Biostatisticians track two rates in most of their studies. Mortality, or death and Morbidity or illness.

The week before labor day was not kind to Wonks Anonymous. Thinking to escape the pressures of his work, he took a week in Tahoe with spouse and child at a relative's cabin. While he was there his general tendency to abuse tea and his neglect of his electrolyte balance landed him in the Emergency Room of Barton Memorial Hospital late Friday morning before Labor Day with a sudden and quite shocking attack of vertigo.

Wonks Anonymous, and the EMT's, thought that this might be a heart attack but, thanks be, the immediate problem seems to have been a potassium deficiency. Several hours later he checked out of the ED promising the doctor that he would arrange a follow up with his own doctor. He would like to thank Dr. Stillwell and the excellent staff at the Barton ED for their care and the quality of their practice. He would also like to thank Dr Hsu and Dr. Cooper of the Permanente Medical group for their great follow up care. Things are not dire but one test leads to another and lifestyle changes are definitely in order.

Note to Cat. It is not serious and I have started a diet. Wish me luck

Enough about Wonks Anonymous, there is a policy point here. After all of the ED excitement was over and Wonks Anonymous was waiting to see if he could look forward to a night in the hospital, he began to contemplate what this incident would have meant to someone who did not have excellent, employer provided, group health insurance.

Suppose that Wonks Anonymous was covered by a High Deductible Individual Policy, the sort of policy that Senator McCain thinks that we all should have, except that Senators and war heroes should get better coverage.

As a savvy consumer, sitting in the South Tahoe library and feeling like he was about to pass out, Wonks Anonymous would have known two things:

• An Ambulance trip and ED visit would probably cost him and his family well over $1,000.  There goes the rent.
• An ED visit for possible heart problems would,  given Wonks Anonymous age and other characteristics, certainly result in a significant increase in the insurance premiums on his family policy. It might even put him into one of those 'assigned risk pools' that John McCain seems to think will take care of us.

Given the impact of an ED visit on his family finances, it is likely that Wonks Anonymous would have sought out a couch in the library and tried to tough it out. If he had recovered he might also be likely to avoid follow up treatment that might have led to expensive tests and - through a possible diagnosis of heart disease - to expensive increases in insurance rates.

Medicine tells us two things about Heart Disease: When a person has a heart attack, fast treatment saves lives and reduces disability and, the earlier a person obtains care for heart disease, the longer their healthy life expectancy.

High Deductible Individual Policies are designed to discourage people from seeking medical care. It does not require evil liberal intent to predict that these policies will discourage sick people from seeking needed care in a timely manner. This will result in unneeded deaths and disabilities.

Wonks Anonymous is sure that the great majority of the people who are pushing for policies that put some of the insured's skin in the game, do not mean this term literally and do not believe that the adoption of High Deductible Individual Policies will result in significant harm. Most of us need to believe that we are good people, people who would not let another human being die or suffer grave injury if they could stop it. If they did not think so they wouldn't be able to look in the mirror in the morning.

Wonks Anonymous does not understand how these people could possibly believe that the policies that they are advocating are harmless. This is not rocket science folks. It is a simple, logical consideration of an individual's response to strong financial incentives. I don't know what Mr. Holtz-Eakin learned in his economics classes but I used to teach this type of analysis in all of my principles classes.

Maybe that explains the beard.