The Centre Cannot Hold, The Blood-Dimmed Tide is LoosedShare
Today at 1:30pm
I have quoted it so often these past eight months or so, I tire myself. Turning and turning in the widening gyre... The great warning from the great William Butler Yeats: Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned; The best lack all conviction, while the worst Are full of passionate intensity...
So my feeling as I watched the health insurance struggles turning and turning in the widening gyre...The falcon, cannot hear the falconer... No, he cannot. Or will not, the net effect is the same. Yeats was writing about watching the planet succumbing to the Great War, not knowing it would only be World War I, still believing it would be the War to End All Wars. So, I understand if some think I'm overreacting. What mere anarchy? What blood-dimmed tide? What loss of innocence?
"We're not on health care now(1) ," Senator Reid said. "We've talked a lot about it in the past." Tick Tock Mr. Reid. "There is no rush," said the Senator observing that Congress still had the balance of year to work on the health bills passed in 2009 by the Senate and the House. Tick Tock Mr. Reid, the blood-dimmed tide is loosed, and everywhere, the ceremony of innocence is drowned.
You see Mr. Reid, people don't stop getting sick, or dying, just because we close our eyes, or decide to cool our jets, or when the falcon, cannot hear the falconer. Take a short walk down the Mall Mr. Reid, it's just under a mile. You will find the Vietnam Veterans Memorial. There are just over 58,000 names of precious, irreplaceable people on those walls. It took us 20 painful years to put them there.
Just across the street, across Constitution Avenue, from the Vietnam Veterans Memorial, is the Institute of Medicine. Stop by and have a chat. They will be able to tell you how we fill four and a half of these walls every year. One recent study has found that readily preventable medical errors have more than doubled in the past decade and now account for more than 200,000 deaths per year(2). Mere anarchy is loosed upon the world. Based on figures from 1988-1994 surveys, dated to be sure, a very conservative study estimates 45,000 American adults die due to a lack of medical insurance alone(3). A blood-dimmed tide by anyone's standard. We have the highest infant mortality rate in the industrialized world, 6.9 deaths/1000 live births. That amounts to 15,000 unnecessary infant deaths per year(4). The ceremony of innocence is drowned.
Together, that adds up to more than 260,000 American deaths every year. Tick Tock. So far. That is four and a half Vietnam Veterans Memorials. So far. Mere anarchy. A blood-dimmed tide. Innocence drowned. Can the falcon hear yet? Tick Tock. But you say, "There is no rush." While real people suffer and real people die. A very conservative estimate of 260,000 each year. A blood-dimmed tide indeed.
The total number of US dead from WWI was 117,465 precious irreplaceable souls, Korea, 36,516 Vietnam, 58,236. A running total there of 212,217. WWII is still the death and destruction winner with 418,500. OK, our conservative health care death toll will catch up with our total war dead since 1917 (630,717) in a mere two years and five months. Tick Tock, Mr. Reid.
And, for the record, you may ask why I call this a conservative estimate. First of all, none of this includes deaths due to "access issues", the inability to utilize care, even if you have insurance; remember, insurance does not equal care. There are many, many access issues, cost is but one. The Commonwealth study showed that 37% of Americans do not access recommended care due to cost issues. In Canada that number was 5% There can be no doubt that there are health implications here, including fatalities, we just don't have the actual estimates yet. Mortality data take time to accrue. Tick Tock.
Finally, scientists are conservative, by nature, you see. Extraordinary claims require extraordinary evidence. So, they put the data to tough tests. They exclude information, and countable people, where the interpretation may be arguable, no matter how tenuous the argument. They control for factors that may account for the observed mortality, even when those factors may have been ameliorated by health care, had insurance been available. The claim of 45,000 deaths per year due to uninsurance by Wilper et al is conservative in that:
1.The data are dated; access to care for the uninsured has dramatically lessened in the intervening years from when the data were collected, leading us to believe that the actual situation is much worse.
2.It excludes those under 17, and we have the highest infant mortality in the industrialized world, SCHIP, the public insurance program for children did not exist in this time frame, even now its implementation is spotty at best.
3.The effects of partial insurance aren't known as people drop out of the insured pool or have had spotty life histories of insurance this affects mortality.
4.Those who die prematurely because of a lifetime of poor care due to uninsurance, yet are over 65 (on Medicare) at the time of their deaths don't get counted .
5.Corrections are made for health status factors which are shown to be effectively treatable by participation in the health care system.
Alright, well, not alright. Apply the same logic to the other estimates. And the fact that we don't have a mortality estimate for access issues. And we are up to 260,000 unnecessary deaths per year at last count. Tick Tock.. And this doesn't include the wounded, and the unnecessary financial cost. Tick Tock. And now we are being told we have time, not to rush. Tick Tock.
I remember people taking to the streets in the 60's and the 70's, to end the Vietnam War. I remember when we said we had had enough.
I don't know where everyone went.
Tick Tock.
Notes
(1) http://www.nytimes.com/2010/01...
(2)HealthGrades, news release, April 8, 2008
(3)Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU. Health insurance and mortality in US adults. Am J Public Health. 2009 Dec;99(12):2289-95. Epub 2009 Sep 17.
(4)Method: Calculated by estimating the current number of estimated infant deaths per year in the US, given the most recent infant mortality rate figures. Then, examining the comparable infant mortality figures for matched industrialized nations and asking, what if the US had the average infant mortality rate of its peers, instead of being a really bad outlier? So, take the US out of the distribution and find the average of the remaining infant mortality rates, apply this to the number of US births. Subtract this from the estimated US infant deaths. This gives us the estimated excess US infant deaths. We're not looking to excel here, just to be average.
(5)http://www.commonwealthfund.org/Content/Surveys/2007/2007-International-Health-Policy-Survey-in-Seven-Countries.aspx
What rough beast slouches toward Bethlehem to be born?
Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity. Surely so
revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spritus Mundi
Troubles my sight: somewhere in the sands of the desert
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Reel shadows of the indignant desert birds.
The darkness drops again; but now I know
That twenty centuries of stony sleep were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?
- WB Yeats's "Second Coming"as first printed in 1920
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