Thursday, October 15, 2009

Diagnosis: Celiac (Part 3 - The Case Study)

Earlier today, I was reminded once again why Celiac Disease and health care reform in the United States is such a timely topic. Sitting in my email inbox was the October newsletter of the National Foundation for Celiac Awareness, and the last article in the newsletter was a link to a Wall Street Journal Health Blog from mid-September.

The WSJ post of a 17-year old girl from the Chicago area who was dropped from her health plan after being diagnosed with Celiac. In a heavily criticized tactic known as recission, her health insurance provider - upon learning of her diagnosis - went back and reviewed three months worth of medical records. Then, looking solely at her symptomology prior to diagnosis, declared that if they had known about those symptoms, they would not have offered her coverage. Seriously? We all experience symptoms leading to the diagnosis of anything... that's how doctors do their job. The more I delve into this topic, the more disgusted I become with the health care system in the United States, and the more I feel like I come across questionable ethical practices on the part of insurance companies that appear to be motivated solely by corporate greed.

I feel like it's not that much a satirical leap of faith to foreshadow a time in the not too distant future when an unregulated health insurance company would turn to a patient and say: "We went back and reviewed your records, and we couldn't but notice that you were born. Your being born constitutes an implied acceptance of the terms of life. Unfortunately, those terms guarantee that you will get sick at some point over the course of your life. Based on those factors, we're declining coverage."

But again, I digress...

As I got my hands dirtier and dirtier with this topic, I wanted to do more than write about it. I didn't want to do a series of posts dealing only in hypotheticals, theories, anecdotal stories, and ideology. I wanted to do a concrete case study about the gauntlet of health insurance coverage faced by someone with Celiac, and who better to be the guinea pig than me?

And so I called four of the most prominent health insurance providers in Colorado (HumanaOne, Cigna, Aetna, and Anthem Blue Cross / Blue Shield), posing as a prospective customer. To each I gave the same set of circumstances: I was a self-employed sole proprietor exploring my options for health insurance coverage. Oh, and I had Celiac Disease. Was that considered a pre-existing condition that would exclude me from being able to obtain coverage? (These were all true statements.) Here's how each customer service department responded:

HumanaOne - Told me that I was not eligible for any of their plans, but recommended I look into Cover Colorado (a state-based health insurance plan offered specifically for people who've been turned away from other health insurance because of pre-existing conditions). The customer service rep also said that "not all companies are the same, and you might find another company that will offer a plan." And so I called other companies...

Aetna - The customer service rep was utterly unhelpful, and when she didn't find Celiac Disease in the underwriting guidelines, recommended I "apply online and see what they say." Basically, it was a crap shoot, and I wouldn't know the outcome unless I formally applied for acceptance to a health insurance plan.

Cigna - Here, too, the customer service rep didn't find any information about Celiac Disease in the underwriting guidelines. But this gentleman was more helpful, asking me to send him an email with my age, height, weight, and a description of the condition, and he'd pass it along to the underwriting team to get an answer.

Anthem BC/BS - The customer service rep told me, with regard to Celiac Disease, "I'm thinking it's not declinable." This was tentative good news. But I wanted a more definitive answer than that, I told him. And so he invited me to submit an application in order to get an official disposition from the underwriters.

In each of the cases where a company asked me to jump through an additional hoop in order to get a decision or answer, I began to follow those leads. But eventually, they all began asking for far more personal information than I was prepared to fork over. Instead, I switched gears and - wearing my investigative journalist hat - called the media relations rep for each company to get an official stance on the subject. Then the plot thickens...

I asked each media rep the same three questions: 1) Was Celiac Disease considered a pre-existing condition that would exclude someone from obtaining health insurance? 2) If so, what was the rationale behind the underwriters' disposition in that regard? And 3) Was that true across all insurance plans offered, or did it differ from plan to plan? (For example, would someone be excluded from one plan, but invited to join another that had higher rates?)

HumanaOne's media rep told me he'd have an answer for me in 1 to 2 days. 4 days later, not a word.

At Aetna, I left both a voicemail and sent an email. I just received word this afternoon that they're working on it.

Cigna was more helpful. The media rep there did some digging, and while she couldn't get an answer on the exclusion question, she was able to confirm that testing for Celiac Disease is covered under the company's insurance policies. (Which raises an interesting question - Do their insurance plans cover a test which, if it comes back positive, would then get you dropped from those plans?) She also recommended I call the Colorado Association of Health Plans to get an industry-wide sort of perspective. I have a message in to CAHP, but haven't yet received a response.

And lastly, there was Anthem BC/BS. Their media rep was by far the most knowledgeable, and the only one to point out several nuances of the health insurance structure in Colorado. (I'll get to that in a minute.)

Before I use Anthem BC/BS as a jumping off point, I wanted to share two other interesting tidbits related to the prior to companies (Cigna and Aetna):

First, when I did a search for "Aetna Celiac" on the Internet, Google returned four consecutive search results that seemed to offer conflicting information. #1 cited that Aetna deems a Celiac screen/test "medically necessary" for people suffering from symptoms of Celiac, and therefor covers the test under its insurance policies. #2 cites donations Aetna has made to the National Foundation for Celiac Awareness. #3 points to Intellihealth, an Aetna website with an extensive information page about Celiac Disease. All three seem to point to Aetna being kind toward people with Celiac. But then you come to #4 - the story of a parent whose 4-year old son was denied coverage by Aetna because he had Celiac Disease.

Second, when I did some digging on Cigna's website, I similarly found an extensive fact page about Celiac Disease. Couple this with the media rep's comment that they cover testing for Celiac, and you feel like you start to get a rosy picture. But then you hear Cigna's notorious reputation for denying coverage on the basis of pre-existing or diagnosed conditions. What does it all mean?

And so, returning to Anthem, the BC/BS media rep was the only one to point out the distinction between individual and group insurance options in Colorado. Here's where things really get interesting:

Colorado law stipulates that coverage cannot be denied to an employee (or their spouse or dependents) who is offered group health insurance through an employer. This is irrespective of pre-existing conditions. Further, Colorado law also ensures that group health insurance is "guaranteed renewable," which means your policy can't be cancelled if you're diagnosed with Celiac (or something else). (Colorado has also enacted other recent legislation, including the Health Insurance Portability and Accountability Act, which offers additional protections.) This is all good news for Celiacs in Colorado seeking to obtain health insurance, and many other states (though not all) have put in place similar legislation to varying degrees.

But what about the nearly 800,000 non-elderly adult individuals in Colorado (1 in 5 in the state for that age bracket!) who don't have health insurance, and who would need to obtain an individual policy? Well, I'm afraid they're largely out of luck. Individual health plans don't have the same state protections as group plans. As a result, a patient could be denied coverage on the basis of a pre-existing condition such as Celiac, which is why HumanaOne told me "no" when I called them.

However, there's even more to this story. The case isn't closed for individuals with pre-existing conditions in Colorado seeking health insurance. Certain self-employed people (such as me) would qualify for state status as a Business Group of One. Officially becoming a BGO in Colorado makes me a company from a health insurance standpoint. In essence, I'd be both the employer, and the only employee. And since I'd then be obtaining health insurance through my employer, I qualify for group health insurance plans, which are protected by state law, and under which I can't be denied coverage, even for a pre-existing condition like Celiac.

And wait...there's even more! Colorado law further states that group health insurance plans may not be underwritten. That's part of the reason why those plans are inclusive of people with pre-existing conditions. But, because they're not underwritten, and because they include all people, they inherently cost more... up to double or triple insurance plans that have underwriters. On the flip side of the coin, individual health plans with underwriters have lower costs, precisely because underwriters exclude people with pre-existing conditions whose heightened medical expenses would cause the overall costs of the plan to rise.

And so in the end, here is what the decision making process would look like for someone in my shoes pursuing health insurance coverage in Colorado, in light of a pre-existing diagnosis with Celiac Disease:

1. Am I employed, and is health insurance offered through my employer? If so, it's a group plan, and I can't be denied. I'll have health insurance, case closed.

2. If I am not employed, do any of the private health insurance companies offer individual plans, or am I excluded from them all on the basis of my pre-existing condition? If I'm excluded from all options, then I pursue Cover Colorado. (Other states have similar plans, such as the Oregon Medical Insurance Pool.) If I'm not excluded from all options, how do the individual plan costs compared to my only other option: Cover Colorado?

3. If I'm self-employed, do I qualify as a Business Group of One? If so, I qualify for group health plans, and I can't be denied. However, because group plans are significantly more expensive than individual plans, do I also qualify for individual plans, or would I be denied from them all? If some would accept me, how do their costs compare to a group plan, and how do either one of those costs compare to the state-based option?

It's enough to really get your head spinning. But as you can see, there are options. The private insurance companies, in my opinion, have some deplorable practices. But some do offer coverage to people with Celiac, and a combination of state-based legislation and a state-based health insurance option offer further protections and choice for consumers like you and me. But if I've made any case over the course of the three posts this week, it's that nationwide health care reform is badly needed.

I can't predict what that reform will look like in the end, but if we (people with Celiac Disease and gluten intolerance and wheat allergy and a long list of other pre-existing conditions) don't speak up and advocate, then that reform may not - or likely, will not - meet our needs. And that's who the reform is most meant to help...we the people. Not we the people without pre-existing conditions. All people. Ensuring health coverage for someone with Celiac Disease shouldn't be this difficult, or this labrynthine. And so raise your gluten-free voice, and be part of making that desperately needed reform happen.

- Pete

12 comments:

jgribble said...

Pete, this is an excellent series of posts. Great writing, great reporting!

Laura B said...

This post is great. And it makes me even happier than I already am to be a CANADIAN. And a Canadian with Celiac, to boot. I can't believe all of the unnecessary strife Americans go through for healthcare. It's truly appalling. The Canadian healthcare system covers all of the country's citizens. Vote for healthcare reform!

Cheryl Doyle-Ruffing said...

Pete,

Interesting series of articles, but I must point out a few areas in which I disagree with you. You may think me cold and callous, but I do not believe that healthcare is a fundamental right. The US Constitution guarantees Americans the rights to life, liberty and the pursuit of happiness, not to healthcare. Although healthcare for everyone seems fair and just, it is not a fundamental right of Americans, and getting involved in the healthcare of private citizens is not a legitimate role of government in a free society. According to George Mason University Professor of Economics Walter Williams, "The Founders favored the free market because it maximizes the freedom of all citizens and teaches respect for the rights of others. Expansive government, by contrast, contracts individual freedom and teaches disrespect for the rights of others." See http://www.hillsdale.edu/news/imprimis.asp

As it stands, many Americans without private health insurance are covered by Medicaid, and both citizens and illegal aliens receive emergency medical treatment that gets paid for by taxpayers like you and me.

Perhaps instead of getting further involved in healthcare, the government should offer tax incentives to doctors and insurance companies who provide free or low-cost healthcare clinics to the uninsured. Maybe greater tax breaks could be given to citizens who charitably contribute to such clinics.

As Adam Smith pointed out in the "Wealth of Nations," social good is best served by pursuing private interests. If the bottom line of an insurance company suffers because its policies cause clients to switch companies, the insurance company will need to improve or risk going out of business. What if a government-run healthcare program fails to give consumers what they want?

You state in your first article that millions of Americans are uninsured. That's true, but it's not 47 million, like some have stated; it's closer to 8 million. Please see this link, http://www.freemarketproject.org/printer/2007/20070718153509.aspx, which points out that many Americans who can afford health insurance have simply chosen not to pay for it. The article also points out that many uninsured Americans are temporarily uninsured, until they get new jobs.

You mentioned the value of life seeming to take a backseat to the cost of medical treatment. I have to ask, how does legalized abortion undermine the value of life?

Here's another question: what role do pharmaceutical companies play in Americans' poor state of health and in the cost of healthcare? How much medical research is funded by pharmaceutical companies? Why should they fund research into a disease, like celiac, that can be managed by diet alone? Won't a company like Pfizer profit more by developing a drug for Irritable Bowel Syndrome and pushing doctors to prescribe it? How much money do pharmaceutical companies contribute to medical schools, where, on the whole, doctors-to-be receive pathetically little training in nutrition. http://www.med-ed-online.org/res00023.htm

How about doctors themselves? I can't begin to tell you how many doctors have ignored the information I've given them about how undiagnosed celiac disease plays a role in other medical conditions from osteoporsis to infertility. They would rather prescribe a drug like Fosamax or get paid for an IVF treatment than suggest a change in diet that the patient may find "too hard." All of the doctors I've talked to are also closed-minded about the limitations of celiac blood tests. See "Before the Villi are Gone" by Dr. Kenneth Fine, http://www.celiac.com/articles/759/1/Early-Diagnosis-of-Gluten-Sensitivity-Before-the-Villi-are-Gone-by-By-Kenneth-Fine-MD/Page1.html

Obviously, there are no easy answers, but until all parties involved start looking at issues from new points of view, nothing will truly improve.

peterbronski said...

Hi Jess and Laura... Glad you enjoyed this series of posts! It was an important topic I really wanted to address, especially because I didn't see any other gluten-free bloggers tackling it.

Cheers, Pete

peterbronski said...

Hi Cheryl, (part 1)

Thanks for adding your perspective to the debate. Only through people getting engaged with this issue will any meaningful change come about. However, while you certainly have a right to disagree with me, I do feel that many of your comments are either misinformed, or frankly, na├»ve. I’ll address them in order, but first, a general statement…

I took the time to read the citations you provided, but was disappointed to find that – with respect to your economic perspective – several of your citations were largely incestuous, and thus, redundant. For example, your freemarketproject.org link leads to the Business and Media Institute, an organization with a clear conservative free market capitalist bias. Elsewhere in your comments, you cite Walter Williams, Professor of Economics at George Mason University. However, you fail to mention that Williams is an advisor to the Business and Media Institute. Is it any surprise, then, that their perspectives are mutually reinforcing? Notwithstanding that, I’ll tackle each of your criticisms:

With respect to “the legitimate role of government in a free society.” First, I’ll point out that “life, liberty and the pursuit of happiness” is language found not in the U.S. Constitution, but rather in the Declaration of Independence. In addition, using the Constitution and the Founding Fathers as the basis for your argument puts you on tenuous footing. While the Constitution (and the people that wrote it) provide an important starting point, you must also keep in mind that many of those men were proud slaveholders who denied women the right to vote. Would you also translate that part of their particular worldview into our modern day society? In the 230 year history of our country since its founding, we have needed to assert and protect additional rights of our citizenry, specifically because the original Constitution failed to adequately do so. Some of those rights have been explicitly defined, as with constitutional amendments that abolished slavery, and which granted women the right to vote. Other such rights have been implicitly defined and subsequently approved by society’s acceptance of those rights, and by our nation’s structure of laws and regulations that protect them.

peterbronski said...

part 2

More specifically to your point that the U.S. government doesn’t have the authority or the rightful power to play a role in healthcare… is not the ultimate function of government to act in the best interests of its citizenry? And how could aiming to create a health care structure which enables all citizens to have adequate and fair access to that health system be reasonably construed as doing anything but? You yourself argue that Americans are guaranteed a right to life. That argument is often cited as a justification for maintaining an army by which we defend U.S. citizens from militant threats abroad. But shouldn’t that same argument create a mandate for defending U.S. citizens from threats domestically, which could easily be envisioned to include threats to our health? Further, you cite Professor Williams (via a Hillsdale website, and one of Hillsdale’s economics professors is ANOTHER advisor to the Business and Media Institute) who makes mention of the “enumerated powers” of Congress. Even by that strictest definition of the powers of government in your “free society,” Congress is explicitly granted authority over commerce. And given that health care industry spending exceeded $2.2 trillion in 2007, don’t you think that makes a pretty compelling case for commerce, and thus the appropriate domain of Congress? What’s more, Congress has many additional implied powers, some of which are bestowed by the Constitution’s own “elasticity clause.” The Founding Fathers had the foresight to recognize that they couldn’t possibly know all the future needs of the country, and therefore built in an inherent flexibility in the Constitution so that Congress’s powers could be expanded or modified to appropriately govern the nation. The nation’s current health care crisis is a perfect example of when a government should respond to the needs of the people. (I won’t even bother to digress about my perspective that society should strive to do better…and the moral/ethical mandate for doing so…)

Next, you argue that “many Americans without private health insurance are covered by Medicaid.” This is only half true. According to the Kaiser Commission on Medicaid and the Uninsured (I’m assuming you’re familiar with them since you errantly quote their numbers) Medicaid provides coverage for some “59 million low-income children, families, seniors and people with disabilities.” However, Medicaid is band-aid on a badly broken health care system, and many recipients of Medicaid and especially Medicare (because Medicaid recipients are too poor to pay for it) require supplemental private insurance to try and cover gaps in their coverage. Further, Medicaid specifically targets the poor and near-poor. For a family of four in 2009, the poor are classified as those with a household income less than $22,050 per year. And yet, Medicaid still excludes many adults. It is targeted at children first, adults second. As a result, more than 40% of poor parents and adults without children remain uninsured. These people are left behind and left out – not covered by private health insurance, and not covered by Medicaid. The Kaiser Family Foundation report further points out that 9 out of 10 of the uninsured are low and MODERATE income families. However, moderate income families are excluded from Medicaid because they do not meet low income requirements, and yet – contrary to the articles you cite – they don’t make enough money to pay for private health insurance. The average cost of a family health plan in 2009 is $13,375 per year. Yet, the moderate income bracket starts at around $44,000 for a family of four. Can these families really feed themselves, keep a roof over their heads, AND pay such exorbitant health care costs (for insurance alone, not even counting out of pocket expenses, co-pays, etc.)?

peterbronski said...

part 3

Next, you argue that the government should offer tax incentives to doctors and health insurance companies. Two paragraphs earlier, you argue that “getting involved in the healthcare of private citizens is not a legitimate role of government…” And yet here you’re hypocritically suggesting just that. To your point, tax incentives will do far too little to have any measurable impact on our health care system. That would be like trying to put a Band-Aid on a gunshot wound and saying, “See. All better.”

Next, you cite Adam Smith and his Wealth of Nations, arguing that the social good is best served by pursuing private interests. Nothing could be further from the truth. In my experience, corporate greed is best served by pursuing private interests. The social good tends to get steamrolled by private interests. For classic examples, just look to the plight of the environment and scenarios commonly known as the Tragedy of the Commons, which is typically applied to issues such as air pollution and water pollution. Each individual or company, acting in its own best interest, is motivated to use a given resource to maximize personal profit to the detriment of competitors. The social good would best be served by self-limiting one’s actions – by not extracting too much water, or not dumping too many chemicals into the air. Yet what we find in practice is that financial greed is the strongest motivator. The same is true in health care. All we have to do to prove this is to apply your own arguments. You say that the social good is best served by pursuing private interests. Later, you also complain about Americans’ deplorable health habits – the fact that they eat poorly, don’t exercise, are obese, etc. But what better personal/private interest is there than one’s own health? If we can’t even act in our own best interest when our lives are literally at stake, do you expect capitalism to magically rectify the problem? It has had a chance to do that, and it has failed, leaving us with astronomical health care costs and millions of Americans who are excluded from coverage.

Which brings me to your next argument: that not nearly as many Americans are truly without health care than we are led to believe. You say that some media suggest the uninsured in America hovers somewhere around 47 million. Then you say that the number is closer to 8 million. Then you cite an outdated Business and Media Institute article from 2007. First, your 8 million figure comes from a single study, and doesn’t reflect the broader body of data. Secondly, that single study from which your number comes actually suggests a RANGE, which spans 8.2 and 13 million plus people. Yet, you’ve chosen to selectively quote only the bottom number of that range, and offer it up as a definitive figure. Isn’t that as misleading as the 47 million figure you’re trying to dispute?

peterbronski said...

part 4

With respect to the outdated and biased article you cite, it makes several central (and incorrect arguments): that the number of uninsured in American is inflated by non-citizens, by those who could be covered by Medicaid, by those who could afford private health insurance but choose not to pay for it, by the temporarily uninsured, etc. It is true that the old 47 million figure includes about 10 million U.S. residents who are not citizens. That’s why current commonly-accepted numbers for the uninsured place the number accurately at 30 million plus. More than 80% of the uninsured in the US are citizens. Period. I already demonstrated in refuting your arguments above that the uninsured cannot afford private health insurance, and that Medicaid excludes many people. In addition, Medicaid is a program that is hurt badly by the economic recession, with many states unable to provide aid, or having to scale back programs. Your argument also fails to account for a reduction in employer-based health care, an increase in the overall number of the uninsured, the fact that people are finding themselves unemployed for longer (thus prolonging their period without health care), and the glaring fact that many people – including those with Celiac – may be excluded from coverage on the basis of pre-existing conditions. I stand by the higher numbers for estimates of the uninsured.

Lastly, you question the role of pharmaceutical companies in the health care equation. Please. While pharmaceutical companies have certainly made valued contributions to health care, they remain dominated by corporate greed as a central motive. Why do prescriptions and over the counter medications cost a mere fraction overseas of what they do in the United States? For example, when Kelli became sick during a trip to Bolivia, I purchased a two-week round of treatment (which included powerful steroids and medication) 100% out of pocket for literally less than two dollars. The same treatment would have cost more than $100 in the United States. Further, why do name brand drugs cost so much more than generic drugs with identical active ingredients? The answer is simple: the drug companies are charging a premium for their name, and profiting as a result. In addition, have you not read the damning criticisms of pharmaceutical companies and how they are engaging in conflicts of interest, and influencing everything from the drugs and procedures doctors prescribe, to the kinds (and outcomes) of research that takes place in academia? This is not speculation in the liberal media. This is fact that has been published in the respected, peer-reviewed journals, such as the New England Journal of Medicine and the Journal of the American Medical Association. For example, I suggest you read JAMA’s “Physicians and the Pharmaceutical Industry,” and NEJMA’s “Doctor’s education: the invisible influence of drug company sponsorship.” They note that drug companies spend an average of $8,000 to $13,000 per year per physician on sales and marketing. Physicians are prescribing medications and procedures from which they personally profit (and so do the pharma companies), engaging in situations of conflict of interest, and doing so to the DETRIMENT of the patient. Lastly, you question why pharmaceutical companies would want to develop a pill to treat Celiac when the condition can be controlled by diet. Answer: profit. It’s the same rationale behind lactose intolerance and high cholesterol and high blood pressure medication. Why do companies sell lactase enzyme pills when lactose intolerance can be controlled through diet? Why do pharmaceutical companies profit billions off of cholesterol and blood pressure meds, when so many Americans wouldn’t need the medication if they simply improved their diet and got some exercise?

peterbronski said...

part 5

I’d also urge you to read the KFF’s “The Uninsured – A Primer” to get your health care facts straight, as well as the JAMA and NEJMA articles. I’m not arguing that anyone should have a free ride when it comes to health care. But I AM arguing that everyone should have fair access to the health care system, and shouldn’t be excluded on the basis of pre-existing conditions, nor by the fact that they’ll be bankrupted by the corporately-inflated cost of care.

You and I do agree on two points, however: 1) Americans do a terrible job of taking care of themselves, and are partly to blame for their terrible health. And 2) “There are no easy answers, but until all parties involved start looking at issues from new points of view, nothing will truly improve.” Rather than read the biased kind of reporting I found at the Business and Media Institute, I hope you’ll look at the raw data, as I have, and come to a sensible realization: that health care needs drastic reform, and that corporations and free market capitalism won’t provide it. Corporations and capitalism still will play a role, but so must the government – via regulation, incentivization, and perhaps a public option, if not a more socialist solution. Capitalism has had a chance up until now, and it has failed us. As I cited in one of my posts, we have deplorable health statistics in the US when compared to a comparative set of similar countries. And yet, we spend more than $7,000 per capita per year on health care. That is more than $2,000 more than any other country in the comparative set, and more than triple some. The take home message is thus: We spend the most, and achieve the least. Conversely, other countries spend far less, and yet are far healthier. That’s a mandate for drastic change if I’ve ever heard one, and it makes the argument with economics…a language clearly up your alley. Whether you’re a free market capitalist, or a socialist, or somewhere in between, it’s hard to argue with the numbers. And if we look to the success stories – the other countries in the comparative set – they’ve done it with heightened government involvement and something of a public option, and they’ve made a compelling economic argument for it, to boot, which makes it hard for the free market capitalists to refute.

Cheers, Pete

Cheryl Doyle-Ruffing said...

Pete,

Since defending myself in a manner up to your standards would take more time than I am willing to expend, I won't bother. It is simply not worth it to me. I apologize for taking up so much of your time, commend you on your journalistic standards, and wish you well.

peterbronski said...

Hi Cheryl,

Thanks for your follow up note. I can appreciate your interest in simply putting the debate to rest.

My detailed response to your comment was motivated by several factors. The length and detail of your original comment, I felt, deserved the courtesy of a detailed response (rather than a short and dismissive acknowledgement of your comment). Your comment also included several invitations for me to read the sources you cited. I accepted that invitation, and also took it as an implied invitation to react to the information contained in both your comments and the sources you provided. And then of course there's my background as a journalist. Challenging people's claims and holding them up against "the facts" is partly what I do. When I compared your arguments and source material with the raw data, peer-reviewed journal articles, respected reports, etc., I saw glaring discrepancies. Others may disagree with my conclusions (Others may agree. I think it'd be interesting, and possibly illuminating, for others to chime in on this discussion as well). Never the less, when I weighed the arguments and the information, I felt compelled to offer my rebuttal.

While it seems we disagree (deeply, in places) on this issue, I do also firmly believe our exchange has been valuable. We haven't simply sat in polarized positions, lobbing superficial claims and knee jerk reactions at one another. Instead, your detailed challenge to my original posts, and my challenge to your comments, cause us each to revisit our position on the issue, to critically evaluate a differing perspective, and to assimilate new information into our viewpoint. Whether either one of us was swayed by the exchange I can't say. But the mere fact that the exchange took place was a good thing.

Cheers, Pete

Cheryl Doyle-Ruffing said...

Pete,

Thank you for your thoughtful response. I, too, am glad the discussion took place, as I welcome the opportunity to look at important issues from new points of view. I'm afraid I did a poor job of getting my points across, but homeschooling the oldest four of my six kids (aged 4 months to 13 years), leaves me with little time for research or writing. It is, however, a sacrifice I am very willing to make.