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Tags health care issues , maternal mortality , Texas issues , Texas politics

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Old 23rd August 2016, 08:47 AM   #41
marplots
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Originally Posted by ponderingturtle View Post

The trick is stopping thinking of texas as part of the developed world. It really is a pretty decent third world nation.
Are we on to anchor babies now? I suppose, if illegal immigration was high enough, Texas might have to be bumped into another category.
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Old 23rd August 2016, 09:01 AM   #42
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Originally Posted by marplots View Post
Are we on to anchor babies now? I suppose, if illegal immigration was high enough, Texas might have to be bumped into another category.
No it is more the effort to reduce american citizens to that level.
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Old 23rd August 2016, 09:05 AM   #43
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Originally Posted by Ziggurat View Post
Indeed. From the article:

"At the same time, Texas eliminated all Planned Parenthood clinics – whether or not they provided abortion services – from the state program that provides poor women with preventive healthcare. Previously, Planned Parenthood clinics in Texas offered cancer screenings and contraception to more than 130,000 women."

Cancer screenings and contraception. Neither of these things is prenatal care. Why would they significantly impact maternal mortality rates? The women at most risk of cancer are older, and not likely to be pregnant, so that impact should be negligible. A lack of contraception may increase pregnancy rates among vulnerable populations, but in order to double the mortality rate, you would have to more than double the pregnancy rate among such a population. That would be quite remarkable, and I would expect evidence of such an increased pregnancy rate to be easy to find if it's responsible. So did such a rise occur?

A doubling of the maternal mortality rate is definitely something to be concerned about, but without evidence for the cause (and this study doesn't provide any), it's illogical to simply try to blame your political opponents. Not only is that unfair, but if something else is responsible (like the spread of an infectious disease), then attacking the wrong cause can get people killed.
I think the part I highlighted is incorrect. If the maternal mortality rate is calculated as how many mothers die vs. all mothers, the number of pregnancies wouldn't affect the rate. It would affect the raw numbers, but not the ratio.

Or am I being too kind in supposing the newspaper accounts did the math correctly? If they just took the number of maternal deaths in the state without regard to the number of pregnancies, that would be a fundamental error - one I doubt an honest researcher would make.
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Old 23rd August 2016, 09:16 AM   #44
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Reducing the number of clinics for maternal care would only make sense if the pregnancy numbers would drop by the same percentage.

Otherwise you will always be left with (expecting) mothers unable to get care if you reduce access to clinics.

John Oliver highlighted some of the weirdest things on the subject in:
https://www.youtube.com/watch?v=DRauXXz6t0Y

Often, real abortion clinics are replaced by so-called Crisis pregnancy centers (CPCs), that fake being actually clinics but are staffed by non-professionals. So it's no wonder that women die if they think they are going to get medical help, but are in fact brainwashed by anti-abortion fanatics.
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Old 23rd August 2016, 09:52 AM   #45
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Originally Posted by marplots View Post
I think the part I highlighted is incorrect. If the maternal mortality rate is calculated as how many mothers die vs. all mothers, the number of pregnancies wouldn't affect the rate. It would affect the raw numbers, but not the ratio.
That's why the bit about vulnerable populations matter. The mortality rate for a poor 16 year old is probably different than for a rich 28 year old. If pregnancy rates go up uniformly, then sure, the rate won't change, but if they go up unevenly, it could.

But I don't see how you can get a doubling of the rate this way. For example, suppose that ALL maternal mortality was due to some small (say, 5%) subset of mothers. If we double the pregnancy rate for that subset, we double the total mortality, but only increase the total pregnancies a bit, and that will almost double the maternal mortality rate.

But of course, the maternal mortality rate isn't that concentrated, which means that you'd have to do a lot more than double the pregnancy rate among your higher risk population to get a doubling of the maternal mortality. And I just don't see that as even remotely realistic.

Quote:
Or am I being too kind in supposing the newspaper accounts did the math correctly?
You're being too kind in supposing the newspaper did any math at all. They probably got the rates directly from their source, and never even tried to do any calculations with them.
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Old 23rd August 2016, 10:01 AM   #46
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Originally Posted by The Great Zaganza View Post
Reducing the number of clinics for maternal care would only make sense if the pregnancy numbers would drop by the same percentage.

Otherwise you will always be left with (expecting) mothers unable to get care if you reduce access to clinics.
It's not that simple. Maternal care isn't only provided through clinics, it's also provided through hospitals. Isn't it strange that in a report about clinics and maternal care, there is no information about how much care those clinics actually provide? Isn't it strange that the two forms of clinic care explicitly mentioned in the article are not maternal care? If clinics were providing, say, 80% of maternal care, then closing half the clinics is going to have a much larger impact than if clinics were providing, say, 20% of maternal care. And has the closing of clinics led to any increase in hospital-provide care? Or has that stayed static? Who the hell knows?

There are a ton of questions which one would need to answer in order to evaluate this problem objectively, and the source provides answers to almost none of them.
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Old 23rd August 2016, 11:12 AM   #47
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dup
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Old 23rd August 2016, 11:13 AM   #48
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Quote:
Indeed. From the article:

"At the same time, Texas eliminated all Planned Parenthood clinics – whether or not they provided abortion services – from the state program that provides poor women with preventive healthcare. Previously, Planned Parenthood clinics in Texas offered cancer screenings and contraception to more than 130,000 women."

Cancer screenings and contraception. Neither of these things is prenatal care. Why would they significantly impact maternal mortality rates?

<snip>

Maybe because those aren't the only services which the clinics offer, but rather just two which the article happened to mention?

Just a guess, mind you.
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Old 23rd August 2016, 11:23 AM   #49
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Originally Posted by quadraginta View Post
Maybe because those aren't the only services which the clinics offer, but rather just two which the article happened to mention?

Just a guess, mind you.
I'm sure they weren't the only services. But why mention two non-natal services in an article nominally about prenatal care issues? At best, that's sloppy reporting.
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Old 23rd August 2016, 12:30 PM   #50
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Originally Posted by Ziggurat View Post
I'm sure they weren't the only services. But why mention two non-natal services in an article nominally about prenatal care issues? At best, that's sloppy reporting.

In general I suspect sloppy reporting may be more the norm than the exception.

I try not to let that mislead me too much.
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Old 24th August 2016, 12:02 AM   #51
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Originally Posted by ponderingturtle View Post
Well the idiots at the World health organization seem to think that health care can reduce maternal morality rates, but that is all lies I am sure...
In that case, I can understand why the bible bashers want to reduce health care.
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Old 24th August 2016, 04:49 AM   #52
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Originally Posted by Foolmewunz View Post
If "illegals" was the cause, then your state would be right up there. California has almost double the number of illegal immigrants as Texas. Yet the maternal mortality rate in CA actually went down over the same period as Texas' skyrocketed.

Hmmm? If only there was some other correlation? El Nino? Continental drift?

It's really rather pathetic. Thailand has no national health program to speak of but because they attacked infant mortality a couple of decades ago, along with that comes "maternal mortality". Thailand has a lower rate of maternal mortality than Texas does.

Guys..... Guys!!!! We are the third world over here.
I know correlation is not causation, but this likely proves that infant mortality is lowered by hot Asian chicks, spicy food and bad pop music.
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Old 24th August 2016, 05:30 AM   #53
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Originally Posted by Ziggurat View Post
Indeed. From the article:

"At the same time, Texas eliminated all Planned Parenthood clinics – whether or not they provided abortion services – from the state program that provides poor women with preventive healthcare. Previously, Planned Parenthood clinics in Texas offered cancer screenings and contraception to more than 130,000 women."

Cancer screenings and contraception. Neither of these things is prenatal care. Why would they significantly impact maternal mortality rates? The women at most risk of cancer are older, and not likely to be pregnant, so that impact should be negligible. A lack of contraception may increase pregnancy rates among vulnerable populations, but in order to double the mortality rate, you would have to more than double the pregnancy rate among such a population. That would be quite remarkable, and I would expect evidence of such an increased pregnancy rate to be easy to find if it's responsible. So did such a rise occur?

A doubling of the maternal mortality rate is definitely something to be concerned about, but without evidence for the cause (and this study article that may or may not quote properly from the study doesn't provide any), it's illogical to simply try to blame your political opponents. Not only is that unfair, but if something else is responsible (like the spread of an infectious disease), then attacking the wrong cause can get people killed.
FTFY.

Or have you read the original paper? It's behind a paywall. You may have access when you're accredited at a university or otherwise work scientifically. I have no access, and don't want to pay the prices they charge.

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Old 24th August 2016, 05:55 AM   #54
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Assuming causation, how much money was saved? Dos the cost/benefit analysis come out in favour of the cuts?
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Old 24th August 2016, 06:25 AM   #55
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Originally Posted by 3point14 View Post
Assuming causation, how much money was saved? Dos the cost/benefit analysis come out in favour of the cuts?
Good question. Add to that the additional efficiency of cremating babies in bulk.

Why resort to cumbersome ethics when one could simply use a spreadsheet?
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Old 24th August 2016, 07:08 AM   #56
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Originally Posted by Eddie Dane View Post
Good question. Add to that the additional efficiency of cremating babies in bulk.

Why resort to cumbersome ethics when one could simply use a spreadsheet?

I'm a bleeding heart liberal, on a US scale I'm so far to the left as to have fallen off the scale.

However, we can and must only have those ethics we can afford. As an extreme example, if all of those mothers that died could have been saved but at a cost per taxpayer of USD10,000 would you still think we don't need the spreadsheet?

A financial calculation is fundamental to the apportioning of healthcare.
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Old 24th August 2016, 07:14 AM   #57
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Other states seem to manage without going bankrupt.
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Old 24th August 2016, 07:16 AM   #58
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Originally Posted by 3point14 View Post
I'm a bleeding heart liberal, on a US scale I'm so far to the left as to have fallen off the scale.

However, we can and must only have those ethics we can afford. As an extreme example, if all of those mothers that died could have been saved but at a cost per taxpayer of USD10,000 would you still think we don't need the spreadsheet?

A financial calculation is fundamental to the apportioning of healthcare.

Were all of the clinics which were closed supported through taxes?

Most of them?

Any?
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Old 24th August 2016, 07:16 AM   #59
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Originally Posted by 3point14 View Post
I'm a bleeding heart liberal, on a US scale I'm so far to the left as to have fallen off the scale.

However, we can and must only have those ethics we can afford. As an extreme example, if all of those mothers that died could have been saved but at a cost per taxpayer of USD10,000 would you still think we don't need the spreadsheet?

A financial calculation is fundamental to the apportioning of healthcare.
I'd be pretty appalled if we are letting people die over a measly $10,000. Thats dirt cheap compared to many life saving treatments and operations.

ETA: and a big nevermind. I see you said per taxpayer.

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Old 24th August 2016, 07:18 AM   #60
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Originally Posted by The Great Zaganza View Post
Other states seem to manage without going bankrupt.

Yes. I imagine the cost-benefit analysis would show (if causation is a factor) that the lives lost saved very little money.

I'd still like to see the calculation though.
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Old 24th August 2016, 07:20 AM   #61
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Nevermind
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Old 24th August 2016, 07:47 AM   #62
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Do we know how many of the clinics that closed offered pre-natal care? Planned Parenthood doesn't offer it at every location. One stat I found is they provided prenatal care to 18684 women in 2013. Assuming about 4 million patients a year, that's less than 1%. The other big name in the news stories about the closings was Whole Women's Health. According to their website they don't offer prenatal care.

Community Health centers offer prenatal care as do hospitals. Were they closed as a result of the laws?
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Old 24th August 2016, 07:59 AM   #63
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Originally Posted by Peterson View Post
Do we know how many of the clinics that closed offered pre-natal care? Planned Parenthood doesn't offer it at every location. One stat I found is they provided prenatal care to 18684 women in 2013. Assuming about 4 million patients a year, that's less than 1%. The other big name in the news stories about the closings was Whole Women's Health. According to their website they don't offer prenatal care.

Community Health centers offer prenatal care as do hospitals. Were they closed as a result of the laws?
I kind of like the "abortions for high-risk pregnancies" as a provisional explanation, although "giving birth control to women who shouldn't get pregnant" also sounds plausible.
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Old 24th August 2016, 08:13 AM   #64
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Originally Posted by marplots View Post
I kind of like the "abortions for high-risk pregnancies" as a provisional explanation, although "giving birth control to women who shouldn't get pregnant" also sounds plausible.
I don't think there's a definite number but I've seen figures around 1-2% of abortions are to save the life of the mother (no idea what percentage of that percentage live in TX). Would that account for a doubling of deaths? Whatever the percentage is, some would have been able to get an abortion either at a clinic that didn't close, at a hospital, or going out of state. You can still get abortions and contraception in Texas.

Has the closure of clinics caused an increase in still births, low birth weight, or death in newborns?
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Old 24th August 2016, 11:26 AM   #65
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Originally Posted by marplots View Post
I kind of like the "abortions for high-risk pregnancies" as a provisional explanation
Do the numbers make sense?

Quote:
although "giving birth control to women who shouldn't get pregnant" also sounds plausible.
No, it's not plausible. That's what my whole discussion about pregnancy rates was about.
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Old 24th August 2016, 12:58 PM   #66
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It is more than likely many factors, but the defunding and closings of the clinics have a very, very plausible connection. It simply doesn't have to account for all of the increase to be condemnable.
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Old 24th August 2016, 01:32 PM   #67
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Originally Posted by Ziggurat View Post
Do the numbers make sense?
I don't have access to the relevant data, so consider it a wild guess on my part.

Quote:
No, it's not plausible. That's what my whole discussion about pregnancy rates was about.
I disagreed with your analysis. However, my second "plausible" is also a wild guess, so I'm unwilling to do much to defend it. The best I could do is make it work mathematically.
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Old 24th August 2016, 01:41 PM   #68
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IIRC, the numbers went up from 18/100,000 to 36/100,000/ Umm, per 100,000 live births? or pregnancies? Is it possible that there is some kind of accounting going on- fewer clinics to keep track of things distorts the numbers? Or something to skew the definition of "maternal death"- pregnant women suiciding/car accidents /ODing? There were only 78 additional deaths per year...

Double reporting? Doc reports one death, hospital reports same death, total is TWO?
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Old 24th August 2016, 01:53 PM   #69
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Originally Posted by marplots View Post
I don't have access to the relevant data, so consider it a wild guess on my part.
As far as I can tell, nobody has any data that would point to causation. All of the speculation is wild guesses.
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Old 24th August 2016, 01:59 PM   #70
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Originally Posted by tyr_13 View Post
It is more than likely many factors, but the defunding and closings of the clinics have a very, very plausible connection. It simply doesn't have to account for all of the increase to be condemnable.
Does it have to account for *any* of the increase to be condemnable?
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Old 24th August 2016, 02:06 PM   #71
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Originally Posted by theprestige View Post
Does it have to account for *any* of the increase to be condemnable?
No.
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Old 24th August 2016, 02:06 PM   #72
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It might not be direct services from the clinics, but a gatekeeper effect. Community-based clinics might have been referring based on risk factors instead of treating directly. Screening is an important function too.
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Old 24th August 2016, 04:36 PM   #73
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I just wanted to pop in and tell you all that Texas is really not that bad. It's a big state and there a lot of people here. We have our fair share of idiots.

Did I also mention we have no state income tax?
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Old 25th August 2016, 05:49 AM   #74
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Originally Posted by Eddie Dane View Post
I know correlation is not causation, but this likely proves that infant mortality is lowered by hot Asian chicks, spicy food and bad pop music.
As does spending money on medical services...

Originally Posted by 3point14 View Post
Assuming causation, how much money was saved? Dos the cost/benefit analysis come out in favour of the cuts?
As I pointed out previously the cuts were US$73.6M. I've leave you to do the CBA.
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Old 26th August 2016, 08:33 AM   #75
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Here's another article about this:

Maternal Mortality in Texas Is a "National Embarrassment"

It doesn't point to a single cause. Drug overdoses are the 2nd most common cause of maternal death. Suicide is up there as will I believe. Basically, it's more complicated than blaming the clinics closing (which happened in 2012-2013).

A couple highlights:

Quote:
The lack of health insurance—Texas has the largest number of uninsured people in the country and has rejected Medicaid expansion under the Affordable Care Act—could be contributing to maternal deaths and near-deaths, task force members said. "If a person had been in regular care, maybe those cardiovascular [problems] would have been identified" before the mother died, said June Hanke, a strategic analyst and planner at the Harris Health system in Houston who advocated the creation of the task force and is now a member. Without insurance, "if you need medication, can you really afford it? Do you even know your blood pressure is high?"
Quote:
The task force did not study whether the family planning cuts in the 2011-12 legislative session—largely aimed at Planned Parenthood but affecting other providers as well—might have triggered the spike in mortality. But other analysts doubted the cuts were to blame, noting that they took effect in late 2011 and 2012, after maternal deaths had already started to rise.
Health insurance should be free for pregnant women with no questions asked. When my friend got pregnant (in MA) she got insurance for free with absolutely no hassle. I don't understand why anybody would find free pre-natal care objectionable. There is also a medical shortage across the U.S. that has nothing to do with abortion clinics. It's across the board.
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Old 26th August 2016, 09:25 AM   #76
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Originally Posted by Peterson View Post
I don't understand why anybody would find free pre-natal care objectionable.

Because, somewhere, a tax would have to go up or another service become defunded. Taxation is very, very unpopular in the US and, I'd hazzard a guess, even more so in Texas.
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Old 26th August 2016, 09:55 AM   #77
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Originally Posted by TheGoldcountry View Post
Who hates Texas? The OP is actually bemoaning the fact that there may be a reason maternal mortality rate is rising.

My favorite novel (Lonesome Dove) is (partly) set in Texas.
I agree that it's not about hating Texas, even if some of us do. It is a problem by Texas' own admission. The Mother Jones article points out that Texas set up a task force to deal with it so there's no denying that there is a problem that needs to be solved. Also, the rates are up across the U.S so it appears to be nationwide, at least to some extent.

Personally I'm interested in this because I wasn't sure how I felt about the anti-abortion laws Texas passed. I lean towards being in favor of them but want to know if there was a negative effect (besides abortion becoming more difficult to obtain, that's okay with me). I am very curious how many of the clinics that closed offered pre-natal care.

My uneducated opinion is that it is caused by lack of health insurance, shortage of hospitals/clinics, lack of mental health care, and drug abuse.
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Old 26th August 2016, 09:58 AM   #78
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Originally Posted by Ziggurat View Post
ponderingturtle and shemp. But you're right, the two minute hate isn't just about Texas, it's also about Republicans.



No, it's not. Tony isn't interested in why the rate is rising, he's only interested in using it as a rhetorical bludgeon.
Step back a minute. if you think everything they say is just "I hate Texas and Republicans!" you need a break.
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Old 27th August 2016, 11:23 PM   #79
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Originally Posted by tyr_13 View Post
The point here is that regardless of Tony's beliefs about Republicans, Republican initiated and backed actions by Texas likely contribute to the poor health and deaths of it's citizens while claiming to be doing the exact opposite.
But you don't have any actual evidence to back up that speculation. Not that evidence is needed to support an article of faith.

Quote:
Tony isn't the only poster in this thread,
What part of "I admit to some hyperbole with many of the posters" did you not understand?

Quote:
and him being hateful doesn't make him wrong about all this.
And this is exactly the sort of stuff I've been complaining about. The environment here is hostile to conservatives, and you don't care. I used to think you were better than Tony, but you aren't, not really, which is why you'll never call him out for his behavior.
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Old 27th August 2016, 11:25 PM   #80
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Originally Posted by Ziggurat View Post
But you don't have any actual evidence to back up that speculation. Not that evidence is needed to support an article of faith.
Well.. there is that spike in mortality thing....
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