Bacon's Rebellion

Democracy Thrives in Sunlight

Mountain Women Die Younger

—

by

James A. Bacon
in

Virginia boasts of many fine medical centers including the Medical College of Virginia, the University of Virginia and others. Doctors’ offices in metro areas are chock-a-block with diagnostic and surgical devices that can do in seconds what used to take hours.

So, it comes as a bit of a shocker to realize that in some parts of Virginia, life expectancies for women are actually declining. That is the case in mountain areas such as Radford and Pulaski. In 1983, females living in those areas could expect to live 84 years. By 1999, according to The Washington Post, it had dropped by 5.8 years to 78.

The trend in those spots of the Old Dominion was repeated in other sections of the U.S., notably in the Deep South around the Mississippi Delta, in some parts of the Upper Plains and in the Southern Appalachia coalfields not far from Pulaski and Radford. All in all life expectations for females dropped in 1,000 counties in the U.S. This is from a recent report put together by researchers from the University of Washington, The University of California, San Francisco and Harvard.

A big reason for the declining female mortality rates: diet, sedentary lifestyles and a lack of decent medical insurance. Besides super-sized fries, soft drinks and Double Whoppers, the mountain ladies also like cigarettes and beer. This adds up to weight gain, which in turn leads to what one local general surgeon calls the “Five Fs” – “female, forty, fertile, fair and fat.” The oversized ladies are prone to diabetes, vascular and heart issues and cancer.

Is it time to get serious about mandated health insurance with some kind of government intervention? I think so. Do you?

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  1. James Atticus Bowden Avatar
    James Atticus Bowden

    PG: How does government intervention and or medical insurance make women eat less, exercise more, stop smoking ,cut back on booze, and give up drugs?

    What is the relationship that establishes cause and effect?

    If you care about health – then the folks need to change their behavior.

    If you care about the quality and availability of health care then we need less government intervention in regulations and mandates – and involvement in turning existing tax dollars into individual health savings accounts for all Virginians.

  2. Anonymous Avatar
    Anonymous

    J.A. Bowden,

    Changing behavior is one thing (I expected that to be the first argument from Republican readers), but losing medical insurance is quite another. I suspect that when Volvo lays people off, or Wal-Mart, they are hard-pressed to replace their medical insurance. Without it, they lose medical monitoring and education about harmful behavior — plus the ability to do much about it if they are confronted with the expense of a big medical problem.

    PG

  3. Anonymous Avatar
    Anonymous

    You say “Is it time to get serious about mandated health insurance with some kind of government intervention? I think so. Do you?”

    Some kind of government intervention … do you mean the government intervening in my life (life style)? Or do you mean intervening in health insurance? I can’t say I’m clear on what you mean.

    As for government monitoring my life style – go sit on a corn cob. I’m over 21 and free, once I moved out of my parents house I’m responsible for myself and I like it that way; keep your big brother for a socialist country thank you.

    As for government messing with health insurance companies. Again, no – any time the government mixes itself into something it rarely gets better, more often it gets radically worse.

    As for your cry for those who have no health insurance. If you have a condition and have no health insurance there should be some government funded programs that allow for life saving immediate operation. However, where do you draw the line between someone who needs a broken arm fixed and someone who has incurable cancer or a kidney that is failing? If your arm doesn’t get fixed, you will have a small to large problem down the road. If your kidneys are failing, should the government and tax payers be on the hook for all the dialysis treatments; and possibly the costs of a new kidney operation? What about those with incurable cancer? What if the cancer has a 50% recovery, do we fund that operation? What about the trans-sexual who wants a sex change operation? Mental stress you know, do we fund that? Look at the countries that have socialized medicine, the waiting lines for operations like gallbladder removal are insane. I had mine out, it was taken out the day after it was diagnosed – I would have hated to have been in pain for 3 to 12 weeks under socialized medicine to wait to have it out (not to mention, if it had ruptured during the time my life would have been in peril).

    Keep government out of medicine. Exception, set up clinics to fix broken arms and diagnose things like cancer (or whatever). As far as putting the entire country on it… no thanks. When I think of government and medicine I think of the post office and the DMV. They get the job done but efficiency and speed do NOT come to mind (as I stand in line).

  4. Anonymous Avatar
    Anonymous

    “As for government messing with health insurance companies. Again, no – any time the government mixes itself into something it rarely gets better, more often it gets radically worse.”

    That’s the most asinine statement I have ever read when it comes to health care.

    In case you didn’t notice the govn’t IS involved in our nations health care system….they just happen to be involved on the side of insurance companies and HMO’s.

    If you want to “fix” health care in this country start with what is lacking the most……competition.

    And, I would even take it a step further and implement price controls….there is no reason a broken arm should cost $500 in one hospital and $2500 in another.

  5. Michael Ryan Avatar
    Michael Ryan

    there is no reason a broken arm should cost $500 in one hospital and $2500 in another.

    Actually, there is. The folks at the later are subsidizing everyone who doesn’t have health insurance. not just to pay for their broken arms, but that immediate critical care for gunshot victims, and the rest.

  6. Groveton Avatar
    Groveton

    Peter:

    Great comments. Life, liberty and the oursuit of happiness….

    Life is the first.

    Better education and health insurance that varies by behavior.

    Would it be a subsidy? Yeah, probably. Should we do it? Yeah, definitely.

    I recommend Deer Hunting with Jesus as a companion book to all things small town in Virginia.

  7. Larry Gross Avatar
    Larry Gross

    the problem with a lack of access to medical care – be it voluntary or involuntary is that it is not a permanent condition.. and then you die.

    You don’t go… until.. you are so bad off that you seek help – at which point – you EXPECT to get FREE treatment…and our system will not turn you away.

    so.. if you work 20 years without paying your share of health insurance payments and then need help.. you expect it.

    so basically.. we’ve got scofflaws “out there” who save money by not paying into a fund that, at some point, unless they are lucky enough to die quickly without costly medical, they WILL expect OTHERS to pay for their medical.

    How this plays into folks who could not afford insurance to start with and a toxic lifestyle… is more complicated….

    … but if such people HAD access to continuing health care.. and the Doctor URGING them to take better care of themselves -you know.. like your own Doctor does if you DO have access to medical care….

    … People are cut off not only from treatments and therapies but the “care” part also…

    People say they don’t want a single-payer universal health care system in this country.

    Folks, we already have one and it has 5 times lower administrative costs than private sector insurance and it’s called … Medicare.

  8. Anonymous Avatar
    Anonymous

    Larry Gross makes good points in that some people ignore their health until it is a must and then expect free care.

    J.A. Bowden likewise has worthy points about people not taking care of themselves. But I’m not sure how his idea of individual health savings accounts would work and if an underclass can’t take care of themselves in the most basic ways, how can they be expected to manage their own health care account successfully?

    The fact is that the U.S. is one of the few countries left with a private, for-profit insurance care form of health care. Such care tends to push medical technology at the higher ends, but neglects preventive care which is more cost-effective in the long run.

    Hate to be anecdotal, but several of my doctor friends believe the time has come for universal coverage. They are sick and tired of screwing around with insurance companies constantly changing their policies and then pay part or none of the cost.

    Peter Galuszka

  9. Larry Gross Avatar
    Larry Gross

    one more thing…

    how many folks who currently are not insured because of “pre-existing” conditions were born that way?

    My point is that many of the folks who NOW have pre-existing conditions – at one time perhaps had the option of insurance and chose not to have it.

    It can describe many 20 and even 30 year olds.. who chose to not get insurance.. until.. suddenly they have a ‘pre-existing” condition.

    We have a punitive system that does not reward prudent behavior but instead eviscerates those that are clueless and/or shortsighted and then charges the rest of us – the bill.

    I don’t think we could have a dumber system as it actually kills innovation and entrepreneurship .. drives employees to jobs that provide benefits and away from possibly more productive careers and puts huge obstacles in the way of small business… and cripples our manufacturing that competes on world markets.. actually spurring outsourcing…

    We argue strongly for “free” mobility… free roads.. but heaven forbid we have “free” health care..

    grump

  10. Anonymous Avatar
    Anonymous

    Anonymous 7:11 is missing one big point.

    I have a chronic, non-threatening condition. Because of it, I am not insurable, not availble for me, at any price.

    I have a full time job, and I’m vigorously active the rest of the time, yet I’m not insurable. I have insurance only because of my job – otherwise, forget it.

    So, basically, because my feet and joints hurt sometimes, I can’t get my heart insured.

    It is as if because you had a flat tire once, you couldn’t get liability insurance.

    Why should one controllable condition knock you out of the pool entirely? As long as we alllow this kind of cherry picking, we will always have selective healtcare, which should NOT be confused with managed healthcare.

  11. James Atticus Bowden Avatar
    James Atticus Bowden

    PG: The underclass wouldn’t manage anything with their healthcare if Virginia started HSAs except choosing which company would manage their money for them.

    The money would be invested and managed by the for-profit, regulated insurance company the Commonwealth certifies as acceptable.

    When the underclass (I’m using that as an umbrella term to cover all the persons who are at the margins of society and weak on individual resources, competence, literacy etc. – no offense intended) goes to see the doc – the doctor will bill the HSA first. What is left over (unpaid) will be handled as it is now…

    The idea is to start with $1.5b+(the bogus sales tax increase from 2004) and return that money to Virginians in HSAs. It means about $200 in year one for every single Virginian. That is a transfer of $1.5b (took off admin costs – recommend the state office be in SW Virginia) to the health care system.

    Over time the individual accounts would grow based on larger dump from the sales tax and all the incentive (tax)for individuals and corporations to give to HSAs.

  12. Anonymous Avatar
    Anonymous

    I’m still trying to figure out why you’re blaming Walmart and Volvo:

    – In 2007 Walmart closed its small store in the town of Pulaski, but built a Super Walmart in nearby Dublin, also in Pulaski County.

    – The Volvo plant layoffs will be in 2008.

    What on earth do these events have to do with a study from 1983 to 1999 ?

    Dan S.

  13. Anonymous Avatar
    Anonymous

    J.A.Bowden,
    Some questions on HSAs. Would a doctor’s office or hospital simply bill the HSA through the approved insurance company? Would there be the usual running the bill through to see if the procedure is allowed, etc? Would this lead to more timely payments for health folk? How have insurance companies reacted to the idea. Sounds interesting.

    Txs.

    Peter Galuszka

  14. James Atticus Bowden Avatar
    James Atticus Bowden

    PG: As in every human endeavor there will be cheating and graft.

    The law will legislate what is medical or not – braces, chiropactery (sp – better to just write quack/exercise), homotherapy, glasses, etc etc) which puts the usual lobbyists to work on the GA.

    The management of payment should be simply the doc bills the insurance company. The doc is a registered doc – he has a computer code. The procedure is based on the law…ugh,but unavoidable, and whether or not the doc did it is subject to the same oversight as any welfare, medical, etc program. There should be some admin money to oversight.

    I wish I could convince you and all of our Dem friends to use the marketplace, not the state, expand supply of medical services, encourage competition, and mandate as little as possible. It never works well.

  15. Anonymous Avatar
    Anonymous

    Captain Obvious

    (Hope you don’t take offense at being called that).

    I support market-based endeavors a lot more than you may realize. I worked for three years dealing, every day, with the absolute weirdness caused by a fouled-up, hostile, Communist, planned economy. I didn’t just read about it, I had to deal with it becuase I ran an office besides being a reporter. Every day. Talk about getting totally irrelevant job experience.

    But just as one might hear of the magic of the market, there is a role for government in some sectors of the economy. The two are not necessarily mutually exclusive

    Look at health care. You used to have pretty much laissez-faire with doctors’ running the show. As my late father, who was a doctor, predicted, rip-off docs were going to get hung. (He hated any thought of socialized medicine, by the way, even though he had been a career Navy doctor before retiring and going into private practice. Go figure.).

    The rip off docs got hung when wild cost overruns brought on “managed care” in the late 1970s and 1980s. What they evolved into was a kind of socialized medicine but it was run by for-profit and often ruthless corporation and not by the government. But so what, it was pretty much the same. Some costs came down, but you had big imbalances. Plus, the new system depended upon companies paying for their employees. As the world got global and competition got tough, companies and Wall STreet wanted costs cuts and company shares got cut. And with the underclass, you deal with layoffs and when people lose their jobs, they lose their benefits. So you have a lot of folks out there with no insurance at all.
    I’d be interested in some kind of universal care, be it government or some version of the HSAs you like. The point of the Harvard study seems to be that we are supposed to be the most powerful nation in the world but we have declining mortality rates in some areas. That’s wrong.
    As for my Dad, what happened to the practice he created in small town Eastern N.C. is instructive. About three years after he died, his partners sold it to the local hospital. Why? They were sick and tired of dealing with managed care paperwork and lack of payment. When the hospital made an offer, they took it.

    Peter Galuszka

  16. Anonymous Avatar
    Anonymous

    I grew up in SW VA, moved to NoVA in 1967, where I worked in IT until 2002. Then I moved back to SW VA, specifically Blacksburg. For about the last year or so I have been doing a lot of volunteer work in several areas. Two areas that relate to the current story are my work in helping seniors and the disabled sign up for Medicare (especially the drug plan) and my work in a public health project headed by Dr Jody Hershey, who was mentioned in the WaPo story regarding the “early” deaths of women in Pulaski County and Radford. I think that my work in these areas has given me some insight in this issue.

    First of all, I don’t really believe that there are, on a per capita basis, any more fat, smoking, non-exercising women in Pulaski/Radford than there are in most of NoVA. However, SW VA has suffered a lot more of closing factories, disappearing insurance, and sub-par housing stock than NoVA, as well as lack of access to health care. Lots of the type of housing that I see in my home visits would have long since been “plowed under” by new developments in NoVA. There is a huge amount of respiratory ailments down here, and you don’t get them from Big Macs but you might get them from deteriorating houses and trailers. You certainly can from smoking but most of the women I’ve seen with these ailments aren’t smokers. I suspect (1) environmental effects and (2) second hand smoke starting with Daddy, maybe husbands later on. These women also end up being care-givers to multiple relatives, no sooner getting their kids raised than getting the sick old parents, disabled siblings, and grandchildren needing a stable environment.

    For a more recent assessment see http://www.roanoke.com/news/nrv/wb/160927 in today’s Roanoke Times.

    I do believe that there is a lot less access to good medical care in SW VA than in NoVA for a number of reasons: lack of specialists – BTW folks with college degrees down here complain about this, unaffordable dental service (no insurance), lack of insurance, and lack of transportation. This last is often older women (65+) with no family in the area and who don’t drive and have no means to get to medical services. They ignore symptoms until they progress and then discover that something that could have been “fixed” easily early is a major problem now.

    As for the free market, let’s look at Medicare Part D (drugs) and Medicare Advantage Plans. I spend a lot of time helping people with the drug plans. Unless you are so low-income that SS and the state subsidize your health care, you can change drug plans only once a year. If you don’t know to check during open enrollment (11/15-EOY), you can get stuck in a plan that may have stopped covering some critical drugs that you need. Also Plans can drop drugs during the year.

    The Donut Hole or Gap legislates that after your drugs cost about $2,500, YOU pay for them – along with your premiums – until they equal a bit over $4,000, when you qualify for catastrophic rates. I’ve had to inform people on fixed incomes that they would pay $500-700 or more for drugs for several months starting in May because they have serious illnesses and therefore expensive drugs. These are not people who can afford $500-700 a month for drugs.

    Also you can’t buy drugs from Canada. It’s against the law. Nor will the government negotiate with drug companies for better prices. However, big Pharma can off-shore drug manufacturing to third-world countries where all sorts of things can happen like with China and heparin. Did you know that something like 80% of our drugs use ingredients from abroad – mainly China and India – in their manufacture? They do.

    The MSM has had numerous recent articles regarding the fraud and abuse in Medicare Advantage plans, which FWIW cost the Federal Government about 15% more than Medicare A & B. I won’t belabor the point – just go to Google and enter “Medicare Advantage” +fraud and read to your heart’s content. I will say that I have personally turned an agent in to the State Corp Commission for informing clients that they needed to sign up for this MA plan NOW because Medicare was going out of business. Last month I dealt with an extremely low-income woman in her late 70’s who had been sweet-talked by a MA agent, signed up, and realized that she’d made a big mistake when she went to get her drugs and had to pay more than usual. At least we caught it before she needed medical services since her usual doctors – not to mention her hospital – may well have refused to accept that insurance plan.

    Is single payer government operated insurance the answer? I don’t know because what I fear is that universal health insurance might end up like universal K-12 education with the financially set getting great service and most of the rest taking what’s offered. But I am willing to say that more “free market” isn’t the answer.

    Deena Flinchum

  17. Jim Bacon Avatar
    Jim Bacon

    A key point that everyone is missing: The insurance sector is not the only source of inefficiency in U.S. health care. Another huge problem is government regulation at the state level: certificate of public need, which restricts the evolution of health care delivery models; mandated benefits, which jacks up the price of medical insurance; and occupational licensure, which transforms health care professions into quasi-craft unions.

    You can nationalize health insurance in this country (hopefully eliminating a lot of administrative overhead, but also opening up the system to even greater manipulation by organized interests than already exists), but you won’t touch the other problems. Anyone who thinks that we can increase productivity and improve patient outcomes by simply manipulating the way we insure people (whether we adopt a nationalized approach or a free market approach) is simply kidding themselves.

    I’m inclined to think that *more* competition in the medical insurance arena is the way to go. HSAs are a necessary step towards consumer-driven health care, in which people take more responsibility for their own health, rather than expect someone else to take care of them. But even then, I’m under no illusions that all problems will be solved.

  18. Anonymous Avatar
    Anonymous

    Jim,
    Certificates of Public Need may be a problem in Virginia but not all states use them.

    Deena,
    I know exactly what you are talking about. When I worked at Virginia Business (This was after Bacon had left), a photographer and I did a story on coal country, went into a deep mine with low coal, etc. It was a cold, dreary December. We drove past a community hospital near Clintwood (if I remember coorectly). It had been completely boarded up because the Ohio company that owned and operated it had gone bankrupt. A sign advised emergencies to travel to Wise or other places, but they were miles away. We ran the picture along with others and earned the wrath of the Coalfield Development Authority and Richmond economist Chris Chmura who worked with them. They wanted to present the coalfields in a much more cheerful light to attract new investment. But hey, the truth is the truth and pictures don’t lie.

    Peter Galuszka

  19. Anonymous Avatar
    Anonymous

    Peter,

    My personal opinion is that the MSM reporters who wrote about this came with their own agenda: They set out to find that the problems with the women in Pulaski/Radford were of their own doing. After all, these are rednecks we are talking about, and they’re not of our class, Dear, so any harm that befalls them is their own damn fault. They could have just as easily found recently deceased women who were thin as rails, who probably hadn’t eaten out anywhere in months, and who got plenty of exercise working their fingers to the bone. Not as good a story.

    White working class, lower middle class, and poor people are the last open targets. Criticism of any other groups seems to be designated as hate crimes.

    Deena Flinchum

  20. Anonymous Avatar
    Anonymous

    Deena,
    Yes, I understand what you are saying. I entirely understand how some 20 or 30 something reporter who was hot shot enough to get to the big time media like the WashPost has an agenda canh come in, shoot from the hip, and write his or her story.
    I have been there as a small town reporter who cared about the community I was in (details upon request). But I did find that the out of towners often wrote with a dispassion because they weren’t everybody’s friends or cousins. They didn’t care about whom they might piss off.
    The same is true in foreign correspondence which I also have done.
    Sometimes that’s the most honest reporting.

    Peter Galuszka

    PS: I think your work with the elderly is wonderful.

  21. Larry Gross Avatar
    Larry Gross

    re: single-payer universal health care

    don’t we already have that if you are over 65?

    and my understanding is that Medicare is by far, the most efficient with regard to administrative expenses.

    No?

    Please clue me in to what is the truth.. if I am wrong…

  22. Anonymous Avatar
    Anonymous

    Peter,

    Thanks for the kind words. I have found my work in this area to be one of the most rewarding things I’ve ever done.

    I think that these women need to hear about unhealthy diets, exercise, etc. though a more successful means of reaching them would be via people whom they trust, such as doctors, etc. To lay all blame for early deaths on the women themselves, as I think the WaPo article did, would be like seeing New Orleans after Katrina and blaming the folks left stranded there for being too lazy to leave.

    Larry,

    When 65, most people qualify for Medicare A & B, which is single-payer and reputed to have a much lower admin cost than private insurance. However, this doesn’t cover all medical costs. Medicare Supplement (MS) insurance, bought in addition to A & B, covers most of what A & B doesn’t. Part D (drugs) covers drugs. Medicare Advantage (MA) plans replace A & B, leaving you with copays, coinsurance, etc just as A & B does. If you have an MA plan you cannot buy an MS. All 3 of the above are run by private companies.

    In 2007 about 20% of Medicare clients had MA plans, which are sort of a means of privatizing Medicare. They were originally set up to offer more choice and lower costs via competition. As it happens, an MA plan costs Medicare more than A & B for a client. If you are an educated consumer who asks good questions, shops around, consults with your health care providers, etc, you may be OK if you can afford the copays, etc. My big concern is that they are being pitched to people who aren’t able to do this. In the NYT today, see http://www.nytimes.com/2008/05/09/washington/09medicare.html?th&emc=th

    Deena Flinchum

  23. Larry Gross Avatar
    Larry Gross

    Deena – thank you, congrats on giving of yourself to others..

    .. and I see now how good you are at what you do.. and why you are such a resource for the folks you help.

    The Government (which I suspect you are familiar with) has multiple single payer options that range from minimal to gold-plated but they cannot deny people with pre-existing conditions.

    Those plans also meld with Medicare once one retires.

    These are the same plans that Congressmen have access to – that millions of citizens do not – and in my mind – it’s pretty hypocritical for them to blather on about private sector “solutions” while they enjoy what many Americans cannot…

    I would vote in a heartbeat to force all of Congress to get insurance on the same basis that they tell the uninsured and/or those with pre-existing conditions to get it.

  24. Richard G. Williams, Jr. Avatar
    Richard G. Williams, Jr.

    No, I don’t. More government nannyism.

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