Broad Form Insurance Quotes

Society never advances. It recedes as fast on one side as it gains on the other. It undergoes continual changes; it is barbarous, it is civilized, it is christianized, it is rich, it is scientific; but this change is not amelioration. For every thing that is given, something is taken. Society acquires new arts, and loses old instincts. What a contrast between the well-clad, reading, writing, thinking American, with a watch, a pencil, and a bill of exchange in his pocket, and the naked New Zealander, whose property is a club, a spear, a mat, and an undivided twentieth of a shed to sleep under! But compare the health of the two men, and you shall see that the white man has lost his aboriginal strength. If the traveller tell us truly, strike the savage with a broad axe, and in a day or two the flesh shall unite and heal as if you struck the blow into soft pitch, and the same blow shall send the white to his grave. The civilized man has built a coach, but has lost the use of his feet. He is supported on crutches, but lacks so much support of muscle. He has a fine Geneva watch, but he fails of the skill to tell the hour by the sun. A Greenwich nautical almanac he has, and so being sure of the information when he wants it, the man in the street does not know a star in the sky. The solstice he does not observe; the equinox he knows as little; and the whole bright calendar of the year is without a dial in his mind. His note-books impair his memory; his libraries overload his wit; the insurance-office increases the number of accidents; and it may be a question whether machinery does not encumber; whether we have not lost by refinement some energy, by a Christianity entrenched in establishments and forms, some vigor of wild virtue. For every Stoic was a Stoic; but in Christendom where is the Christian?

Deuteronomy’s notion of tithes—that for two out of three years surplus is shared broadly with the disadvantaged, and in the third year is given to them outright—is sound economics when seen in light of conceptions of redistributive economics in primitive societies. In modern capitalist societies, surplus earnings are placed into savings, and insurance policies are taken out to hedge against various forms of adversity. The laws of tithing may be construed as another element in a program of primitive insurance. In a premodern society, A will give some of his surplus in a good year to B, who may have fallen on hard times in exchange for B’s commitment to reciprocate should their roles one day be reversed.

I WOULD OFTEN think back to that Santelli clip, which foreshadowed so many of the political battles I’d face during my presidency. For there was at least one sideways truth in what he’d said: Our demands on the government had changed over the past two centuries, since the time the Founders had chartered it. Beyond the fundamentals of repelling enemies and conquering territory, enforcing property rights and policing issues that property-holding white men deemed necessary to maintain order, our early democracy had largely left each of us to our own devices. Then a bloody war was fought to decide whether property rights extended to treating Blacks as chattel. Movements were launched by workers, farmers, and women who had experienced firsthand how one man’s liberty too often involved their own subjugation. A depression came, and people learned that being left to your own devices could mean penury and shame. Which is how the United States and other advanced democracies came to create the modern social contract. As our society grew more complex, more and more of the government’s function took the form of social insurance, with each of us chipping in through our tax dollars to protect ourselves collectively—for disaster relief if our house was destroyed in a hurricane; unemployment insurance if we lost a job; Social Security and Medicare to lessen the indignities of old age; reliable electricity and phone service for those who lived in rural areas where utility companies wouldn’t otherwise make a profit; public schools and universities to make education more egalitarian. It worked, more or less. In the span of a generation and for a majority of Americans, life got better, safer, more prosperous, and more just. A broad middle class flourished. The rich remained rich, if maybe not quite as rich as they would have liked, and the poor were fewer in number, and not as poor as they’d otherwise have been. And if we sometimes debated whether taxes were too high or certain regulations were discouraging innovation, whether the “nanny state” was sapping individual initiative or this or that program was wasteful, we generally understood the advantages of a society that at least tried to offer a fair shake to everyone and built a floor beneath which nobody could sink.

Runaway costs are crushing the American medical system. Hispanics are the group least likely to have medical insurance, with 30.7 percent uninsured. Ten point eight percent of whites and 19.1 percent of blacks are without insurance. Illegal immigrants rarely have insurance, but hospitals cannot turn them away. In 1985, Congress passed the Emergency Medical Treatment and Active Labor Act, which requires hospitals to treat all emergency patients, without regard to legal status or ability to pay. Anyone who can stagger within 250 yards of a hospital—a distance established through litigation—is entitled to “emergency care,” which is defined so broadly that hospital emergency rooms have become free clinics. Emergency-room care is the most expensive kind. Childbirth is an emergency, and hospitals must keep mother and child until both can be discharged. If the mother is indigent the hospital pays for treatment, even if there are expensive complications. Any child born in the United States is considered a US citizen, so thousands of indigent illegal immigrants make a point of having “anchor babies” at public expense. The new American qualifies for all forms of welfare, and at age 21 can sponsor his parents for American citizenship. In 2006 in California, an estimated 100,000 illegal immigrant mothers had babies at public expense, and accounted for about one in five births. The costs were estimated at $400 million per year, and in the state as a whole, half of all Medi-Cal (state welfare) births were to illegal immigrant mothers. In 2003, 70 percent of the babies born in San Joaquin General Hospital in Stockton were anchor babies. In Los Angeles and other cities with heavy gang activity, hospitals must deal with “dump and run” patients—criminals wounded in shootouts who are rolled out of speeding cars by fellow gang members. Illegal-immigrant patients often show up without papers of any kind, and doctors have no idea whom they are treating. Mexican hospitals routinely turn away uninsured Mexicans, and if the US border is not far, may tell the ambulance driver to head for the nearest American hospital. “It’s a phenomenon we noticed some time ago, one that has expanded very rapidly,” said a federal law enforcement officer.

Fiscal Numbers (the latter uniquely identifies a particular hospitalization for patients who might have been admitted multiple times), which allowed us to merge information from many different hospital sources. The data were finally organized into a comprehensive relational database. More information on database merger, in particular, how database integrity was ensured, is available at the MIMIC-II web site [1]. The database user guide is also online [2]. An additional task was to convert the patient waveform data from Philips’ proprietary format into an open-source format. With assistance from the medical equipment vendor, the waveforms, trends, and alarms were translated into WFDB, an open data format that is used for publicly available databases on the National Institutes of Health-sponsored PhysioNet web site [3]. All data that were integrated into the MIMIC-II database were de-identified in compliance with Health Insurance Portability and Accountability Act standards to facilitate public access to MIMIC-II. Deletion of protected health information from structured data sources was straightforward (e.g., database fields that provide the patient name, date of birth, etc.). We also removed protected health information from the discharge summaries, diagnostic reports, and the approximately 700,000 free-text nursing and respiratory notes in MIMIC-II using an automated algorithm that has been shown to have superior performance in comparison to clinicians in detecting protected health information [4]. This algorithm accommodates the broad spectrum of writing styles in our data set, including personal variations in syntax, abbreviations, and spelling. We have posted the algorithm in open-source form as a general tool to be used by others for de-identification of free-text notes [5].