Dear Amy,

I am very familiar with the British & Irish models of health care. They both have what is essentially a two-tiered system of private insurance and publicly funded health care. I agree with the need for a lowest level safety net for all in a society regardless of status, etc., because the health of the poorest affects the quality of care and the health of everyone else. Some of the problems that arise from a "socialized medicine" system is that from the health care provider's point of view, the less you do the better off you are. Anything greater than the minimum amount of work required to be done for the pay for service is not only not compensated but viewed as an added burden.

There must be some kind of minimal level of care. It is unpleasant for some to consider this, but it saves money for everyone to prevent illness before it begins. (Consider how much money would be saved if millions of Americans never started to smoke.) This is such a fundamental issue. I can't understand why we don't have some kind of national health care system in place for people who cannot pay or would be wiped out by one serious illness.

Regards,

emkeane

Amy, the reason we need to fund universal care at some level (treatment, not just preventative care) is so no one has to choose between chemotherapy and keeping their house. Or face the triple bypass and the likelihood of bankruptcy for the widow if it fails. Or choosing between health insurance and paying your utilities. These are very real and frequent occurances these days for the middle class, not just the welfare recipients or the working poor. And there are early interventions and less costly alternatives that don't fall under the heading of "preventative" but are still more cost effective for all of us to shoulder together.
The UK and Canadian systems may not be perfect, but they're a heckuva lot better than what we've got in the U.S.

> so no one has to choose between
> chemotherapy and keeping their house.

I'm a bitter, moody, selfish video tech who stumbled drunkenly into the California real estate market at the start of the recent upswing. Let's say I caught some freaky kinda cancer (a meaningful probability, given middle age, a diet packed with cheese and a lethargic demeanor).

Why on Earth should other Calfornia and American taxpayers --the (slender) majority of whom been paid less, though all have worked harder-- be expected to cover these bills before my own resources are tapped?

You should read Mickey Kaus for this stuff. He's all over it.

>(Consider how much money would be saved if millions of Americans never started to smoke.)

Consider how much money would be saved if proper Americans would generously die before sixty like we smokers do.

I hesitatingly agree that there should be universal health care in America, but with one MANDATORY stipulation. It should be bad. Real bad. And cheap.

Broken leg? We'll try to shake a branch off the neighbor's tree for you to use as a cane. Both legs broken? Wheel yourself around on this skateboard we found in the dumpster until your legs don't hurt when you walk. Impotent? Here's a Penthouse. You can't take it with you and you have to share it with those four guys over there. If that doesn't work, try homosexuality.

The point is that it should take care of an absolute essential, like a knife wound to the eye or a really bad case of SARS (ooh SARS), but do so poorly with everything else that people will want to get real health care as soon as they can.

In response to Little ted:

>(I hesitatingly agree that there should be universal health care in America, but with one MANDATORY stipulation. It should be bad. Real bad. And cheap.)

"Bad health care" is as bad as no health care, perhaps worse. The patient counts on the *primum nocare* a.k.a. "...first do no harm." Health care must make the patient better, or else the doctor should not do anything at all if acting will only make the patient worse.

>(Consider how much money would be saved if proper Americans would generously die before sixty like we smokers do.)

Smokers don't usually die cheaply. They also miss more work in a year because of their smoking than non-smokers do. Smoking is implicated in at least 6 kinds of cancer and other non-neoplastic diseases such as emphysema, heart disease (coronary artery disease - a symptom of which can be impotence because of damage to vessels needed to achieve an erection), and other diseases you can probably Google or look up on wikipedia. Cheap health care is not the same as effective health care. There is a maxim in medicine that the cheapest pill is the one that is effective. If a doctor has to prescribe a medication that costs more to keep the patient healthy versus a cheaper medicine that doesn't do the job, then it is less cost-effective to go with the cheaper drug. In the long run, recipients of poor health care will tend to use greater amounts of resources that would normally be used for keeping a larger number of people healthy - compare the cost of effective vaccination with the Salk polio vaccine versus a lifetime of treatment for a severe case of polio in just one person. Alternatively, try the same comparison with the care needed for someone who ignores their high blood pressure or diabetes and suffers the sequelae of peripheral vascular disease, stroke or related neurological deficits, blindness, kidney failure, coronary artery disease (myocardial infarction, etc.), loss of income, intensive care treatment and outpatient and rehabilitation - the list is much longer than I will write here and the effects on quality of life are pervasive. This example is limited to people who have both knowledge of the conditions (both are often discovered as an incidental finding during a routine clinical visit) and the possibility of modern medicine intervening in the course of the disease. There are precious few diseases that medicine can actually cure.

When people buy health insurance, they a buying form an insurance company that pools the risks of illness and death for one individual with that of the entire group. Participants that don't take good care of themselves use greater amounts of resources and drive the costs up for everyone in the pool. The members who are discovered to have preexisting conditions are excluded - with extreme prejudice - because they will drive up the costs and drive down the profits. (This is the free market insurance system though it doesn't account for how insurance companies really do make their money in the real world.)

>(Broken leg? We'll try to shake a branch off the neighbor's tree for you to use as a cane. Both legs broken? Wheel yourself around on this skateboard we found in the dumpster until your legs don't hurt when you walk. Impotent? Here's a Penthouse. You can't take it with you and you have to share it with those four guys over there. If that doesn't work, try homosexuality.)

This sounds Dickensian, and as if you lack both imagination and humanity towards your fellow man. What kind of a world would this be if all of my friends and neighbors had the same misanthropy? But I digress here.

>(The point is that it should take care of an absolute essential, like a knife wound to the eye or a really bad case of SARS (ooh SARS), but do so poorly with everything else that people will want to get real health care as soon as they can.)

In has been proposed by epidemiologists that in the eighteenth century approximately 95% of Europe was exposed to or infected with tuberculosis. Not all of them died. Why? If the general health of someone exposed to TB is good, there is a lesser likely to suffer the effects of an active disease. This is often seen in chest x-rays that have evidence of an old infection that has healed or become dormant. A healthy individual is also less likely to get sick in the first place, generally. If medical care were only given when there was a crisis, it would be a crisis for all of us. How about safety goggles before risking an eye injury. SARS? How much time in an ICU does a SARS patient need, at what cost, and is the money well spent if their chance of survival is still not good? Vaccines cost millions to develop, but only pennies to inoculate.

As for your quip about homosexuality, I can only imagine that you subscribe to the origins of this as a theory of a kind of low sales resistance (not that there's anything wrong with it...) I'm so straight I don't understand how women find men attractive let alone my considering another man arousing.

Yes, I had nothing better to do today thank you.

Sincerely,

emkeane

>This sounds Dickensian, and as if you lack both imagination and humanity towards your fellow man. What kind of a world would this be if all of my friends and neighbors had the same misanthropy?

Support of CanadaCare apparently doesn't correlate well with a sense of humor.

>As for your quip about homosexuality, I can only imagine that you subscribe to the origins of this as a theory of a kind of low sales resistance (not that there's anything wrong with it...)

Nope, just trying to play the part of a hypothetical shitty doctor offering poor governmental treatment towards a non-lifethreatening condition like impotence.

Since you've generally missed the point of my 'support' for national health care, I'll spell it out unimaginatively. I'm fine with a safety net, and a safety net only, since private care is better.

>Smokers don't usually die cheaply

But we die young. One year of failed chemo and a morphine drip is insignificant in cost to twenty in an old folk's home, choking on your own drool and being forcefed a hundred pills a day. How many more people have you known who've been bankrupted by living in a primary care home than who've been bankrupted by lung cancer (I'm guessing the latter number is zero)?

>In the long run, recipients of poor health care will tend to use greater amounts of resources that would normally be used for keeping a larger number of people healthy

Ridiculous. Fallacious. Good doctors don't keep people healthy. In fact, no one needs a doctor or health insurance when they're healthy. There's no such thing as a medicine to make people healthy. Medicine and Doctors keep you from getting worse, which has a state of unhealthiness as a given, so they are useful (and necessary, I'm not Tom Cruise here) only to the unhealthy. If you want to be healthy, stop spending all your time at the fucking doctor's office and start spending it at the gym.

I'll take my organic food, cigarettes, sneakers and weightlifting gloves while you keep a vascular surgeon and a drug contract under a cheeto and pepto-bismol encrusted bed and we'll see who does better on a physical at the end of the year.

Missed this part the first time I read it.

>How about safety goggles before risking an eye injury.

Perpetual wearing of safety goggles on the off chance that some nut stabs you in the eye? You should run that by Invention Submission Corp because it sounds like it could be the next big thing.

>Good doctors don't keep people healthy. In fact, no one needs a doctor or health insurance when they're healthy. There's no such thing as a medicine to make people healthy.

Completely untrue. There are many health problems that can be managed, or potential problems that can be avoided, with some sort of medical intervention (tests, advice, medication, etc.). A couple that spring to mind are hypertension and diabetes.

You can argue that treatment to avoid or manage problems like these are not the doctor keeping you healthy, especially when treatment involves lifestyle issues - but it is the same in functional terms, because the patients often don't know when they're at risk, or what specifically to do, without health care professionals.

>Smokers don't usually die cheaply


>>But we die young. One year of failed chemo and a morphine drip is insignificant in cost to twenty in an old folk's home,

That's fallacious reasoning, because those are not the only options. Emphysema patients often need years, even decades, of major care. Lung cancer patients might have multiple operations plus chemo on and off again for several years before finally snuffing it. And many 80 and 90 year olds are still travelling, gardening, or at least not requiring someone else to cut their food and administer multiple meds.

I don't mind being in the same insurance pool as smokers, because I assume that their premiums will be adjusted accordingly. I don't even mind bearing the proportionate costs of smokers' health care if everyone is in one universal insurance pool (though I would lobby for some part of tobacco taxes to go to health care to offset it). But I do mind having the entire medical system overcharge the insured to cover necessary care for those who aren't insured, whether they are smokers, or just unlucky enough to get into a car accident and need trauma care.

Crid, the reason you shouldn't be forced to exhaust your personal resources for required health care before relying on the taxpayer is the same reason that you shouldn't have to pay directly for your own water purification plant, private security force, or roads. Health care should be one of the basic needs that the entire society should shoulder collectively if we want to call ourselves civilized.

And just as you must pay for bottled water if you want something other than what comes from the tap, you should have to pay for elective health care, or if you want Cadillac-level health care instead of Volkswagon level, or if you don't want to wait for non-urgent treatment (which collective health care often requires).

Another thing to think about is that as a taxpayer and a consumer, you're already paying for health care for the uninsured, but currently in the most inefficient, and therefore expensive way possible. Poor people use emergency rooms for primary care, which is incredibly expensive and inefficient, and also impacts treatment for those with true emergencies. Or they delay care for a problem that would be cheaper to treat at an earlier stage. Or they don't get tests and treatment and thus spread something like TB - thereby costing more in treating the people they infect. And so on and so forth.

>Completely untrue. There are many health problems that can be managed

Health problems indicate a state of unhealth. So, like I said, if you need a doctor, you're already unhealthy, and the best Doctor in the world isn't going to make you physically fit enough to pull a Lance Armstrong. Complete a tour de France, I mean.

>Emphysema patients often need years, even decades, of major care

Here I thought lung disease was fatal. Silly me. The dozen or so uncles I had who all kicked it at about fifty must have died because we don't have socialized medicine, not from lung disease.

>many 80 and 90 year olds are still travelling, gardening, or at least not requiring someone else to cut their food and administer multiple meds

Should have replaced 'many' with 'there exist.' I'm not denying that these people exist. I'm also not denying that there're people out there who smoked for sixty years and died at 90 without spending a dime on medication. But both groups are the exception. Aren't generalizations based on the exception more fallacious than those based on the rule?

>I don't mind being in the same insurance pool as smokers, because I assume that their premiums will be adjusted accordingly

By that rationale, shouldn't blacks pay more for health insurance? They die faster and have more health problems, just like smokers. I don't think blacks should pay more than white people.

>But I do mind having the entire medical system overcharge the insured to cover necessary care for those who aren't insured

Don't pretend that that's why health care costs perpetually rise. They rise because people keep paying. They'll stop when people refuse to pay more.

The question is begged:

> Health care should be one of the
> basic needs that the entire society
> should shoulder collectively...

Why?

> ..just as you must pay for bottled
> water if you want something other
> than what comes from the tap...

Ever pay a water bill? Ever pay taxes? The infrastructure that answers your thirst cost hundreds of lives, billions of dollars, required decades (sometimes centuries) to construct, and leaves deep scars on the landscape, the larger environment, and the body politic.

This is not prissy wordplay on my part. Nothing is more revolting than seeing lefties describe the product of other's efforts, sacrifices and taxation as 'free.'

And you want the government to control my healthcare?

Also, a writer mentioned here recently offers his thoughts.

Another response to Little ted:

I apologize if it seems I'm picking on you. I'm not. I'm just having my sadistic fun at your intellectual expense.

>>Completely untrue. There are many health problems that can be managed

>Health problems indicate a state of unhealth. So, like I said, if you need a doctor, you're already unhealthy, and the best Doctor in the world isn't going to make you physically fit enough to pull a Lance Armstrong. Complete a tour de France, I mean.

The tour de France example is unrealistic for the average person; otherwise, any Joe Six-pack would be on the front of a cereal box and not Lance Armstrong.

Where a doctor can make a difference can be as simple as proper management of asthma allowing a patient to be able to function normally and go about the mundane tasks of the day, or caring for a woman with a problem pregnancy. Who knows? She could win an Olympic medal after she gives birth. Many women athletes do continue to compete after delivering a baby. Giving birth does not equal becoming disabled. Granted, being pregnant is not the same as a disease state, but there is still a high mortality associated with pregnancy and even healthy couples can have crisis situations with problems such as Rh incompatibility (the mother's blood type differs from that of the father's and causes the mother to produce antibodies for the baby's blood cells because of inherited genes), a prolonged and difficult labor, a baby too big to fit through the birth canal, preeclampsia/toxemia, infection, postpartum hemorrhage, deep vein thrombosis, etc. (Have I balanced alarmist with boring yet?) — That's only in obstetrics!

>Missed this part the first time I read it.

>>How about safety goggles before risking an eye injury.

>Perpetual wearing of safety goggles on the off chance that some nut stabs you in the eye? You should run that by Invention Submission Corp because it sounds like it could be the next big thing.

That was funny. I didn't realize what a bone-headed thing I had written until you commented on that. What I should have written was that there are some easily preventable problems such as brushing your teeth to prevent cavities. I hope you brush your teeth.

>>Smokers don't usually die cheaply

>But we die young. One year of failed chemo and a morphine drip is insignificant in cost to twenty in an old folk's home, choking on your own drool and being forcefed a hundred pills a day. How many more people have you known who've been bankrupted by living in a primary care home than who've been bankrupted by lung cancer (I'm guessing the latter number is zero)?

A problem with this is assuming that anyone will live long enough to be bankrupted by institutionalization due to infirmity and senescence. I wish I was this psychically gifted. I would be rolling in lottery money and having *the help* type this for me. Melissa answered well by saying,

> That's fallacious reasoning, because those are not the only options. Emphysema patients often need years, even decades, of major care. Lung cancer patients might have multiple operations plus chemo on and off again for several years before finally snuffing it. And many 80 and 90 year olds are still travelling, gardening, or at least not requiring someone else to cut their food and administer multiple meds.

I add to this that when they are ill and dying the family around them suffers both emotionally and economically. The terminally ill do not make for the most productive workers and usually drain whatever financial resources that were accrued before the onset of the illness. Good medicine does not come cheap. We both agree on that. My father-in-law died of mesothelioma a long time ago. It was neither cheap nor quick. I have seen a surprising number of cases of financial hardship due to illness, and it doesn't even have to be terminal. Consider how many elderly people you know taking 14-17 different medications have to choose between getting their drugs and eating. This could be the future for so many of us. Good genes beat good habits, but who can be certain that they have the good genes or that the bad genes will not be expressed and cause disease and disability?

— Enough for now

Regards,

emkeane

>The tour de France example is unrealistic for the average person

As we've learned the past year or two, the average American is grossly out of shape. I used the tour de France as an example of the kind of health human beings should strive for, though not realistically attain.

>A problem with this is assuming that anyone will live long enough to be bankrupted by institutionalization due to infirmity and senescence

I think it's a fair assumption. Life expectancy is in the 80s now even with all the deaths from breast cancer, lung cancer (not just smokers) and heart disease where those people tend to die decades younger than 80. I actually think it's a fair assumption that someone's going to live to 90 if they make it to 65 without a potentially fatal condition.

I'm way off my original, intended point here. My point is that government cannot be the primary care provider for everyone, simply because that's too big a job. The bigger government is, the worse it runs. The more government does, the more inefficient and expensive it becomes. Government jobs exist without accountability and government agencies do not shrink with commensurate need. That leaves government agencies with too many people, who all feel they have to be doing SOMETHING, so the employees just invent new forms that make more irrelevant work for other government employees. So much work that they have to hire more people to do the nothing work. Just look at the debacle that is the Department of Homeland security. They spent six months chasing a child molester in Arizona, which created all sorts of jurisdictional problems with the local authorities and also meant that they weren't doing their job explaning to a hypothetical sheriff in Montana what an orange alert means. Maybe this supposed sheriff thinks it means arrest everyone with brown skin. Look at how much unnecessary work this causes with nothing actually getting done, being that the child molester is likely to get off on the fact that homeland security has no authority to investigate or arrest him. Add to that the House's recent shooting down of the bill that would have prevented government employees from quitting their agencies to take positions for companies they used to regulate and now you have our health care provider as a proxy for Pfizer, since all our health insurance employees are competing for a lobbying gig there.

Another, less hypothetical example, with a good foil is the post office. I tried to get a job with them a few years back, while in college. Seven weeks after expressing interest they sent me a packet. Filled it out, sent it in. Four months later I received a letter saying that it took too long for them to process and I had to fill out another identical form with a different indexing number. They sent me that form four weeks later. Filled it out, sent it in. Two months later I received a letter saying that the first form (that couldn't be processed) had been processed and I had been scheduled for an exam in a community nowhere near where I applied for. Two days later I received a letter saying that the second form had been processed and I had been scheduled for an exam on the same day as the first one, with overlapping times in a different community that was two hours away from both a)the community where I lived and b)the other exam. Nine month application process. Contrast this with the college summer I applied for Fedex. Applied on Tuesday. Scheduled for an interview on Wednesday, offered the job on Thursday, turned it down on Friday. What do you want to bet it was someone's first day stacking boxes on Monday?

My original reference to bad care was mostly a joke about my belief that if the USgov was to offer health care, it would need to be absolutely minimal, so it didn't turn into one of these behemoths that doesn't get the intended job done and costs five times more per person than private health insurance as outrageous as that currently is. People would need an incentive to NOT use USgov health care.

I just lost a half hour of necessary sleep. Should have waited until tomorrow.

"no one has to choose between chemotherapy and keeping their house. Or face the triple bypass and the likelihood of bankruptcy for the widow if it fails."

It's called paying for health insurance. And if you want to gamble that you won't need it and you get socked - well, tough for you. I have an HMO -- Kaiser Permanente -- because I chose to be a newspaper columnist not a sitcom writer. I'd rather have Blue Cross. I'd also rather live on the ocean in the row of houses next to the Santa Monica Pier.

>It's called paying for health insurance. And if you want to gamble that you won't need it and you get socked - well, tough for you.

The problem, Amy, is that even HMO coverage is too expensive for a lot of people to afford - not just because they are making bad choices, too bad for them, but because they truly can't afford to eat, have heat in the winter, and pay for coverage. And guess what - when those folks show up at the ER (maybe with something that could have been prevented or treated much cheaper if they'd seen a doc earlier, or maybe just because an idiot driver creamed them), we all pay for it.

Plus a lot of people that should be in the coverage pool, to spread the risks more evenly (and thus make it more affordable for all) don't opt for coverage - e.g., 20-somethings, who think they're invincible - until they have a head injury on their motorcycle and require a few decades of care, at our expense. Like I said, you're paying for it anyway - the only question is whether it is going to be equitable and efficient.

And one more thing - even with coverage, you can still face bankruptcy if you have a bad enough medical problem. And health problems aren't always volitional or self-imposed, like from smoking - you could be hit with Parkinson's, MS, Alzheimers, cancer, any number of things due to no fault of your own, and be out of pocket thousands, even if you are insured. The rest of the civilized world can't believe that we Americans could face years of crushing payments just for needing an appendectomy while between jobs.

In response to Little ted:

>As we've learned the past year or two, the average American is grossly out of shape. I used the tour de France as an example of the kind of health human beings should strive for, though not realistically attain.

I liked your point about [people] striving for an optimum level of health that allows athletic excellence, or at the least, full participation in activities. A confounding factor for the inclusion of wine and other eyebrow raising foods in the diet of the French and their longevity is probably related to the greater amount of physical activity that they have compared to average Americans. Europeans spend more time walking than North Americans.

>>A problem with this is assuming that anyone will live long enough to be bankrupted by institutionalization due to infirmity and senescence

>I think it's a fair assumption. Life expectancy is in the 80s now even with all the deaths from breast cancer, lung cancer (not just smokers) and heart disease where those people tend to die decades younger than 80. I actually think it's a fair assumption that someone's going to live to 90 if they make it to 65 without a potentially fatal condition.

There are several reasons why life expectancy has increased over the past hundred or so years. One of them is the introduction of antibiotic therapy. This helped reduce the death rate from infectious disease for many people of all ages in the population. The generally healthy benefitted from this too. Vaccines have also played a part here. Vaccine development and implementation are the kind of big government program in health that has worked extremely well. (Do you know anyone who has ever had a case of smallpox?) Another big player in the increase in life expectancy is the reduction in infant mortality. There are many different factors that successfully go into bringing this level down; improved understanding of and quality of nutrition, antibiotics, hygiene, medical intervention, etc. Both life expectancy and infant mortality taken together are used to assess the quality of life not just the quantity of life, e.g., there is a very strong relationship between the increased rate of literacy in young women worldwide and the reduction of infant mortality rate in these related populations. Conclusion: The more illiterate, the more likely that infant mortality is higher and quality of life is lower. (This is from a United Nations study published a few years ago.) I'm not championing public education here. I'm just explaining that the quality of life and the quantity of life are interrelated concepts.

>I'm way off my original, intended point here. My point is that government cannot be the primary care provider for everyone, simply because that's too big a job. The bigger government is, the worse it runs. The more government does, the more inefficient and expensive it becomes...

I can agree with your assessment that there are big problems with some government programs and the idea that government is the answer to all social problems. However, I do see many success stories. Rural electrification is one. Public schools are a hotly contested topic, but they do produce some educated citizens, though they could do a better job of it. I would like a health care system that does a little better than that of public schools. Public utilities and services such as water, road building, the Postal Service, the military, etc. all come with both benefits and liabilities. The private sector does do some things well, but it cannot replace government on all issues. I worked for UPS for a year a long time ago. They were very good at what they do. I think FedEx is good competitions for them. I still marvel that the US Postal Service can do what it does as cheaply as it does and as reliably as it does.

Actually, wine and foods enjoyed by the French (small portions, too) are not confounding but contributing factors to their longevity. As is the fact that they tend to move more than we do. Bodily, not from dwelling to dwelling, I mean. Book about this: The Fat Fallacy by Will Clower. And Gary Taubes, who's a fantastic investigative science journalist, is finishing a book on a similar topic.

Even when I was truly struggling, I always made having health insurance a priority. I didn't want to come down with some horrible illness and leave my parents with some tough decision about mortgaging their lives to pay for me. There's catastrophic care insurance for people who can afford less. Or want less. Or what I have: Kaiser HMO. I'd like better health care, but that's the best I can do, vis a vis my expenses. Sure, let's pay for the poor. But not for the people who nix health care so they can afford a new car. Some people can't make ends meet for good reason -- lost job, etc. Other people are just greedy and materialistic, and think others should pick up the slack for them. Well, pick up your own damn slack - and ahead of time, thank you.

>Public schools are a hotly contested topic, but they do produce some educated citizens

I'm a product of public schools and I really do believe I learned more in the year that I've had the history channel than in the twelve I spent doing mindless worksheets. But no matter.

There aren't any federal schools, thank god. Just imagine how backwards any federal scholastic curricula would be if the federal CDC is telling Americans that masturbation causes pregnancy (it was the CDC, wasn't it?). Now that you've imagined how horrible that national school system is, imagine now that it was mandatory for every living man, woman and child of American citizenry to attend, and private schools were outlawed.

Now you've got a fair nightmare of what the US socialized medical system would be like.

>Actually, wine and foods enjoyed by the French (small portions, too) are not confounding but contributing factors to their longevity...

I agree with this. People in the US generally eat far more than they need. The portions in a restaurant here are huge in comparison with what I expect to get on a plate in Europe. North Americans are more sedentary as a group. I don't live in L.A. though I can imagine that people who do don't usually spend as much time walking as someone who lives in a large European city. I've visited L.A. and I did drive everywhere I went. I've lived in Europe and I've worn out several more pairs of shoes Than I did in the same amount of time in the U.S.

I remember, with some humor, the conferences and lectures I've attended that focused on the influence of alcohol and life expectancy. The group that had one drink a day had a lower mortality rate than the groups that had either no alcoholic beverages or had more than two drinks each day. The trend was graphically displayed and the more a person drank after two drinks, the greater the mortality rate. However, I don't think the study was able to make distinctions of what else was going on in their lives that also-influenced this trend. It was a big study, but I'm fuzzy on the other *confounding* factors. By confounding I mean issues that would undermine the validity of the study or the basis from which the conclusions are drawn. Fats are essential in the diet; some do better with these than others. I do think that the importance of a higher cholesterol as a risk factor for heart disease has been hyped a little too much. Cholesterol is an essential structural component of cell the cell membrane. If you don't eat enough of it you will synthesize it, and there is a complex relationship between life expectancy and serum cholesterol: Extremely high is bad but so is extremely low. There are strong guidelines that support lowering of cholesterol for patients in medicine, but this tend to overwhelm the exceptions to the rule.

Amy, I had a suspicion that as soon as I mentioned something French your fingers would find their way to the keyboard and you would follow them.

--emkeane

>I'm a product of public schools and I really do believe I learned more in the year that I've had the history channel than in the twelve I spent doing mindless worksheets. But no matter.

Mindless worksheets aside, did those twelve years of public school somehow make learning from the history channel easier and more interesting than no school at all?

-- Just curious

I was just kidding about that. But honestly, public history, which should be the most contentious subject among schoolboards setting curricula sue to political polarization (even though science inexplicably now is), is ridiculously inadequate. All I learned in all that history is that the Europeans failed to take back Jerusalem in their crusading attempt to make it safe for Jews, George Washington never lied, Lincoln attacked the south to free the slaves and that white people kidnapped all the africans that slaved for cotton. All are erroneous.

Although I guess I also did learn that Babylonians like Ziggurats. If only we could somehow apply that to Iraq...

Little ted,

>All are erroneous.

You've done well here. I learned and unlearned the same stuff. It think it was Plato who thought that for the very simple people, it was better to tell them lies (laws come from the gods...) than try to engage and educate them. (That's still true today.) I'm glad you went to the level of asking how does this work and why?

Regards

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tjfokyqvb njki rgqsxevic mnso yvmuklfb smbet tolq

Just in case you're surfing this blog and read this far...

The idea that roads are equivalent to health care is nuts. It ought to be obvious why.

Anyway, here's an answer.