for a few generations.
- maxerickson 10y ago
  The Oregon thing started in 2008. It has mostly benefited the recipients financially rather than medically.
  - willholloway 10y ago
    Oregon is just one program, why is life expectancy for wealthy rising, and falling for the poor? Why is the gap around a full dozen years?
    - maxerickson 10y ago
      I don't know. But if I understand correctly, the point of bringing up the Oregon study was that access to medical care doesn't seem to have a lot to do with it. At least not the incrementally better access provided by Medicaid programs. I would certainly speculate that there is a bundle of ideas that contribute to it. Ideas about personal decisions being impactful, leading to things like less smoking and better diet, and even better life situations (which can presumably lead to a different relationship with stress).
    - yummyfajitas 10y ago
      Probably because the poor behave differently from the rich - they tend to overeat more, exercise less, smoke more and drink more. Also any disabled person (who probably has other health problems that reduce life expectancy) is by definition poor (poverty is defined as low market income).
      - facetube 10y ago
        All of the behaviors you cite could be caused by extreme stress, poverty, or threats to safety/well-being (rather than being a cause of poverty). I've felt it, and I've done it.
      - willholloway 10y ago
        It is poverty itself that creates short term thinking that leads to those choices. This is why poverty is expensive for society, and investment by society to eliminate it would be paid back and much more.
facetube 10y ago
The RCT you cite examines the effects of "wealth shocks" (read: unexpected winnings) in a population of Swedish lottery winners on mortality and health care utilization, in a country that already has access to taxpayer-funded universal health care. The state pays 97% of all medical costs there [1]. Using this to support your claim borders on intellectual dishonesty IMO. Re: Medicaid, it's difficult to find high-quality health care in the US as a Medicaid patient, mostly because practices are free to turn you away simply because you're a Medicaid patient. "We don't take Medicaid". That's it. One of the major academic health systems here (in Oregon) systematically directed all Medicaid and Medicare patients to a single low-resource clinic across town by policy, citing inadequate reimbursement rates. The result is long wait times and inadequate care. [1] Glenngard, A., Hjalte, F., Svennson, M., Anell, A., & Bankauskaite, V. (2005). Health Systems in Transition: Sweden. WHO Regional Office for Europe, 2005
- yummyfajitas 10y ago
  The state provides health care, yet there are still disparities between rich and poor. This confirms my second and third studies which show health care doesn't help. This study also shows that (as postulated by folks down thread) that money doesn't change health behaviors. That's the point - health disparities are mostly not caused by either health care or wealth. They are caused by something else (e.g.diet, exercise, genetics).
  - facetube 10y ago
    The US absolutely does not have a universal health care system; roughly 33 million remain uninsured, and a large number of those who are insured do not have adequate savings to pay their high deductible (which can be as high as $6,000 per person per year in-network, and twice that out of network).
    - yummyfajitas 10y ago
      Read all three studies. Rand and Oregon show more health care doesn't improve health. Sweden shows more money doesn't. What, exactly, are you disputing here?