purplerat wrote:

OlivierK wrote:
The study does not count any death in isolation, it compares death rates over subsets of populations. If uninsured and insured drop dead at the same rates from asymptomatic aneurysms, then the methodology will, contrary to your claims, not inflate the numbers for deaths associated with being uninsured. Your criticism is based on implicit premises which anyone who understands the methodology of the study can see are false. You've made a claim that is partly wrong, and partly "not even wrong".

Edit: to put it another way, 45,000 is not the number of deaths from amenable causes amongst the uninsured. It's the number of deaths amongst the uninsured over and above the number you'd expect if the uninsured had the same mortality rates as the insured.

But OS was addressing a comment which did say that those 45000 people were dying because they can't afford insurance.

Teague wrote:
As I understand it, yes. It's 45000 a year dying because they can't afford to pay for medical care.

is the person you need to explain the study to.

Quote mining me I see with another idiotic post. Is there a problem going on here or do you just say "fuck it" and throw intelligence out the window. Your post has been reported for quotemining.

I quoted your response to a direct question about your claim that people were "dying in droves". Here's the full context with the pertinent parts highlighted.

Teague wrote:

Acetone wrote:

Teague wrote:

willhud9 wrote:

People are dying in droves?

123.28 people a day - I'd cal lthe droves.

Is that the number of people dying without medical care of medically treatable illnesses because they couldn't afford it?

As I understand it, yes. It's 45000 a year dying because they can't afford to pay for medical care. This was the figure that was given when a senator or congressman was asking the question about how many people in Canada die. They didn't have the figures (because it wasn't relevant as the discussion was about US healthcare) so the response was "I don't know but I do know 45,000 people die each year in the US" - I'm paraphrasing heavily.

Don't be getting all pissy because you run around here making idiotic comments all day then actually get called out on them.

purplerat wrote:

OlivierK wrote:
The study does not count any death in isolation, it compares death rates over subsets of populations. If uninsured and insured drop dead at the same rates from asymptomatic aneurysms, then the methodology will, contrary to your claims, not inflate the numbers for deaths associated with being uninsured. Your criticism is based on implicit premises which anyone who understands the methodology of the study can see are false. You've made a claim that is partly wrong, and partly "not even wrong".

Edit: to put it another way, 45,000 is not the number of deaths from amenable causes amongst the uninsured. It's the number of deaths amongst the uninsured over and above the number you'd expect if the uninsured had the same mortality rates as the insured.

But OS was addressing a comment which did say that those 45000 people were dying because they can't afford insurance.

Teague wrote:
As I understand it, yes. It's 45000 a year dying because they can't afford to pay for medical care.

is the person you need to explain the study to.

Well, that's pretty much exactly what the study says: if the uninsured had the same mortality rates as the insured, there would be 45,000 less early deaths from conditions amenable to treatment per year. The study controlled for other variables so that it could calculate the effect attributable to uninsuredness. It was much higher before controlling for socioeconomic factors. If you want to nitpick, the study didn't attribute the extra mortality to not being able to afford health iinsurance, just not having health insurance. Teague has smuggled in the premise that people don't have health insurance primarily because they can't afford it. That's pretty defensible, in my opinion, but that's your only real avenue of complaint, as far as I can see. Beyond that, he's just stating the results of the study. Have you read it?

If it were my study, the next thing I'd look at was mortality from conditions amenable to treatment amongst those who had insurance, specifically whether it correlated with higher deductibles and/or lower income. I'd imagine those for whom deductible payments represented a larger proportion of their disposable income would have worse health outcomes. Don't know what sort of data's available for that, though.

I'm not sure where the pushback here is coming from. It's hardly controversial to note that lower access to healthcare leads to worse health outcomes. All this study is doing is quantifying a known phenomenon.

Thanks. I didn't read the study so if that's the case I'm not sure where the pushback is coming from either or why I'm being reported for quoting mining Teague saying exactly that, lol.

And just clearing up another odd conflation of OldSkeptic's:

The study doesn't say that US rates of amenable early mortality are 40% higher than other countries, it says that US rates of amenable mortality amongst the uninsured are 40% higher than US rates of amenable mortality amongst the US insured. Given the fact that the USA's total numbers include both groups, you'd expect a total national performance less than 40% worse than UHC countries.

The fact that the US is fully 40% worse than the average of other countries is cause to look for further factors, such as poor outcomes for the insured due to access issues like high deductibles, issues relating to other known risks such as poverty rates and greater income inequality, diet, exercise levels, and so forth.

OlivierK wrote:And just clearing up another odd conflation of OldSkeptic's:

The study doesn't say that US rates of amenable early mortality are 40% higher than other countries, it says that US rates of amenable mortality amongst the uninsured are 40% higher than US rates of amenable mortality amongst the US insured. Given the fact that the USA's total numbers include both groups, you'd expect a total national performance less than 40% worse than UHC countries.

Your averaging the 15 countries to get 69.26 amenable deaths makes no sense, since adding the 96 of the US to the other 15 returns an average only 1.67 higher at 70.93.

If you're going to average all the rest then to get an accurate picture you have to include the US.

The valid comparisons are country to country and legitimate questions are brought up when doing so. Such questions as to why the UK has ~32% higher deaths amenable to health care than France and Australia? All three have well run universal health care systems, or so I'm told. The differences between France/Australia and Finland, Germany, Greece, Ireland, New Zealand, Denmark, and the UK are greater than the differences between the US and any of those countries. So, "What's going on?" is a legitimate question.

Given these differences among these fifteen wealthy countries, all with some form of universal health care, I can't see how anyone can simply say that the problem in the US is because of lack of universal health care. If the US is a joke then compared to France and Australia seven of the other thirteen are also somewhat of a joke and they should being doing better.

OlivierK wrote:The fact that the US is fully 40% worse than the average of other countries is cause to look for further factors, such as poor outcomes for the insured due to access issues like high deductibles, issues relating to other known risks such as poverty rates and greater income inequality, diet, exercise levels, and so forth.

I've got a present for you and all others that want to cling to that 40% higher risk and that 45,000 deaths from lack of health insurance number. Or rather I should say that Richard Kronick and Health Service Research Journal does:

Richard Kronick wrote:

"Abstract

Objective. To improve understanding of the relationship between lack of insurance and risk of subsequent mortality.

Data Sources. Adults who reported being uninsured or privately insured in the National Health Interview Survey from 1986 to 2000 were followed prospectively for mortality from initial interview through 2002. Baseline information was obtained on 672,526 respondents, age 18–64 at the time of the interview. Follow-up information on vital status was obtained for 643,001 (96 percent) of these respondents, with approximately 5.4 million person-years of follow-up.

Study Design. Relationships between insurance status and subsequent mortality are examined using Cox proportional hazard survival analysis.

Principal Findings. Adjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline (hazard ratio 1.03, 95 percent confidence interval [CI], 0.95–1.12). Omitting health status as a control variable increases the estimated hazard ratio to 1.10 (95 percent CI, 1.03–1.19). Also omitting smoking status and body mass index increases the hazard ratio to 1.20 (95 percent CI, 1.15–1.24). The estimated association between lack of insurance and mortality is not larger among disadvantaged subgroups; when the analysis is restricted to amenable causes of death; when the follow-up period is shortened (to increase the likelihood of comparing the continuously insured and continuously uninsured); and does not change after people turn 65 and gain Medicare coverage.

Conclusions. The Institute of Medicine's estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect. It is not possible to draw firm causal inferences from the results of observational analyses, but there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.

Note: At the time of this study the uninsured rate stood at 16% to 20% and now since ACA the uninsured rate stands at ~11% and the 45,000,000 and growing uninsured in the last paragraph of the study now stands at ~35,000,000 and dropping.

Note: The 2009 Wilper study included 9,004 individuals and 351 deaths and the Kronick study included 643,001 individuals and 23,657 deaths.

Note: From Kronick's study "It is not possible to draw firm causal inferences from the results of observational analyses"

Note: The 2009 Wilper study never mentions causes amenable by health care and the Kronick study limits itself to deaths from amenable causes. Exactly what I was talking about with things like asymptomatic aneurysms. "[M]any causes of death cannot be prevented by better health care. I reestimate the basic model, but limit the causes of death to causes thought to be amenable to better health care."

Yes, as I said in the post that you're quoting, there are clearly more factors worsening US performance in amenable mortality than uninsuredness alone could explain. The impact of uninsuredness is a hard thing to isolate, and it's not surprising to have some studies show a large impact, and others smaller. Both seem well done, but it's not an exact science.

"What's going on?" is indeed a legitimate question, which I gave my answer to last time you asked it. If you want my personal opinion, not based on data but on anecdotal experience derived in part from talking to American doctors, the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

OlivierK wrote: the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

So do you think if these underinsured were taken into account in the Kronick approach amenable deaths would go up? Kronick has to be missing something because it's hard to believe lack of access to healthcare has no impact.

OlivierK wrote:Yes, as I said in the post that you're quoting, there are clearly more factors worsening US performance in amenable mortality than uninsuredness alone could explain. The impact of uninsuredness is a hard thing to isolate, and it's not surprising to have some studies show a large impact, and others smaller. Both seem well done, but it's not an exact science.

Both do not seem to be well done to me. Only one does. I had my misgivings when first reading in the 2009 Wilper study that their very high results were derived from only 351 deaths over eleven years. And on reading that the survey team was composed of people with strong connections to PNHP and two of the members were co-founders of that organization my misgivings were compounded.

OlivierK wrote:"What's going on?" is indeed a legitimate question, which I gave my answer to last time you asked it. If you want my personal opinion, not based on data but on anecdotal experience derived in part from talking to American doctors, the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

And in my opinion, not based on personal anecdote, is that people promoting European style, or Scandinavian style, or Canadian, or UK, or Australian style universal health care as the end all and be all of solutions to a higher mortality rate in the US are, as the saying goes, ignoring the elephant in the room. Obesity in the US. I don't think that it's a coincidence that on this chart 7 of the 8 nations that with the lowest mortality rates are among the nations with the lowest rates of obesity; under 10%. And that 4 out of 6 of the nations with the highest mortality rates are among the nations with the highest rates of obesity; above 20%.

Obesity in the US from 1960 - 2012.


Obesity is linked to 7 of the top ten causes of death in the US.

The issue with the US system vs a universal health care system isn't really about mortality rates, or how many lives could be saved, or even general health for that matter, it's an economic issue and it should be about health insurance reform as much or more that getting everyone covered by some kind of insurance. Because not only do the 11% that are still not covered by some kind health insurance after ACA face financial rack & ruin because of catastrophic illness or injury, so do quite a lot of the 89% that are covered by policies with 20% deductibles and that allow for limits and or cancellations.

@Oldskeptic

Obesity is not an elephant in the room.

Compare France which has lowest rate of mortality amendable to healthcare with the US.

Based on World Health Organisation (WHO) data published in 2014, 23.9% of French adults (age 18+) were clinically obese with a body mass index (BMI) of 30 or greater. The data showed the incidence of obesity in French women in 2014 was 24.0% and among French men 23.8%. Overall adult obesity rates in France were significantly ahead of the Netherlands at 19.8%, Germany at 20.1% and Italy at 21.0%, but behind the United Kingdom and the United States at 28.1% and 33.7% respectively.

https://en.wikipedia.org/wiki/Obesity_in_France

So you would expect if obesity was this major block in that statistic that France would technically be worse off than Germany or the Italy on the chart with Mortality Amendable to Healthcare.

Wilbur wrote:

OlivierK wrote: the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

So do you think if these underinsured were taken into account in the Kronick approach amenable deaths would go up? Kronick has to be missing something because it's hard to believe lack of access to healthcare has no impact.

Kronick tested his results by pretty much every way applicable that he could think of (something that Wilper didn't do) and the results were the same. He shortened the reporting time periods, he divided it into age groups, he separated ethic groups, he extended his study past medicare age and the results where the same; no appreciable difference in mortality rates between insured and uninsured. And found no significant differences between the insured and the uninsured when those with low income, low levels of education, those not in the labor force, those in poor health, and those who are smokers where selected out and examined as subgroups.

Given that, I can't think of a reason for being under insured having a more significant affect than being uninsured.

Thinking that Kronick must be missing something does a disservice to a man that had been doing this kind of research for 17 years at the time of his study, and set out to settle the matter. A well respected professional in his field that did everything he could to get to the truth and that admitted that the results of his study were counterintuitive and not what he exspected, but Kronick put his personal incredulity aside in favor of evidenced results.

Your personal incredulity means nothing when it comes to Kronick's results. And he didn't say that not being insured had no impact. Not being insured or being under insured has impact on quality of life just not on risk of mortality. Kronick wrote as his last paragraph:

"The results of this work strongly suggest that arguments in favor of universal coverage should not focus on the beneficial effects of that policy on the life expectancy of the currently uninsured. It makes more sense to turn the question on its head and ask, “What benefits are there to our economy or our society from a system that allows 45 million Americans (and growing) to be without coverage?” A set of well-worn arguments in economics considers the tradeoffs between equity and efficiency, noting that policies that increase equity often do so at the cost of efficiency. But the American health insurance conundrum stands these arguments on their head—by most standards we have the most inefficient health care system in the developed world, as well as the most inequitable (Garber and Skinner 2008). Achieving universal coverage in the context of a more sensible and equitable system of health care financing will not magically solve the problems of inefficiency or reduce the unsustainable growth rate of health care expenditures, but arguably would be a good start."

Oldskeptic wrote:

OlivierK wrote:Yes, as I said in the post that you're quoting, there are clearly more factors worsening US performance in amenable mortality than uninsuredness alone could explain. The impact of uninsuredness is a hard thing to isolate, and it's not surprising to have some studies show a large impact, and others smaller. Both seem well done, but it's not an exact science.

Both do not seem to be well done to me. Only one does. I had my misgivings when first reading in the 2009 Wilper study that their very high results were derived from only 351 deaths over eleven years. And on reading that the survey team was composed of people with strong connections to PNHP and two of the members were co-founders of that organization my misgivings were compounded.

OlivierK wrote:"What's going on?" is indeed a legitimate question, which I gave my answer to last time you asked it. If you want my personal opinion, not based on data but on anecdotal experience derived in part from talking to American doctors, the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

And in my opinion, not based on personal anecdote, is that people promoting European style, or Scandinavian style, or Canadian, or UK, or Australian style universal health care as the end all and be all of solutions to a higher mortality rate in the US are, as the saying goes, ignoring the elephant in the room. Obesity in the US. I don't think that it's a coincidence that on this chart 7 of the 8 nations that with the lowest mortality rates are among the nations with the lowest rates of obesity; under 10%. And that 4 out of 6 of the nations with the highest mortality rates are among the nations with the highest rates of obesity; above 20%.

Obesity in the US from 1960 - 2012.


Obesity is linked to 7 of the top ten causes of death in the US.

The issue with the US system vs a universal health care system isn't really about mortality rates, or how many lives could be saved, or even general health for that matter, it's an economic issue and it should be about health insurance reform as much or more that getting everyone covered by some kind of insurance. Because not only do the 11% that are still not covered by some kind health insurance after ACA face financial rack & ruin because of catastrophic illness or injury, so do quite a lot of the 89% that are covered by policies with 20% deductibles and that allow for limits and or cancellations.

Well, definitely don't get universal health care then. Whew! You dodged a bullit there!

Oldskeptic wrote:
Thinking that Kronick must be missing something does a disservice to a man that had been doing this kind of research for 17 years at the time of his study,

You doubt the great kronick? How dare you!

Wilbur wrote:

OlivierK wrote: the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

So do you think if these underinsured were taken into account in the Kronick approach amenable deaths would go up? Kronick has to be missing something because it's hard to believe lack of access to healthcare has no impact.

It's something that would need to be tested. But as I said, if there are access problems amongst both the insured and the uninsured, then that will reduce the difference in mortality outcomes between the two groups due to poor access.

As for obesity, yes, it's a factor in the US's poor outcomes. But Australia has obesity rates not a long way behind the US, so pinning your hopes on obesity being the silver bullet seem sillier even than trying to pin it all on uninsuredness. Clearly, there are many factors combining to produce the result, and the US is on the wrong end of most of them.

OlivierK wrote:
It's something that would need to be tested. But as I said, if there are access problems amongst both the insured and the uninsured, then that will reduce the difference in mortality outcomes between the two groups due to poor access.

It seems failing to account for that would skew the findings as much as not controlling for obesity or smoking. There's quite a lot of people underinsured in the US -

31 Million People Were Underinsured in 2014; Many Skipped Needed Health Care and Depleted Savings to Pay Medical Bills
Forty-two percent of people who were insured all year and had incomes below 200 percent of the federal poverty level ($22,980 for an individual, $47,100 for a family of four) were underinsured in 2014, compared with 49 percent in 2010.

Oldskeptic wrote:

Wilbur wrote:

OlivierK wrote: the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

So do you think if these underinsured were taken into account in the Kronick approach amenable deaths would go up? Kronick has to be missing something because it's hard to believe lack of access to healthcare has no impact.

Kronick tested his results by pretty much every way applicable that he could think of (something that Wilper didn't do) and the results were the same. He shortened the reporting time periods, he divided it into age groups, he separated ethic groups, he extended his study past medicare age and the results where the same; no appreciable difference in mortality rates between insured and uninsured. And found no significant differences between the insured and the uninsured when those with low income, low levels of education, those not in the labor force, those in poor health, and those who are smokers where selected out and examined as subgroups.

Given that, I can't think of a reason for being under insured having a more significant affect than being uninsured.

Neither can I, which is why didn't suggest such a thing. Uninseredness restricts access, so does underinsuredness. So maybe the scales are in balance because there's a finger on both sides.

And before you go off on (another) one, I'm not saying that that's what's going on, I'm saying that's what I'd be investigating if I had appropriate data.

Willie71 wrote:

Oldskeptic wrote:

OlivierK wrote:Yes, as I said in the post that you're quoting, there are clearly more factors worsening US performance in amenable mortality than uninsuredness alone could explain. The impact of uninsuredness is a hard thing to isolate, and it's not surprising to have some studies show a large impact, and others smaller. Both seem well done, but it's not an exact science.

Both do not seem to be well done to me. Only one does. I had my misgivings when first reading in the 2009 Wilper study that their very high results were derived from only 351 deaths over eleven years. And on reading that the survey team was composed of people with strong connections to PNHP and two of the members were co-founders of that organization my misgivings were compounded.

OlivierK wrote:"What's going on?" is indeed a legitimate question, which I gave my answer to last time you asked it. If you want my personal opinion, not based on data but on anecdotal experience derived in part from talking to American doctors, the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

And in my opinion, not based on personal anecdote, is that people promoting European style, or Scandinavian style, or Canadian, or UK, or Australian style universal health care as the end all and be all of solutions to a higher mortality rate in the US are, as the saying goes, ignoring the elephant in the room. Obesity in the US. I don't think that it's a coincidence that on this chart 7 of the 8 nations that with the lowest mortality rates are among the nations with the lowest rates of obesity; under 10%. And that 4 out of 6 of the nations with the highest mortality rates are among the nations with the highest rates of obesity; above 20%.

Obesity in the US from 1960 - 2012.


Obesity is linked to 7 of the top ten causes of death in the US.

The issue with the US system vs a universal health care system isn't really about mortality rates, or how many lives could be saved, or even general health for that matter, it's an economic issue and it should be about health insurance reform as much or more that getting everyone covered by some kind of insurance. Because not only do the 11% that are still not covered by some kind health insurance after ACA face financial rack & ruin because of catastrophic illness or injury, so do quite a lot of the 89% that are covered by policies with 20% deductibles and that allow for limits and or cancellations.

Well, definitely don't get universal health care then. Whew! You dodged a bullit there!

Not being a starry eyed idealist I got off a train going nowhere sometime ago. I've always been for a UK style health care system, but I don't think it's ever going to happen in the US; There's too much opposition for such a sweeping change. I think that comprehensive healthcare insurance reform is achievable or at least has a lot better chance of becoming a reality and ACA is a reality. The former needs to be began, maybe one reform at a time, the latter needs improvement and expanding, and the high/exorbitant costs of the medical care in the US need to be reined in.

My Idea is that with a system with affordable healthcare insurance premiums, no deductibles, no cancellation, no exclusions for existing conditions, reasonable healthcare costs, and something like the ACA as a safety net that a US system would be indistinguishable from some systems that are labeled "universal". It's not what you want to call it that matters, it's the results.
For me the "universal" means everyone is covered and no one is going to be financially strapped in paying healthcare premiums or financially ruined because of injury or illness, that's what's important.

Wilbur wrote:

Oldskeptic wrote:
Thinking that Kronick must be missing something does a disservice to a man that had been doing this kind of research for 17 years at the time of his study,

You doubt the great kronick? How dare you!

Well, I'd put his 17 years of experience in "understanding the causes and consequences of lack of insurance, on the development and implementation of risk-adjusted payment systems designed to encourage insurers to develop systems of care that are responsive to the needs of the most vulnerable, and on design and evaluation of health care financing interventions" and commitment to throughness up against your incredulity every time.

OlivierK wrote:

Wilbur wrote:

OlivierK wrote: the US has problems with healthcare accessibility that go beyond uninsuredness; in particular many insured are still deterred from elective/preventive doctor visits by their plan's deductible.

So do you think if these underinsured were taken into account in the Kronick approach amenable deaths would go up? Kronick has to be missing something because it's hard to believe lack of access to healthcare has no impact.

It's something that would need to be tested.

It has been, in Kronick's study. One of the controls is for income, and the largest factor, if not the defining factor, in determining under insurance is low income. So, that playing field was leveled.

"Lack of insurance may have no effect on survival probabilities for the entire population, but might matter for those who are most vulnerable. I estimate the basic model in Table 3 on subsets of the population—respondents with low income, low levels of education, those not in the labor force, those in poor health, those who are smokers, those who are 50–64 years at baseline—and find no significant effect of insurance among any disadvantaged subset(Table S4)."

OlivierK wrote:But as I said, if there are access problems amongst both the insured and the uninsured, then that will reduce the difference in mortality outcomes between the two groups due to poor access.

Only if it is not accounted/controlled for, which it was. And since the differences between the two groups has already been reduce effectively to zero how much more do you think it could be reduced?

OlivierK wrote:As for obesity, yes, it's a factor in the US's poor outcomes. But Australia has obesity rates not a long way behind the US, so pinning your hopes on obesity being the silver bullet seem sillier even than trying to pin it all on uninserdness. Clearly, there are many factors combining to produce the result, and the US is on the wrong end of most of them.

As you've said there are many factors and given that, there will be outliers. Pointing to Australia as you did as a high obesity nation with a low number for amenable deaths, or Germany as Willhud did for low obesity and high amenable mortality doesn't nullify the general pattern of the higher the obesity rate the higher the probability of higher rates of death due to amenable to health care and vice versa.

Australia may have a high obesity rating and a low mortality rate, but not nearly an obesity rate as high as the US. What we have in the US is the highest obesity rate among "wealthy" nations and the highest mortality rate due to amenable healthcare. The UK has the 2nd highest obesity rate and is 3rd highest in mortality rates. That says something about obesity having an large effect on high mortality rates.

Japan with the lowest obesity rate has the 2nd lowest mortality rate. France with the 6th lowest obesity rate out of thirty nations has the lowest mortality rate. In every nations there are unique mitigating and aggravating factors so there is not, and will not be, any one to one correlations of lowest-lowest, highest-highest, or middle to middle, but the pattern remains.

With obesity being linked strongly to the #1 cause of death in the US, and at least somewhat to six of the other top ten causes of death in the US, denying that bringing down the obesity rate significantly could put the US mortality rate more in line with other "wealthy" nations is denying the facts. Obesity, that is at ~35% in the US, standing alone returns a control factor of +1.26 over normal weight at 1.0.