Allright, so there is a bit of evidence that lead might possibly, maybe, p
Allright, so there is a bit of evidence that lead might possibly, maybe, potentially be linked to certain types of cancer. Not exactly convincing.
1) There is evidince that lead causes cancer in lab animals (and we have a reasonable mechanism of action - impaired DNA repair).
2) There is weak evidence that lead causes certain types of cancer in humans.
3) The reason that the evidence is weak is not because there is a weak effect (it was a 30-50% increase in the pooled studies), but because it is exquisitely hard to study the effect of toxins to produce relatively rare outcomes (cancers of the CNS and kidneys, etc) that takes decades to emerge. Its easy to show that lead causes anemia and decreased IQ in children, because most kids with significant lead exposure will get anemia and a measurably lower IQ within a few years time. However if you are studying a disease that takes 20-30 years to emerge and occurs in 1/100 people in a no exposed population and 1.3-1.5/100 in an exposed population, that will have to be a freaking massive study. That is in fact why I can remember the tobacco companies arguing that the evidence that smoking causes cancer was inconclusive. (And I'm only 38...)
However, this conversation is specifically about assigning the blame to this person's cancer death. Given the above, I assert that the mention of lead is irrelevant given the context of the conversation, however bad it may otherwise be.
Perhaps you should consider a job as an attorney for the Pharmaceutical industry. I think the Merck/Vioxx cases were argued on the same premise: well you can't prove that this heart attack was due to Vioxx rather than bacon, so we can't be found at fault (conveniently in all cases.)
Oh, and for the record, I think that the guy who claimed that cancer is caused by, essentially, evil, is a total asshole who doesn't know what he's talking about.
Then maybe you should have mentioned that asshattery a bit more and focused less on ripping into the guy who lost his brother to cancer. Not that this makes him less vulnerable to logical errors, but you might want to save the flamethrower for the people who so richly deserve it.
Perhaps you should stop talking out of your ass - especially when you are responding to a guy who is expressing a reasonable response to an unreasonable suggestion: that people deserve the cancer's they get because they haven't been forgiving enough.
Moreover even if lead doesn't cause cancer, its still an extremely toxic agent. Saying 'well it doesn't cause cancer' is the equivalent of saying Mussolini made the trains run on time.
Enough of this "We found a cure! We're headed to trials!" crap. We've seen this for the past 20 years, yet NONE of these 'cures' are actually used on a daily basis. Either put up, or shut up.
While big leaps and bounds are great. The progress in cancer treatment and research is made through slow and consistent work at the same problem. More power to these people. But each one of these 'we're headed to trials' announcements is one grain of sand - possibly a big one - working toward grinding the machine to a halt.
Men tended to get sent to wars, which at least evened out the mortality with women and childbirth. Actually it didn't quite. A woman's life expectancy at twenty was slightly less than a man's in the medieval period. (Though slightly more girls then as now survived to adulthood than boys.) Without modern sanitation, nutrition, prenatal and antenatal care, about 15% of women can expect to die from complications of childbirth.
Plus, if nothing else, wars only happen sometimes. Sex is perpetual. (I'm excepting Bush's America from this obviously - where war is perpetual and sex is only sometimes.... in the missionary position... for procreation.... among heterosexual married couples.)
"So the employer becomes responsible for what each person does at all times. This means that the employer will need to setup dormitories so they can monitor all activity. Any activity that deviates from the legislated "norm" would be actionable. Those found in violation would be fired for cause. The sad part is that if one company fires you for one of these "lifestyle laws" *(trade mark pending) no other company is going to hire you. It will be like having a felony conviction."
Wow. Just wow.
In future can I use that as an example of a slippery slope fallacy? That was an impressively good example. Almost as good as seatbelt laws and tobacco tax as a prelude to forced abortion and a prohibition on fast food.
Forcing employers who don't establish a healthy environment for workers to pay proportionally more for their healthcare smart policy, not some dystopian totalitarian future. Come out of your bunker and put down the tin foil hat.
Actually, lifespans were quite normal. If you lived to be 10 you could expect to live to be 60. The problem was, many did NOT live to be 10, and when you're taking an average, (60+0)/2 = 30, so just looking at average lifespans you see very low numbers. Actually you are quite wrong. The statistic you are searching for is the average life expectancy at age twenty. (Ten doesn't get you out of the ballpark for childhood diseases, so twenty is used.) The average life expectancy at age twenty for males in medieval Europe was 45. For women it was 40. http://assets.cambridge.org/97805215/92079/sample/9780521592079ws.pdf
So, no. While those numbers are quite different from the overall life expectancy at birth (30-35 years) they are not even close to sixty, much less current life expectancies in developed countries of well into the 70's.
"Sounds like instead of doing any real good, it just be yet another excuse to discriminate against a certain type of person. If your company gets fined for employing fat people, then the obvious solution is not to employ them."
Unless your company also gets fined even more if they are found to discriminate against workers that are overweight or obese.
TFV talks about the steps that NEC is taking to encourage healthy habits in workers. That's the kind of response that this sort of law would ideally produce. You can engineer an environment to keep people healthier or not. This law has the potential to force employers hands in making environments more healthy which benefits the employers (less sick days, more productive employees), the employees (improved health), and the national health program of Japan (I'm not going to pay a lot for this muffler).
average lifespans were short because of massive infant mortality, not because people who survived to be adults didn't live to old ages. No. Average lifespan was shorter in part because of higher infant mortality. Infectious disease was (and is still to a lesser extent) a threat to even healthy adults. While plague wiped out a third of the population of Europe in the worst epidemics in the middle ages, people still commonly die in the first world from infectious disease. Trauma and violence was (and is) a significant risk, but the difference is that now if you get an open fracture of your femur and you live in the developed world odds are you will be up and walking on it within a few months. And while childhood and infant mortality contributed to those lower averages, so did maternal mortality. (The biggest hurdle for men to make it to old age was childhood mortality. The biggest hurdle to women was surviving childbirths.)
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The best way is to look at the median lifespan - the age to which 50% of people reached or to look at life expectancy at age 20. Life expectancy at 20 didn't reach the 60's till the last century. There were certainly some lucky people who survived to age 70 or 80, but that was the exception rather than the rule. However the biggest gains in life expectancy in the modern era weren't because of level 1 trauma centers and ICUs. The big improvements were due to things like public sanitation, improved nutrition, vaccinations, refrigeration, and simple prenatal and antenatal care.
There's no evidence to suggest people died earlier 5,000 or 50,000 years ago -- and there's strong counter evidence for that during historical periods of the last 3-5k years. Um. No. The life expectancy at birth in the Bronze age, Upper Paleolithic, and Neolithic was all 33 years or less. If you assume a 30% infant mortality it still doesn't average out to approach modern life expectancy. And until the early 20th century, the average life expectancy at birth didn't cross 40. That's not even cutting edge research, that's textbook/encyclopedia data. However if you have some citations supporting your argument, please provide them.
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Hobbes was right: life in the state of nature is "nasty, brutish and short".
It would be nice to know the proper balance between too much and not enough. Given the fact that too much will cause cancer and an equally alarming rate. Even if the rate of skin cancer was much higher though, it would still favor greater sun exposure since the cancer that sun exposure makes you vulnerable to is visually detectable while the cancer that sun exposure protects you from is often only detectable by more invasive means. For some reason people seem much more amenable to getting a good visual skin inspection than a camera on a stick up the butt.
That said, as an extremely pale physician (who can burn in bright flourescent light) with a family history of colon cancer and skin cancer... my choice is the safest route: I've been taking 800iu of Vitamin D daily for the past few years and happily wear my SPF 10^6.
That's one but certainly not the only way. My mom is a whackadoodle that believes in aliens, invisible sky fairies, reincarnation, and all manner of crap. Getting emails from her is like a study of snopes.com. Dad's a nut too, but wasn't present from my upbringing.
I'm an atheist skeptic who would would be incredulous even if I had the abduction complete with anal probe insertion. But then I didn't pick up her smoking habit either.;)
The best way is personal experience. Have a strongly held belief effectively challenged and have an epic fail. Then don't do what most of humanity does and use cognitive dissonance defenses to justify why you are still incredibly smart despite the fact you were in this regard a complete tool.
Generalize from your own experience and realize we are all flaming idiots but by using tools such as logic and the scientific method we can start to approach a modicum of cleverness. Then from that point on trust only 10% of what you hear and 50% of what you see, break a bunch of stuff while learning how not to break stuff as badly, and apply your skills to future problems.
Oh, and I would recommend reading 'Why People Believe Weird Things' by Michael Shermer. He describes this in great detail and even describes one of his own epic failures (he was abducted by aliens - kinda hard to own up to for a skeptic.)
Decline the scan, then when it comes time for your pat down, gay it up so much that you when in comes time for your pat down, gay it up so much that you make Carson Kressley look like Chuck Norris. Then make a joke about a full body cavity search.
You will be out of there in 3 seconds flat.
I had to go through the Lubbock TX airport. I was wearing a superqueer shirt, and when they pulled me aside, I was like sure honey, but are you gonna buy me dinner first? Blink-blink.... he chuckled nervously at which point I said, well if you want to do a full body cavity search would you mind if I brought BF in here to watch?
If you RTFA, you'll see the thing only grows in cold, low nutrient, low oxygen environments. We are (generally) warm, high nutrient, high oxygen environments.
After watching a fictional killer virus on "I Am Legend", I am feeling nervous about new germs in labs. That's why its called fiction.
There is nothing forcing doctors to treat people who cannot pay. They can always practice in a facility that does not accept any federal funding. The only hospitals in the US who are functionally not covered under EMTALA are the Shriners Hospitals for Children and some government run hospitals (largely the VA system). Given that I am a gay man who is board certified in Emergency Medicine (so the VA system is not acceptable due to the homophobia, and I am not a peds specialist,) please be so kind as to tell me about this mythical 'hospital where I can practice' that is not covered under EMTALA?
'Doctors' are not a uniform block with one set of interests and one set of laws applied to them. In particular EM specialists like myself are covered under one the largest unfunded mandates in the entire US. And the mandate does not only cover billing. For example, say I am working at community hospital X and there is a flood of patients because of a local flu epidemic. You come to the ER with chest pain and are triaged by the nurse, but not brought back to the treatment area because there is simply no place to put you (not uncommon in the US currently, BTW.) The reason that we're overcrowded is partially because of the politics that makes the ER the court of last resort for US health care, partially because of poor funding of services (by the hospital, but ultimately by the system), and partially statistical variations... in a system that provides emergency care, unless you are willing to accept a lot of idle time, you also have to accept that there will be overcrowded times. So you are having a heart attack and you code in the waiting area.
That is not only an EMTALA violation, but you (or rather your estate) can sue the shit out of me (and the hospital) even though I was not even aware of your existence and was working the fastest humanly possible.
What they are doing in LA is even crazier. Say the ER is over-crowded and you (the hospital or the doctor) announce to the EMS system that you are dangerously over-crowded. EMS unit X ignores this (which they are allowed to do) and brings a patient with a broken leg. You literally have no stretcher on which to put the patient much less a nurse to care for them, so you make them wait on the ambulance stretcher for 31 minutes.... yep, its an EMTALA violation (referred to as a 'parking violation').
And the laws governing emergency care are often in stark opposition. The state of CA mandates a nurse ratio law that says an RN can care for no more than X number of patients at a given time. But then EMTALA says that all ERs must accept all incoming patients (ambulance and foot traffic) and treat them promptly (else its a delay EMTALA violation.)
However, if you are an ER specialist there is no way to practice outside of this system (unless you are a peds-ER person and are willing to work for the semi-creepy Shriners OR you wish to work for the government. So saying 'just work at a facility that doesn't accept federal funds' that is the equivalent in cluelessness of saying 'let them eat cake'. There ain't any cake in this case either.
TOBACCO ADDICTION IS NOT A DISEASE. Results of tobacco addiction, like emphysema, lung cancer, THOSE are diseases. Addiction is a precursor, and nothing more. Its nice that you feel that way. Fortunately the AMA (and also the WHO, and pretty much every major medical association who had rendered an opinion on the subject) disagrees. Though the formal name (ICD-9) is "Tobacco use disorder" (305.1).
But then by your same assumption, alcoholism is not a disease either.
Whether or not nicotine addiction is a disease is completely irrelevant. The issue is control and choice. Tobacco users had control and made a choice which led to them becoming nicotine addicts. Except most people become addicted to tobacco while they are still children and are unable to make that informed choice. Once they enter adulthood and are at the point where they can be expected to make a reasoned adult choice, they are already screwed.
Comparing tobacco users to people with inherited disorders is bullshit. Tobacco users have a disease, if that's what you want to call it, because they made a stupid decision. A person with hemophilia inherited defective genes. One has a disorder because of something under their control, their decision to smoke. The other has a disorder because of something completely out of their control, the mixture of genes they inherited from their parents. Well 1) there are genes that make people more susceptible to tobacco addiction. 2) People in certain socioeconomic groups are more likely to be tobacco dependent. and 3) There are lots of diseases one gets in part because of what you would refer to a 'stupid choices' - basal cell carcinoma, melanoma, diabetes type 2, alcoholism, heart disease, renal failure, syphilis, etc. You would not consider those to be non-diseases just because they are complex entities that are the result of a genetic propensity, environmental conditions, and craptastic luck.
But then almost all diseases are exactly that: a genetic propensity + environmental conditions. Even things we think of as '100% genetic' like cystic fibrosis. 100 years ago, most kids with CF didn't survive infancy. 50 years ago most kids with CF didn't survive their teens. 20 years ago most kids with CF didn't survive their 20s. Today many survive into their 40s or even later. Thats a huge positive impact exerted by the environment (i.e. a modern western one with access to advanced medical care.)
Believe it or not, insurance companies are not there to help. They are there to provide a service in the free market. People have to stop thinking about them as something that should help people but doesn't. The insurance company should not be forced to pay for people who have more of a chance of getting sick. That raises the prices for everyone else. And by your logic, the same goes for physicians. So should you get sick and be unable to pay for my services, you should not expect me to offer you assistance... unless I feel like it and am in a charitable mood.
However I suspect you would be the first one crying foul if you were refused care in an ER because you didn't have insurance. And fortunately for you, we do regulate that access to care and state that its your right regardless of your ability to pay.
Though I have a question for you in that same line... do you think the EMTALA act is a good thing? If yes: Why is it OK to mandate that I as an individual ER doctor have to de facto pay for that uninsured care, but its not a bad thing that a large corporation have to pay. Personally I believe that its better to restrict the freedom of a corporate entity rather than a person.
Life's not fair and when you try to make it that way someone gets screwed. Great. So then if your health or auto insurance lapses, and you get in a car wreck and have major traumatic injuries, you won't mind if EMS leaves you on the side of the road... since rescuing you would cost others' money. If we did rescue you, it would be an undue burden on others and you should just accept that its your bad luck that put you in that situation and die quietly.
The point of insurance is not to spread risk. The point of insurance is to mitigate the consequences of negative outcomes for the insured. Having car insurance doesn't spread the risk of having a car accident out among the insured, it mitigates the consequences for people who do have crashes. The risk one is spreading is the financial risk, not the risk of getting sick. Similarly, having car insurance doesn't decrease the risk you will get in a wreck, it just spreads out the financial risk to any one person should they be the unlucky sod who gets in that wreck.
Just pass a law that says health insurance companies can't discriminate for any reason. There has to be a community rate for health insurance (like there was 50 years ago.)
Then we can say just mandate that everyone has to carry individual coverage so we solve the uninsured problem. Plus we would insure that the young and healthy were in the pool - thus keeping the overall rates down.
Of course it would be a lot easier to deduct it from people's paychecks rather than have a whole system whereby we monitor citizen's compliance with the law. So it would just be an amount deducted from your pay.
And we would need to make it something people who were poor could afford, so there would be subsidies so that the poor paid less... and the wealthy paid proportionately more. So it would be a progressive deduction from your taxes.
Plus we could save a LOT if in addition to providing preventative care instead of what we do (ER care as a last ditch effort when diseases are harder and more costly to treat) we got rid if the thousands of insurance providers and just had one large provider. I know as a physician I spend a lot of money on hiring people just to fill out insurance forms for me. If there was one form that was consistent, I would be able to provide care a lot more economically. And if everyone was in the same system, we would have better assurance that the care would be reasonable since the people with the most power would also have to have that same insurance... no way to make what the poor get be shoddy. So we would just cover everyone under one large pool.
And then.... well we'd have the most humane and cost effective system possible: a single payer national health service funded by an income tax spread fairly on the population. Or as the nutters refer to: socialized medicine.
What is fundamentally wrong with hiring policies that prohibit smoking? Because tobacco addiction is a disease. I'm a non-smoking, tobacco-hating, asthmatic physician, and I find the idea of hiring policies that prohibit smokers to be as repulsive as refusing to hire someone with diabetes. If there is some compelling reason that a smoker can't safely do it (childcare for a kid with CF,) great. Otherwise its discrimination. Its also a bad precedent for employment discrimination based on what one does on his off time. You want to drink like a fish or smoke a doobie on your off time? As long as you always show up for work sober, that's your business
That said, prohibiting smoking on the job is perfectly OK.... just as requiring drinkers to show up sober is reasonable.
You can't compare this to genetic discrimination. Yes you can, since we know there are genes that predispose to tobacco addiction. The ultimately cruel joke though is that recently we discovered that one of the same genes that is linked to tobacco addiction is also linked to propensity to develop lung cancer.
I'm sorry. You'll have to help me out with that one. Where do I find that in the U.S. Constitution? That is an example of a human right. That is why just after I gave an example of a civil right - the ADA. The ADA is not part of the constitution, but then not every right in the US is in that document.
Slashdot Mirror
Allright, so there is a bit of evidence that lead might possibly, maybe, p
Allright, so there is a bit of evidence that lead might possibly, maybe, potentially be linked to certain types of cancer. Not exactly convincing.
1) There is evidince that lead causes cancer in lab animals (and we have a reasonable mechanism of action - impaired DNA repair).
2) There is weak evidence that lead causes certain types of cancer in humans.
3) The reason that the evidence is weak is not because there is a weak effect (it was a 30-50% increase in the pooled studies), but because it is exquisitely hard to study the effect of toxins to produce relatively rare outcomes (cancers of the CNS and kidneys, etc) that takes decades to emerge. Its easy to show that lead causes anemia and decreased IQ in children, because most kids with significant lead exposure will get anemia and a measurably lower IQ within a few years time. However if you are studying a disease that takes 20-30 years to emerge and occurs in 1/100 people in a no exposed population and 1.3-1.5/100 in an exposed population, that will have to be a freaking massive study. That is in fact why I can remember the tobacco companies arguing that the evidence that smoking causes cancer was inconclusive. (And I'm only 38...)
However, this conversation is specifically about assigning the blame to this person's cancer death. Given the above, I assert that the mention of lead is irrelevant given the context of the conversation, however bad it may otherwise be.
Perhaps you should consider a job as an attorney for the Pharmaceutical industry. I think the Merck/Vioxx cases were argued on the same premise: well you can't prove that this heart attack was due to Vioxx rather than bacon, so we can't be found at fault (conveniently in all cases.)
Oh, and for the record, I think that the guy who claimed that cancer is caused by, essentially, evil, is a total asshole who doesn't know what he's talking about.
Then maybe you should have mentioned that asshattery a bit more and focused less on ripping into the guy who lost his brother to cancer. Not that this makes him less vulnerable to logical errors, but you might want to save the flamethrower for the people who so richly deserve it.
I'm just sayin.
Lead does not cause cancer.
Well, the American Cancer Society says the evidence disagrees with your point of view. http://www.cancer.org/docroot/PED/content/PED_1_3X_Lead.asp?sitearea=PED
Perhaps you should stop talking out of your ass - especially when you are responding to a guy who is expressing a reasonable response to an unreasonable suggestion: that people deserve the cancer's they get because they haven't been forgiving enough.
Moreover even if lead doesn't cause cancer, its still an extremely toxic agent. Saying 'well it doesn't cause cancer' is the equivalent of saying Mussolini made the trains run on time.
Enough of this "We found a cure! We're headed to trials!" crap. We've seen this for the past 20 years, yet NONE of these 'cures' are actually used on a daily basis. Either put up, or shut up.
OK, sure. Have a look at the Kaplan-Meier curves for survival for Acute Lymphocytic Leukemia in children. In the 60's your child's chance of long term cancer free survival was less than 10%. Today, your child's chance of long term cancer free survival is in the 90% range. http://scienceblogs.com/pharyngula/2008/06/support_cancer_research_now.php Orignial article: http://content.nejm.org/cgi/content/full/354/2/166
While big leaps and bounds are great. The progress in cancer treatment and research is made through slow and consistent work at the same problem. More power to these people. But each one of these 'we're headed to trials' announcements is one grain of sand - possibly a big one - working toward grinding the machine to a halt.
Plus, if nothing else, wars only happen sometimes. Sex is perpetual. (I'm excepting Bush's America from this obviously - where war is perpetual and sex is only sometimes.... in the missionary position... for procreation.... among heterosexual married couples.)
Wow. Just wow.
In future can I use that as an example of a slippery slope fallacy? That was an impressively good example. Almost as good as seatbelt laws and tobacco tax as a prelude to forced abortion and a prohibition on fast food.
Forcing employers who don't establish a healthy environment for workers to pay proportionally more for their healthcare smart policy, not some dystopian totalitarian future. Come out of your bunker and put down the tin foil hat.
So, no. While those numbers are quite different from the overall life expectancy at birth (30-35 years) they are not even close to sixty, much less current life expectancies in developed countries of well into the 70's.
Unless your company also gets fined even more if they are found to discriminate against workers that are overweight or obese.
TFV talks about the steps that NEC is taking to encourage healthy habits in workers. That's the kind of response that this sort of law would ideally produce. You can engineer an environment to keep people healthier or not. This law has the potential to force employers hands in making environments more healthy which benefits the employers (less sick days, more productive employees), the employees (improved health), and the national health program of Japan (I'm not going to pay a lot for this muffler).
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The best way is to look at the median lifespan - the age to which 50% of people reached or to look at life expectancy at age 20. Life expectancy at 20 didn't reach the 60's till the last century. There were certainly some lucky people who survived to age 70 or 80, but that was the exception rather than the rule. However the biggest gains in life expectancy in the modern era weren't because of level 1 trauma centers and ICUs. The big improvements were due to things like public sanitation, improved nutrition, vaccinations, refrigeration, and simple prenatal and antenatal care.
There's no evidence to suggest people died earlier 5,000 or 50,000 years ago -- and there's strong counter evidence for that during historical periods of the last 3-5k years. Um. No. The life expectancy at birth in the Bronze age, Upper Paleolithic, and Neolithic was all 33 years or less. If you assume a 30% infant mortality it still doesn't average out to approach modern life expectancy. And until the early 20th century, the average life expectancy at birth didn't cross 40. That's not even cutting edge research, that's textbook/encyclopedia data. However if you have some citations supporting your argument, please provide them..
Hobbes was right: life in the state of nature is "nasty, brutish and short".
That said, as an extremely pale physician (who can burn in bright flourescent light) with a family history of colon cancer and skin cancer... my choice is the safest route: I've been taking 800iu of Vitamin D daily for the past few years and happily wear my SPF 10^6.
That's one but certainly not the only way. My mom is a whackadoodle that believes in aliens, invisible sky fairies, reincarnation, and all manner of crap. Getting emails from her is like a study of snopes.com. Dad's a nut too, but wasn't present from my upbringing.
;)
I'm an atheist skeptic who would would be incredulous even if I had the abduction complete with anal probe insertion. But then I didn't pick up her smoking habit either.
The best way is personal experience. Have a strongly held belief effectively challenged and have an epic fail. Then don't do what most of humanity does and use cognitive dissonance defenses to justify why you are still incredibly smart despite the fact you were in this regard a complete tool.
Generalize from your own experience and realize we are all flaming idiots but by using tools such as logic and the scientific method we can start to approach a modicum of cleverness. Then from that point on trust only 10% of what you hear and 50% of what you see, break a bunch of stuff while learning how not to break stuff as badly, and apply your skills to future problems.
Oh, and I would recommend reading 'Why People Believe Weird Things' by Michael Shermer. He describes this in great detail and even describes one of his own epic failures (he was abducted by aliens - kinda hard to own up to for a skeptic.)
Decline the scan, then when it comes time for your pat down, gay it up so much that you when in comes time for your pat down, gay it up so much that you make Carson Kressley look like Chuck Norris. Then make a joke about a full body cavity search.
You will be out of there in 3 seconds flat.
I had to go through the Lubbock TX airport. I was wearing a superqueer shirt, and when they pulled me aside, I was like sure honey, but are you gonna buy me dinner first? Blink-blink.... he chuckled nervously at which point I said, well if you want to do a full body cavity search would you mind if I brought BF in here to watch?
'Doctors' are not a uniform block with one set of interests and one set of laws applied to them. In particular EM specialists like myself are covered under one the largest unfunded mandates in the entire US. And the mandate does not only cover billing. For example, say I am working at community hospital X and there is a flood of patients because of a local flu epidemic. You come to the ER with chest pain and are triaged by the nurse, but not brought back to the treatment area because there is simply no place to put you (not uncommon in the US currently, BTW.) The reason that we're overcrowded is partially because of the politics that makes the ER the court of last resort for US health care, partially because of poor funding of services (by the hospital, but ultimately by the system), and partially statistical variations... in a system that provides emergency care, unless you are willing to accept a lot of idle time, you also have to accept that there will be overcrowded times. So you are having a heart attack and you code in the waiting area.
That is not only an EMTALA violation, but you (or rather your estate) can sue the shit out of me (and the hospital) even though I was not even aware of your existence and was working the fastest humanly possible.
What they are doing in LA is even crazier. Say the ER is over-crowded and you (the hospital or the doctor) announce to the EMS system that you are dangerously over-crowded. EMS unit X ignores this (which they are allowed to do) and brings a patient with a broken leg. You literally have no stretcher on which to put the patient much less a nurse to care for them, so you make them wait on the ambulance stretcher for 31 minutes.... yep, its an EMTALA violation (referred to as a 'parking violation').
And the laws governing emergency care are often in stark opposition. The state of CA mandates a nurse ratio law that says an RN can care for no more than X number of patients at a given time. But then EMTALA says that all ERs must accept all incoming patients (ambulance and foot traffic) and treat them promptly (else its a delay EMTALA violation.)
However, if you are an ER specialist there is no way to practice outside of this system (unless you are a peds-ER person and are willing to work for the semi-creepy Shriners OR you wish to work for the government. So saying 'just work at a facility that doesn't accept federal funds' that is the equivalent in cluelessness of saying 'let them eat cake'. There ain't any cake in this case either.
But then by your same assumption, alcoholism is not a disease either.
But then almost all diseases are exactly that: a genetic propensity + environmental conditions. Even things we think of as '100% genetic' like cystic fibrosis. 100 years ago, most kids with CF didn't survive infancy. 50 years ago most kids with CF didn't survive their teens. 20 years ago most kids with CF didn't survive their 20s. Today many survive into their 40s or even later. Thats a huge positive impact exerted by the environment (i.e. a modern western one with access to advanced medical care.)
However I suspect you would be the first one crying foul if you were refused care in an ER because you didn't have insurance. And fortunately for you, we do regulate that access to care and state that its your right regardless of your ability to pay.
Though I have a question for you in that same line... do you think the EMTALA act is a good thing? If yes: Why is it OK to mandate that I as an individual ER doctor have to de facto pay for that uninsured care, but its not a bad thing that a large corporation have to pay. Personally I believe that its better to restrict the freedom of a corporate entity rather than a person.
Just pass a law that says health insurance companies can't discriminate for any reason. There has to be a community rate for health insurance (like there was 50 years ago.)
Then we can say just mandate that everyone has to carry individual coverage so we solve the uninsured problem. Plus we would insure that the young and healthy were in the pool - thus keeping the overall rates down.
Of course it would be a lot easier to deduct it from people's paychecks rather than have a whole system whereby we monitor citizen's compliance with the law. So it would just be an amount deducted from your pay.
And we would need to make it something people who were poor could afford, so there would be subsidies so that the poor paid less... and the wealthy paid proportionately more. So it would be a progressive deduction from your taxes.
Plus we could save a LOT if in addition to providing preventative care instead of what we do (ER care as a last ditch effort when diseases are harder and more costly to treat) we got rid if the thousands of insurance providers and just had one large provider. I know as a physician I spend a lot of money on hiring people just to fill out insurance forms for me. If there was one form that was consistent, I would be able to provide care a lot more economically. And if everyone was in the same system, we would have better assurance that the care would be reasonable since the people with the most power would also have to have that same insurance... no way to make what the poor get be shoddy. So we would just cover everyone under one large pool.
And then.... well we'd have the most humane and cost effective system possible: a single payer national health service funded by an income tax spread fairly on the population. Or as the nutters refer to: socialized medicine.
Gasp!
We hate asshats like him too, if that is any consolation.
That said, prohibiting smoking on the job is perfectly OK.... just as requiring drinkers to show up sober is reasonable. You can't compare this to genetic discrimination. Yes you can, since we know there are genes that predispose to tobacco addiction. The ultimately cruel joke though is that recently we discovered that one of the same genes that is linked to tobacco addiction is also linked to propensity to develop lung cancer.
Well by that same argument we are wrong in depriving heroin and crack addicts their drug and hence causing them the same sort of withdrawal pain.
The plural of anecdote is 'not data.' - Roger Brinner.