JayB

There's clearly nothing more regressive than masculinity.

One of the many rumors circulating is that resorts will no longer build jumps with "kick" (slope that progressively steepens over the length of the jump and will only build "wedge" type jumps with a constant slope over the course of the jump - in order to improve safety. If true (which I doubt) this would be a strange approach to take, since wedge jumps make it way easier to overshoot the landing, which is the cause of most of the serious/fatal accidents in terrain parks that involve jumps. Nevertheless, it'll be interesting to see how things pan out. Hopefully the response will include instituting park passes and other gaper-exclusion measures.

Have you guys released a list of names yet? I didn't see anything concerning who was selected on the Beyond website.

Good reminder that chairlifts evolved from mining equipment...

It'll be interesting to see how this goes over, business wise.

Sort of goes along with paying out of pocket until you reach your deductible. Ditto for choosing which catastrophic coverage you buy, etc.

I definitely think that there'd be a significant role for the state on the catastrophic insurance side, and on the upfront care side, in order to insure that that vulnerable populations are neither excluded nor have to entirely fend for themselves. I'd prefer to see the role of the state restricted to tax incentives/credits for catastrophic insurance, and setting rules for HSA's for non-vulnerable populations. In neither case should the state attempt to set or control the prices that providers charge for care. I also think that mentally competent adults who happen to be poor are perfectly capable of administering their own care, and would respond to incentives in the same way as people who make enough money to pay for routine car on an out-of-pocket basis - and I think that with the right incentives they'd tend to look after themselves better than a bureaucrat would, no matter who the said bureaucrat happens to be employed by.

I couldn't agree more with this statement. The kind of free market model JayB's talking about requires two things: easily definable goods and services, and fluid, open information. The health care market has neither. The system is so complex that the administering companies can't even negotiate it, nevermind a consumer. We regularly get bills we don't owe, and mysterious refunds from our insurer. It's not just difficult for consumers, including companies, to compare costs...it's impossible. Furthermore, the very nature of providing health care to humans means in an infinity of complications and unknowns. Not only are there almost an unlimited array of goods and services involved, but those services can quickly expand when complications, which are never very predictable, happen. I agree. The current system has neither. I don't think that you can make this argument about all systems other than a single payer system that's centrally administered by the state. Take a moment and look at the links I posted above for an example of an alternate model. If our plan comes together, my wife and I will be taking some time off from work this summer - might be several months - and this is the approach that we're going to use. High deductible catastrophic coverage, and cash-only providers for routine care. Tax credits and a HSA would be nice, but the advantages of this approach over paying hundreds of dollars a month for comprehensive coverage are incentive enough to make the switch.

If you click on the links that I provided above, you'll see the beginnings of a different model which eliminates insurers and the inefficiencies that they represent from the provision of routine medical care. It should be easy to see how such a model would work in conjunction with high-deductible plans coupled with health-savings accounts, especially those that permit the accumulation of assets in the said HSA's, with the cost of the policies offset by tax incentives that accrue to individuals, rather than employers. I don't think that it's inconceivable that you could structure the catastrophic plans in such a way that you encourage people to make prudent choices about their care, such as increasing premiums for those who don't get routine physicals, screenings, etc. For those who can't afford care, giving them access to a fixed dollar amount of money to spend on routine care every-year, that could only be used at clinics, hospitals, and pharmacies, and refunding them a portion of the balance that they don't spend* in cash provided they get the necessary checkups, etc - in conjunction with a gap that they have to cover themselves before the state kicks in the money for the amounts that exceed the balance is at least worth considering. Instead of giving doctors an incentive to refuse care to people who are on medicaid because they lose money every time they see a medicaid patient, they'd have an incentive to compete for their business, and medicaid patients would have more control over who they got their care from. *The "rebate" could be placed into a HSA that they could apply towards the "donut hole." in their coverage. For people who can't reasonably be expected to be responsible for their own care or the care of their dependents, it doesn't seem like there's many options other than letting the state assume full responsibility - both in terms of paying for and directing - their care. This would have elements of a single payer system in that the state would be paying out quite a bit of money for medical care, but at least when it came to routine care - neither a public nor a private bureaucracy would come into play.

So we would have you all believe. How I fathered and provided for three children who are now well into adulthood by the age of 34 is an attainment that I wish I could disclose more about were it not for the constraints imposed by trying to effectively maintain a duel online identity.

According to these guys Solution "Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans." So you like the idea of reducing the costs of a bureaucracy JayB, just not the idea of those savings going to those who are supposed to be the beneficiaries of a "health care" system - namely, the patients? You must have had a rough childhood http://www.simplecare.com/about.html http://www.aafp.org/fpm/20060200/642500.html

According to these guys Solution "Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans." So you like the idea of reducing the costs of a bureaucracy JayB, just not the idea of those savings going to those who are supposed to be the beneficiaries of a "health care" system - namely, the patients? You must have had a rough childhood If insurers are competing for market share, particularly in a marketplace that's not composed of a mishmash of state-specific fiefdoms, are you suggesting that insurers that realize gains in efficiency will have no incentive to use the said gains to capture more market share by providing identical coverage for a lower price?

The administrative-cost-analysis may still come out in favor of single-payer systems if you account for the costs associated with raising the revenue via taxation in the same manner that you account for raising revenue via billing, but if intention is to compare costs accurately this is one of a few points that should be taken into account. It doesn't necessarily follow that if administrative costs are high, the only way to reduce them is via nationalizing every private component of the health-care system.

It was kind of a surprise to see the most immediate and dramatic impacts from the Salvini decision materialize north of the border. "Calgary, Canada - Citing guest safety, Resorts of the Canadian Rockies, operators of six Canadian ski resorts from British Columbia to Quebec, announced on Thursday that they would eliminate all man-made snow jumps from terrain parks at the company's ski areas this season. We are undertaking an industry-leading initiative,” says Matt Mosteller, Senior Director of Business Development for Resorts of the Canadian Rockies (RCR). “We have found that one of the main issues that increase the likelihood of serious injury on our mountains is big air. When we are making decisions about safety at our resorts, the big jumps in the terrain parks always come into the equation. We decided to make a change.” At the same time, RCR will be making an increased investment in new rails and features for RCR’s terrain parks. For example, this year’s RCR TELUS Park at Lake Louise Mountain Resort features the highest-ever investment in new features. RCR will have rail parks this season at Lake Louise Mountain Resort, Fernie Alpine Resort and Nakiska. In addition, RCR also owns and operates Kimberley Resort in B.C. and Mont-Sainte-Anne and Stoneham, both in Quebec. Mosteller acknowledges that the news will be disappointing to some. "We realize that this change may disappoint some guests who regularly use these man-made jump features," he acknowledged. "However, we believe we have a strong moral obligation to not compromise the safety of our guests.” With the new rail park format, RCR will host a Rail Jam Series that will take place at Lake Louise, Fernie and Nakiska. Features used in the Rail Jam Series will be suitable for a high level of competition, while also adhering to safe practices, resort officials indicate. For the past three seasons, RCR has also worked hard on developing its family-friendly terrain parks. These unique parks, separate from the larger parks, feature small rails, boxes and rollers, encouraging learning, safety and fun in a non-intimidating environment. The feedback on these parks has been positive and they will continue to develop at all of the company's resorts." http://www.firsttracksonline.com/index.php?name=News&file=article&sid=3188

Sierra Trading Post: As of now they have both the hammer and adze available. Old/discontinued model, not the new model. http://www.sierratradingpost.com/p/325,96680_Black-Diamond-Equipment-Cobra-Adze-Ice-Axe.html

There's one set of conceptual/cognitive traps that we needn't worry about Prole ever falling into...

What happens to life expectancy when you correct for deaths that occur in murders and automobile accidents in each country.... Table: Raw Life Expectancy vs Corrected Life Expectancy [Left side = raw life expectancy, right side = life expectancy for those that do not die in homicides or car accidents] I can't vouch for the numbers, but I think they're worth considering. Once you correct for mortality in cases in which routine preventive care, or medical care undertaken to treat disease and/or illness, would do little or nothing to affect the outcome - what do the numbers that you end up with tell you about the actual quality of care in each country? If the numbers are correct, how would investments in addressing crime and road safety yield affect longevity in comparison to comparable investments in preventive medicine?

BC or Calgary?

I always thought it was "Fah-vrey."

Where are you thinking of heading? Colorado, Utah, Canada? Overseas?

Would you say that they are nearly identical in ethno-cultural terms as well? If the proximity between Canada and Mexico were the same as between Mexico and the US, and Canada had been absorbing the same number of immigrants (in percentage terms) from Mexico and other locales south of the border for the same amount of time, are you certain that this would have no bearing whatsoever on the aggregate behavior in Canada, or wouldn't present some challenges with regards to neonatal/maternal health that the system there doesn't currently have to contend with? I couldn't actually find the report that they were referring to, but hopefully someone can dig it up. With regards to Ireland, here's a partial explanation for the difference between Ireland and, say, Canada, from the Irish Medical Journal: "Maternal Mortality Statistics in Ireland: Should They Carry a Health Warning? C Murphy, C O Herlihy University College Dublin and National Maternity Hospital Holles Street ,Dublin 2 Sir, Maternal mortality statistics are the most important indicators of reproductive women’s health care. Ireland has experienced a gratifying progressive decline in maternal deaths for over 60 years; rates cited by the Central Statistics Office (CSO), and taken up by the news media, suggest that this is one of the safest countries in the world in which to deliver a baby. Nevertheless, closer inspection of maternal death rates in the Republic indicate significant under-reporting by the CSO thus casting considerable doubt on any comparative conclusions, and in fact, on the overall reliability of figures in recent years. Each of the three chartered Dublin maternity hospitals (National Maternity, Coombe and Rotunda) publish Annual Clinical Report 1-3 of their activity before the end of the following year. In five of the fifteen years from 1990-2004, these reports have indicated that more maternal deaths have occurred in Dublin than have been reported in the National birth cohort (see Table 1). These repeated discrepancies are consistent with persistently defective case ascertainment by the current mechanisms used by the CSO. This should be addressed as a matter of priority." As far as the discrepancy with the rest of the world is concerned, it would be interesting to see a breakdown of the statistics concerning who dies of what. My understanding - which may be incorrect - is that most deaths associated with childbirth in developing countries these days are a consequence of something that occurs during the delivery or shortly thereafter, which suggests that they're likely to occur within a hospital environment. I could be wrong about this, but if that's the case, I have a hard time believing that a woman haemorrhaging after delivery is more likely to die in a US delivery room or hospital than in, say, Italy - but perhaps this is the case. As far as maternal mortality in the US is concerned, I think that we actually keep reasonably good records of this, at least when someone's doing a study. I think that this study may address your question to a certain extent: "1: MMWR Surveill Summ. 2003 Feb 21;52(2):1-8.Links Pregnancy-related mortality surveillance--United States, 1991--1999. Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, Syverson CJ. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, USA. PROBLEM/CONDITION: The risk of death from complications of pregnancy has decreased approximately 99% during the twentieth century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982. However, since 1982, no further decrease has occurred in maternal mortality in the United States. In addition, racial disparity in pregnancy-related mortality ratios persists; since 1940, mortality ratios among blacks have been at least three to four times higher than those for whites. The Healthy People 2000 objective for maternal mortality of no more than 3.3 maternal deaths per 100,000 live births was not achieved during the twentieth century; substantial improvements are needed to meet the same objective for Healthy People 2010. REPORTING PERIOD COVERED: This report summarizes surveillance data for pregnancy-related deaths in the United States for 1991-1999. DESCRIPTION OF SYSTEM: The Pregnancy Mortality Surveillance System was initiated in 1987 by CDC in collaboration with state health departments and the American College of Obstetricians and Gynecologists Maternal Mortality Study Group. Health departments in the 50 states, the District of Columbia, and New York City provide CDC with copies of death certificates and available linked outcome records (i.e., birth certificates or fetal death certificates) of all deaths occurring during or within 1 year of pregnancy. State maternal mortality review committees, the media, and individual providers report a limited number of deaths not otherwise identified. Death certificates and relevant birth or fetal death certificates are reviewed by clinically experienced epidemiologists at CDC to determine whether they are pregnancy-related. RESULTS: During 1991-1999, a total of 4,200 deaths were determined to be pregnancy-related. The overall pregnancy-related mortality ratio was 11.8 deaths per 100,000 live births and ranged from 10.3 in 1991 to 13.2 in 1999. The pregnancy-related mortality ratio for black women was consistently higher than that for white women for every characteristic examined. Older women, particularly women aged >/= 35 years and women who received no prenatal care, were at increased risk for pregnancy-related death. The distribution of the causes of death differed by pregnancy outcome. Among women who died after a live birth (i.e., 60% of the deaths), the leading causes of death were embolism and pregnancy-induced hypertension. Interpretation: The reported pregnancy-related mortality ratio has substantially increased during 1991-1999, probably because of improved ascertainment of pregnancy-related deaths. Black women continued to have a 3-4 times higher pregnancy-related mortality ratio than white women. In addition, pregnancy-related mortality has the largest racial disparity among the maternal and child health indicators. Reasons for this difference could not be determined from the available data. PUBLIC HEALTH ACTIONS: Continued surveillance and additional studies should be conducted to monitor the magnitude of pregnancy-related mortality, to identify factors that contribute to the continuing racial disparity in pregnancy-related mortality, and to develop effective strategies to prevent pregnancy-related mortality for all women. In addition, CDC is working with state health departments, researchers, health-care providers, and other stakeholders to improve the ascertainment and classification of pregnancy-related deaths." (Incidentally, using figures generated by measuring the actual number of deaths (11.8) and multiplying that by the average number of births-per-woman in the US (2.13) and dividing 100,000 by this number actually gives figures that are higher(worse) than the figures from the WHO.) I would guess that in summary - I would say that -I'm not convinced Ireland or any other stats are completely accurate, and that when the overall incidence is low across the board, minor variations in standards for reporting can have significant impacts on the values that show up in the statistical record. -More pregnancies in high risk groups where neither the mother nor the baby receive adequate pre-natal care. I'd wager that quite a bit of this is correlated with teen-pregnancy rates in the said groups. I'll leave it to others to speculate as to the effect that changing to a single-payer plan would have on outcomes in these cases.

I think the idea with respect to savings accounts isn't that those who held them would no longer need insurance, but that they would be used to cover non-catastrophic medical expenses in conjunction with high deductible insurance plans that would kick in when and if the expenses exceeded the annual deductible. The idea here is that by increasing the deductible you decrease your premiums enough that you are actually reducing your total expenditures on health care each year, and a greater percentage of the money that you do spend goes directly to providers rather than to insurance companies. As far as the endpoints under discussion are concerned, I'm not convinced that the intercountry comparisons are completely valid, and that a baby born at a particular gestation point, birthweight, etc is more likely to die in the US than in another country, I'd like to see it. The study that Murray cites for maternal mortality may be valid, but I'd need to see the study before conceding that a pregnant woman in the US is more likely to die before, during, and after giving birth than than in other countries. That's possible, but I'd like to see the data. As far as your frustrations are concerned, I share them, but mine are the inverse of yours. In my opinion, when you compare data across countries you have to be very careful when attempting to determine which outcomes are due to differences in the manner that the country provides health care, and which are due to cultural factors and lifestyle choices that are unlikely to vary much from one health-care delivery model to the next, and I rarely see much enthusiasm for this task.

If there's one thing that you can trust in this world, it's third hand statistics. (And yes, do lecture me on this point, ye champion of the "Fat Virus.") I could be incorrect, but I also think it's possible that the methodology they used for their rankings may not produce an accurate result. It's hard to say without seeing the study. Just for that, I'm going to force you to do some scrolling: " Maternal mortality in 2000 Estimates developed by WHO, UNICEF and UNFPA Maternal mortality: The measurement challenge Definitions The Tenth Revision of the International Classification of Diseases (ICD-10) defines a maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.4 The 42-day limit is somewhat arbitrary, and in recognition of the fact that modern life-sustaining procedures and technologies can prolong dying and delay death, ICD-10 introduced a new category, namely the late maternal death, which is defined as the death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy. According to ICD-10, maternal deaths should be divided into two groups: * Direct obstetric deaths are those resulting from obstetric complications of the pregnant state (pregnancy, labour and the puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. * Indirect obstetric deaths are those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but was aggravated by physiologic effects of pregnancy. The drawback of this definition is that maternal deaths can escape being so classified because the precise cause of death cannot be given even though the fact of the woman having been pregnant is known. Such under-registration is frequent in both developing and developed countries. Deaths from “accidental or incidental” causes have historically been excluded from maternal mortality statistics. However, in practice, the distinction between incidental and indirect causes of death is difficult to make. To facilitate the identification of maternal deaths in circumstances where cause of death attribution is inadequate, ICD-10 introduced a new category, that of pregnancy-related death, which is defined as: the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. In practical terms then, there are two distinct approaches to identifying maternal deaths, one based on medical cause of death following the ICD definition of maternal death, and the other based on timing of death relative to pregnancy, that is, using the ICD definition of pregnancy-related death. This has important implications for the approaches to measurement described below. Measures of maternal mortality There are three distinct measures of maternal mortality in widespread use: the maternal mortality ratio, the maternal mortality rate and the lifetime risk of maternal death. The most commonly used measure is the maternal mortality ratio, that is the number of maternal deaths during a given time period per 100,000 live births during the same time period. This is a measure of the risk of death once a woman has become pregnant. The maternal mortality rate, that is, the number of maternal deaths in a given period per 100,000 women of reproductive age during the same time period, reflects the frequency with which women are exposed to risk through fertility. The lifetime risk of maternal death takes into account both the probability of becoming pregnant and the probability of dying as a result of that pregnancy cumulated across a woman’s reproductive years. In theory, the lifetime risk is a cohort measure but it is usually calculated with period measures for practical reasons. It can be approximated by multiplying the maternal mortality rate by the length of the reproductive period (around 35 years). Thus, the lifetime risk is calculated as [1-(1-maternal mortality rate)35]. Why maternal mortality is difficult to measure Maternal mortality is difficult to measure for both conceptual and practical reasons. Maternal deaths are hard to identify precisely because this requires information about deaths among women of reproductive age, pregnancy status at or near the time of death, and the medical cause of death.4 All three components can be difficult to measure accurately, particularly in settings where deaths are not comprehensively reported through the vital registration system and where there is no medical certification of cause of death. Moreover, even where overall levels of maternal mortality are high, maternal deaths are nonetheless relatively rare events and thus prone to measurement error. As a result, all existing estimates of maternal mortality are subject to greater or lesser degrees of uncertainty. Broadly speaking, countries fall into one of four categories: * Those with complete civil registration and good cause of death attribution – though even here, misclassification of maternal deaths can arise, for example, if the pregnancy status of the woman was not known or recorded, or the cause of death was wrongly ascribed to a non-maternal cause. * Those with relatively complete civil registration in terms of numbers of births and deaths but where cause of death is not adequately classified; cause of death is routinely reported for only 78 countries or areas, covering approximately 35% of the world’s population. * Those with no reliable system of civil registration where maternal deaths – like other vital events – go unrecorded. Currently, this is the case for most countries with high levels of maternal mortality. * Those with estimates of maternal mortality based on household surveys, usually using the direct or indirect sisterhood methods. These estimates are not only imprecise as a result of sample size considerations, but they are also based on a reference point some time in the past, at a minimum six years prior to the survey and in some cases much longer than this (see below). WHO, UNICEF and UNFPA have developed estimates of maternal mortality primarily with the information needs of countries with no or incomplete data on maternal mortality in mind, but also as a way of adjusting for underreporting and misclassification in data for other countries. A dual strategy is used that adjusts existing country information to account for problems of underreporting and misclassification and uses a simple statistical model to generate estimates for countries without reliable data. Approaches for measuring maternal mortality Commonly used approaches for obtaining data on levels of maternal mortality vary considerably in terms of methodology, source of data and precision of results. The main approaches are described briefly below. As a general rule, maternal deaths are identified by medical certification in the vital registration approach, but generally on the basis of the time of death definition relative to pregnancy in household surveys (including sisterhood surveys), censuses and in Reproductive Age Mortality Studies (RAMOS). Vital registration In developed countries, information about maternal mortality derives from the system of vital registration of deaths by cause. Even where coverage is complete and all deaths medically certified, in the absence of active case-finding, maternal deaths are frequently missed or misclassified.5,6,7,8,9 In many countries, periodic confidential enquiries or surveillance are used to assess the extent of misclassification and underreporting. A review of the evidence shows that registered maternal deaths should be adjusted upward by a factor of 50% on average. Few developing countries have a vital registration system of sufficient coverage and quality to enable it to serve as the basis for the assessment of levels and trends in cause-specific mortality including maternal mortality. Direct household survey methods Where vital registration data are not appropriate for the assessment of cause-specific mortality, the use of household surveys provides an alternative. However, household surveys using direct estimation are expensive and complex to implement because large sample sizes are needed to provide a statistically reliable estimate. The most frequently quoted illustration of this problem is the household survey in Addis Ababa, Ethiopia, where it was necessary to interview more than 32,300 households to identify 45 deaths and produce an estimated MMR of 480. At the 95% level of significance this gives a confidence interval of plus or minus about 30%, i.e. the ratio could lie anywhere between 370 and 660.10 The problem of wide confidence intervals is not simply that such estimates are imprecise. They may also lead to inappropriate interpretation of the figures. For example, using point estimates for maternal mortality may give the impression that the MMR is significantly different in different settings or at different times whereas, in fact, maternal mortality may be rather similar because the confidence intervals overlap. Indirect sisterhood method The sisterhood method is a survey-based measurement technique that in high-fertility populations substantially reduces sample size requirements because it obtains information by interviewing respondents about the survival of all their adult sisters. Although sample size requirements may be reduced, the problem of wide confidence intervals remains. Furthermore, the method provides a retrospective rather than a current estimate, averaging experience over a lengthy time period (some 35 years, with a midpoint around 12 years before the survey).11 For methodological reasons, the indirect method is not appropriate for use in settings where fertility levels are low [total fertility rate (TFR) <4] or where there has been substantial migration, civil strife, war, or other causes of social dislocation. Direct sisterhood method The Demographic and Health Surveys (DHS) use a variant of the sisterhood approach, the “direct” sisterhood method.12 This relies on fewer assumptions than the original method but it requires larger sample sizes and the information generated is considerably more complex to collect and to analyse. The direct method does not provide a current estimate of maternal mortality but the greater specificity of the information permits the calculation of a ratio for a more recent period of time. Results are typically calculated for a reference period of seven years before the survey, approximating a point estimate some three to four years before the survey. Because of relatively wide confidence intervals, the direct sisterhood method cannot be used to monitor short-term changes in maternal mortality or to assess the impact of safe motherhood programmes. The Demographic and Health Surveys have published an in-depth review of the results of the DHS sisterhood studies (direct and indirect methods) and have advised against the duplication of surveys at short time-intervals.13 WHO and UNICEF have issued guidance notes to potential users of sisterhood methodologies, describing the circumstances in which it is or is not appropriate to use the methods and explaining how to interpret the results.14 Reproductive Age Mortality Studies The Reproductive Age Mortality Study – RAMOS – involves identifying and investigating the causes of all deaths of women of reproductive age. This method has been successfully applied in countries with good vital registration systems to calculate the extent of misclassification and in countries without vital registration of deaths.9,15,16,17,18 Successful studies in countries lacking complete vital registration use multiple and varied sources of information to identify deaths of women of reproductive age; no single source identifies all the deaths. Subsequently, interviews with household members and health-care providers and reviews of facility records are used to classify the deaths as maternal or otherwise. Properly conducted, the RAMOS approach is considered to provide the most complete estimation of maternal mortality but can be complex and time-consuming to undertake, particularly on a large scale. Verbal autopsy Where medical certification of cause of death is not available, some studies assign cause of death using verbal autopsy techniques.(19) However, the reliability and validity of verbal autopsy for assessing cause of death in general and identifying maternal deaths in particular, has not been established. The method may fail to correctly identify a proportion of maternal deaths, particularly those occurring early in pregnancy (ectopic, abortion-related), those in which the death occurs some time after the termination of pregnancy (sepsis, organ failure), and indirect causes of maternal death (malaria, HIV/AIDS). Census There is growing interest in the use of decennial censuses for the generation of data on maternal mortality. A high-quality decennial census could include questions on deaths in the household in a defined reference period (often one or two years), followed by more detailed questions that would permit the identification of maternal deaths on the basis of time of death relative to pregnancy (verbal autopsy). The weaknesses of the verbal autopsy method have already been noted. Nonetheless, the advantages of such an approach are that it would generate both national and subnational figures and that it would be possible to undertake analysis according to the characteristics of the household. Trend analysis would be possible because sampling errors would be eliminated or greatly reduced. However, data obtained from enquiries into recent deaths in the household in a census require careful evaluation, and often adjustment. A number of countries have used the census to generate maternal mortality figures, and work is under way to assess the extent to which such approaches may prove of value in measuring maternal mortality. (2"

In the case of infant mortality - it's quite likely that the "quibbles" account for the vast majority of the variation between the US and other countries, so reallocating resources on the basis of the said variations could very well result in more spending where it's not needed, and less spending where it is. In the case of the child, that was tragic, but I think the story is more complicated than a simple lack of resources.

I find that hard to believe, but of course that doesn't mean it can't be true. It would be interesting to see the study and look at the study first hand. My hunch is that the figures are not as straightforward as they might seem at first glance, and don't actually capture the risk associated with each pregnancy in one highly developed country (where the risk of dying during or because of complications associated with childbirth is relatively low) versus another terribly well, and that within these subgroups, the variations in the fertility rate will skew the statistics. E.g., in developed states where the women have relatively few children, this distorts the maternal mortality risks downward relative to the average, and distorts the risks upwards where fertility is highest. Maybe you can post a link to the story when you get a chance. In the meantime, here's a link that might have some bearing on this discussion: http://www.who.int/reproductive-health/publications/maternal_mortality_2000/challenge.html My larger point isn't that we should dismiss all data - statistical or anecdotal - that reveals shortcomings in the American healthcare. However, it's incumbent upon anyone who cares about improving healthcare in to insure that both the data and the interpretations of it are as accurate as possible. That is, if the goal is to draw attention to and allocate resources towards the resolution real problems. I don't personally think that the odds of a baby born with a given risk - be it a congenital defect, low birthweight, premature birth, or any other condition - dying ins a US hospital are any greater than those of the same baby dying in Canada, France, etc. I'd make the same claim with regards to mothers, and I think that allocating more resources to neonatal ICU's, and the like would do little to help either newborns or women who've just delivered babies in this country. The area where I do think that the US can improve is with regards to pre-natal care in poor and minority communities, especially recent immigrants. To the extent that women in these groups aren't getting care for their unborn children for for a lack of resources - this is indeed a problem, but I don't think it's reasonable to conclude that socializing all of medicine would be more effective in addressing these problems than other approaches that could be undertaken by selective changes in government spending, insurance regulations, etc. However, I also think in these groups, that there are dimensions to this problem that go beyond the mere availability of resources.