[dnautics]

you don't understand what it means to be a minority. We don't get anywhere near equal quality coverage and are basically forced to subsidize better medical care for white folk. For years, my father was prescribed a drug (simvastatin) that actually did damage to his body because it's nearly universally assumed to be good for him (it is for most white people), and strongly subsidized by the government (he's a military vet).

I only found out because I got 23andMe, and I actually know biology. It was dismaying to find out that very few of the tests on 23andMe are useful for Asians like me (fewer still if you're hispanic and if you're pure African, the affymetrix chip they use is basically useless). As we move into an era of personalized medicine, we'll be subsidizing better healthcare and better outcomes for some ethnic groups over others.

The faulty assumption behind universal healthcare is that a one-size-fits-all prescription is good for everyone, but there are some really ugly disparities that no one talks about; and these disparities serve to reinforce preexisting social inequality. While I'm lucky to be in a minority group that's likely to live a long time - if we have it, a lot of universal healthcare coverage will wind up being plowed into gerontological care costs, which tend to be super-expensive; so in a way, it's a subsidy for rich white people.

Now, I do think the american healthcare system is awful. In particular being able to be put into permanent lifelong debt from healthcare costs is only one small step above barbarism. But I don't think that universal healthcare is the solution we're looking for. Obamacare is even worse, it combines the worst parts of universal healthcare with the worst parts of the crony capitalist system we have, and I won't be surprised when it turns out to be an even bigger albatross on the shoulders of this country.

[sliverstorm]

It sounds to me like your father's issue was not that he was not white, but that he had a rare genetic condition...

There was even a study that found on the whole, simvastatin is equally helpful across races: http://www.ncbi.nlm.nih.gov/pubmed/16709304

[dnautics]

Oh, it reduces his cholesterol level[0]. But he has at least one allele that increases the risk of myopathy when taking simvastatin (Assuming there were no milkmen - I do look quite a bit like him - I'm homozygous, and this allele is not terribly rare).

The part about being asian is that asians tend not to catabolize statins as effectively, so his plasma levels are probably higher, since I found out he was taking a full "white person dose" despite advisories that simvastatin should be given at half dose for asians.

[0]I also recall hearing somewhere from a biochemist that while statins decrease cholesterol levels in asians the effect on coronary heart disease (which is what your really care about) is attenuated, and that there may be a secondary mechanism for CHD in asians... But I cannot find the source he was quoting.

[dnautics]

ah, I found it, after all these years:

http://www.ncbi.nlm.nih.gov/pubmed/21160131

as a bonus, here is the review on why asians should take less statins (hepatic enzyme clearance, probably a cyp450):

http://www.ncbi.nlm.nih.gov/pubmed/17261409

[sliverstorm]

That's not a consequence of being non-white so much as it is a consequence of your doctor being uninformed, which impacts people of all races.

I'm not saying it doesn't suck, I just take issue with your narrative of how race is the issue at hand, and how the medical system is bigoted towards minorities.

[dnautics]

It's not just the medical system. It's just reality. I live with it. I'm okay with it. I'd just rather not these disparities be magnified and exacerbated by universalizing something which shouldn't be.

>That's not a consequence of being non-white so much as it is a consequence of your doctor being uninformed, which impacts people of all races.

But it impacts minorities in the most general sense (i.e. not just color of skin) more than non-minorities. For fundamental reasons, studies are less statistically reliable, for starters.

I should remind you also that my father is being cared for under a universal system (the VA) I think that the unversality of it does play into the way that the doctors are informed.

[dbpatterson]

Universal health care has _nothing_ to do with treating all people alike. It just means treating them all.

[dnautics]

Fine. But government is required to treat all people alike. I think this is a reasonable requirement, given that you cannot 'opt out' of government. If you want to set up a private universal health care charity fund, I would happily cut a recurring check to help your cause, assuming some basic transparency and accountability. At least, if you mess up your charity and start, say, embezzling funds, I can opt out.

http://en.wikipedia.org/wiki/Equal_Protection_Clause

[nknighthb]

Your misunderstanding of the equal protection clause has no basis in reality. The government is absolutely allowed to treat different situations differently. There is no legally recognized interpretation of the constitution -- none -- that would require the government to give person A a treatment inappropriate for A just because it gave person B the same treatment which was appropriate for B.

[dnautics]

of course, the government SHOULDN'T give person A an inappropriate treatment just because it's what it would give to person B. Becuase that would be stupid. But what does it give person A? Perhaps it can offer person A nothing. Then, how is that fair and equal?

that's exactly why the only solution is the null solution.

Bottom line: we need to live in a society where people actually help each other and actually show compassion, not create rediculous byzantine bureaucracies that marginally help the rich and politically well-connected that are an empty simulacrum of compassion.

[nknighthb]

It is fair and equal under the law because the government is offering what it can to whom it can. If there is no treatment for person A, there's no requirement -- legal, moral, or ethical -- that one be given.

The "null solution" is absurd. It simply provides that the rich get treatment and the poor do not. That would be "fair and equal" only to a barbarian.

[dnautics]

>It simply provides that the rich get treatment and the poor do not

You're projecting. If you were rich, would you help pay for the healthcare of the poor? Because I'm very much poor, and I give two hours a week towards helping feed people who are sick.

[robbiep]

>>As we move into an era of personalized medicine, we'll be subsidizing better healthcare and better outcomes for some ethnic groups over others.

I think you miss the point of universal healthcare. It is not that one group has a higher utilisation of the healthcare system and therefore should pay more - the principle is that everyone is guaranteed the same provisions for healthcare, regardless of their risk factors.

Personalised medicine contributes nothing to the concept of universal healthcare; except for the noble aim of enabling better treatment of people through understanding individual responses. ' The idea that someone should be restricted in their level of healthcare utilisation under a universal system is absurd; As is the notion that someone should be forced to contribute extra (apart from the incremental addition of a high income earner through increased taxation) due to a perceived increase in risk.

>>The faulty assumption behind universal healthcare is that a one-size-fits-all prescription is good for everyone,

Again, I feel like you are trying to talk about personalised medicine inside of the concept of universal healthcare. Forget about personalised medicine. What the US needs first is access that won't bankrupt. The fact is we don't know enough about personalised medicine to give people different treatments based on genetic characteristics. And we won't for years. Sure, you can look at 1 or 2 isolated instances at the moment (ACE-inhibitors and ARBs in Black people for instance) - but none of this matters when it comes to life-saving care, for which the treatment is going to be the same for everyone anyway, unless you happen to have some rare blood disorder in which case racial profiling and blood tests at the time of intervention will dictate management.

>> so in a way, it's a subsidy for rich white people.

How so? Because they live longer anyway? Because they are less likely to indulge in the risk factors that result in early mortality? Again, Universal healthcare doesnt discriminate. But since rich black/brown/yellow/white/green people pay a higher proportion of taxes anyway, shouldn't your argument here be that Universal healthcare is a tax on rich people?

Additionally, just because you are on a high dose of a Statin, in a high risk population, doesn't mean you are developing myopathy. CK levels should usually be checked after a month or 2 of Statin therapy in line with followup for new lipid levels, and in the absence of symptoms it can be fairly safely ruled that you aren't experiencing a complication of a statin drug. But you probably already know this.

[dnautics]

>is that everyone is guaranteed the same provisions for healthcare

You're missing my point. If those provisions are the same, that's exactly the problem. It's only worse if they aren't the same (because who chooses?)

CK levels warnings are only triggered when you are having a serious complication from the statin. When you have a lesser complication, like, "going to the gym sucks instead of making you feel good", and you aren't aware of what's happening, and it's making you fatter, and your quality of life is going down, then what?

[robbiep]

Again i'll have to insist you are missing the point. Not my point, although I am advocating it; but the point of universal healthcare is to enable everyone access to the same level of healthcare for free. (Or, paid for by the taxpayers if you insist).

The principle is not about ensuring that someone with a specific amino acid substitution receives a specific drug, because this is an example of the specific medical management of a specific patient. If you are going to continue to insist that your dad was treated inappropriately, and I have no reason to be able to assume one way or the other from my current position on the other side of the planet without a through examination of your father and his medical results, then what you are complaining about is not universal healthcare per se but in fact poor care by the treating physician. Which could happen under any system, anywhere.

[dnautics]

can you define for me what you mean by "the same level of healthcare"?

>universal healthcare ... poor care by the treating physician

These issues are entangled. I should let you know, that despite being in the US, my father is effectively being treated by a "universal healthcare" system - the VA.

[robbiep]

Access to life saving treatment when required, as required, access to free hospital and cheap/free out of hospital medication.

The issues are no more entangled than that 'healthcare providers' are a subset of 'healthcare' and within healthcare providers are going to be doctors administrating care that is not up to the best evidence. Universal healthcare is no defence against that, but either is any other form of healthcare. If you select your own doctor you have every chance of choosing one that may give you treatment against the best evidence.

It seems you are saying that universal healthcare means that you will get poor healthcare. I vehemently disagree with this proposition, not just based on your single anecdote but because I live in a country with a universal healthcare system and I have worked within it and in a few months I will be dispensing care from within it as a doctor. Every system has failures but this criticism isn't an indictment of the entire system

[dnautics]

no, I am saying in universal healthcare, you will get poor or no healthcare if you are poor and you will get good healthcare if you are rich. You will simply shift around who gets marginalized. For example: If you have a country that aggressively hounds, say, educational debtholders - because, maybe the nation decided to socialize educational debt. How long will it be till the bureaucratic machine calculates the bottom line and decides to use the system to redflag people and those people are effectively forced to avoid the government healthcare system. It could be anything else, say, "child support deadbeats". Or "illegal immigrants".

If you think that there will be an effective firewall between the two systems, I've got a bridge I want to sell you.

>Access to life saving treatment when required, as required, access to free hospital and cheap/free out of hospital medication

What happens when that medication is fundamentally uncheap, like herceptin, in New Zealand? Sure, herceptin is contrived, because that's a patenting issue. what if it's discodermolide, which doesn't exist in more than ~10 g quantity in the universe and is rediculously expensive to manufacture? Who gets/who doesnt?

Ultimately, no treatment is life-saving. We all die. Which ones are worth it? Who makes a valuation on life? How long until we find a hyperexpensive drug that prolongs the life of a politically-connected child with an orphan disease, and people begin to question, "why is this person's life subsidized", but not mine?

[Fomite]

For the record, if you don't think health disparities are a topic of intense focus in the healthcare research world, you're reading the wrong sources.