RomneyCare Didn’t End Medical Bankruptcies

Surprise surprise. Getting everyone insurance is not enough to eliminate medical bankruptcies. (h/t Susie)

To gauge whether healthcare reform in Massachusetts had eased bankruptcies, the researchers looked at a random sample of Massachusetts bankruptcy filers in July 2009, sending surveys to almost 500 households. They compared their results to national and Massachusetts data collected in 2007, before the Massachusetts reform was implemented in 2008.

They found that while the percentage was down slightly, medical bills still contributed to 52.9% of all bankruptcies in the state. Absolute numbers of medical bankruptcies were up by a third. Total bankruptcies in Massachusetts went up 51% between 2007 and 2009.

Families still faced substantial medical debt, they wrote, because healthcare costs continued to rise.

Who could have known?

Lucky for us we may never get to the point where national health care reform fails to prevent medical bankruptcies, since the TeaPartiers seem intent on crashing our economy but good because they don’t think the US should have to pay for Bush’s unfunded wars.

BoGlo Proclaims RomneyCare Successful at Transferring Wealth from Consumers to Big Health Care

Okay, I’m getting ahead of myself.

The central thesis of this Boston Globe article is not, in fact, that RomneyCare effected a wealth transfer from consumers to big health care.

Rather, the article proclaims that RomneyCare “achieved its main goals.” But nowhere in the 4,600+ word article does it treat “ensuring MA residents get access to health care” as one of RomneyCare’s goals. Instead, it reports on RomneyCare’s great success at ensuring MA residents get health insurance. And given the article’s admission that the cost of the program is unsustainable, the distinction is critical.

Particularly given two of the article’s more interesting details. First, there’s this passage, which makes it clear that the health insurance exchanges have done little to lower health insurance costs for small businesses.

What group is most unhappy about the changed health care landscape in Massachusetts?

Small business owners, in a landslide.

“I’d give it an ‘A’ for access and an ‘F’ for cost and small business fairness,’’ said Jon B. Hurst, president of the Retailers Association of Massachusetts. “We were supposed to get rid of the free care pool and get all these young folks insured, and that was going to bring costs down.

“Instead, what we did was a wealth shift from consumers and small businesses to big health care in the state, which is not a surprise given who was pushing the bill all along — the biggest hospital chain and the biggest insurer,’’ Hurst said, referring to Partners HealthCare and Blue Cross Blue Shield of Massachusetts.

Partners, because of its market clout and ability to negotiate higher rates from insurers, has been blamed by some for helping to drive up medical costs. The company has said its prices reflect the complexity of care provided by its physicians and teaching hospitals.

The retailers association surveys of its 3,200 members showed a 15 percent average increase in recent years in insurance premiums — a ruinous long-term trend.

Plans offered to small businesses through the connector offer no greater savings than those in the broader commercial market and are limited to a few smaller insurers, said Hurst.

Dick Powers, spokesman for the connector, said in an e-mail: “The value proposition we bring to the table is the ability for small businesses to easily shop on our website and make apples-to-apples comparisons among the plans.’’ [my emphasis]

Dick Powers sounds an awful lot like Ezra Klein, now backing off the claim that exchanges do anything to lower costs to the consumer. And the problem is one that exists at the national level: sufficient concentration such that the big players can use mandates as an opportunity to jack up costs on captive consumers.

Note too Hurst’s suggestion that part of the problem is that the free care pool has not, as promised, been eliminated. BoGlo admits there’s some funny accounting on this front: while RomneyCare supporters claim the cost of providing care to the uninsured has dropped $236 million or 36%. hospitals and state fine print say it has dropped only around $111 million or 17%.

Has the overhaul reduced, as predicted, the quantity and cost of so-called free care provided at safety-net hospitals and health centers?

Yes, but the numbers are rising again.

Before the new law, the cost of treating the uninsured was $656 million in fiscal 2006, a report by the office of administration and finance says. This year it’s carried on the state’s balance sheet at a projected $420 million, which makes it look like there has been a significant drop in this costly category of care.

But it leaves a false impression.

The Massachusetts Hospital Association says those figures do not reflect all the costs they absorb by treating uninsured patients. The real cost was $70 million more last year and about $120 million more this year, they say.

In the fine print of its budget submissions, the Patrick administration estimated the Health Safety Net fund shortfall, which hospitals must absorb, at between $100 million and $125 million this fiscal year and between $100 million to $150 million next. The shortfall represents the cost of services to the uninsured beyond the available funds in the account, which is largely financed by hospitals and insurers with smaller amounts from the state and federal governments.

The full cost of treating the uninsured, if the hospital group’s estimates are accurate, is more like $540 million this year and $580 million next, and slightly less if the administration’s numbers are on target. In either case, it’s a lot more than the $420 million supporters of the law often point to as evidence of the program’s success.

And the total is growing, for reasons not fully understood, though state officials believe the effects of the weak economy have had a significant impact.

If RomneyCare brought the number of uninsured from 530,000 or 6.4% of MA’s total population down to 120,000 or 1.9% (these numbers don’t add up because BoGlo cites different stats here)–if RomneyCare succeeded in getting three-quarters of the uninsured insurance–then shouldn’t the cost of treating the “uninsured” go down more than 17% (even admitting that the remaining uninsured may have the highest medical costs)?

Or is it possible that some of the confusion arises when hospitals provide free care to those with insurance who can’t afford to pay for necessary care–as we know is the case for a substantial number of MA residents?

Because if that’s the case, then in addition to giving small businesses a mandate but little help in keeping that mandate affordable, RomneyCare also forces people to use their last disposable income to pay insurance companies, while still forcing hospitals to treat those people without full compensation, which in turn means others still have to make up for the hospitals’ shortfall.

Again, I don’t know whether that’s what is going on. I don’t know how MA accounts for the care provided to people who have insurance but can’t afford to pay for health care (remember, though, that the bulk of these people are still just forgoing medically necessary care).

But it seems like so long as you have a mandate but measure success solely by whether or not people have insurance, than you are going to end up with a wealth transfer to big health care without, at the same time, ensuring people can actually get health care.

Solicitor General Email FOIA Shows White House Stunt Fail

In all the government shutdown, nuclear meltdown and Libya war of choice news dominating the media landscape the last couple of weeks, a completely juicy little tidbit was pried out of the Obama Administration by a right wing news outfit – and almost nobody picked up on it.

CNSNews, the cyber division of the Brent Bozell run right wing Media Research Center, has scored a bit of a coup with the acquisition of a set of FOIA documents from the Solicitor General’s office partially detailing the unusual grooming of Elana Kagan to ascend to the Supreme Court. The 66 pages of documents are fascinating and offer a unique and rare glimpse into the backstage machinations in the SG Office. The FOIA CNSNews issued was targeted almost solely at the great whale the Ahab like conservative right are pursuing, the Affordable Healthcare Act they unaffectionately refer to as “ObamaCare”.

Here is the thing, why would the Administration agree to turn over the emails? They are almost surely protected within the ambit of deliberative privilege exemption commonly recognized for the Executive Branch. Indeed, the first time CNSNews requested the records, the request was flatly rejected, back on June 22, 2010. But, the Administration, on its own, reconsidered, sought slight clarification and, finally, on March 15 of this year, delivered the FOIA records to CNSNews. The response letter from the Solicitor General’s office facially states that they would have been well within their rights to so withhold, but “it would be appropriate to release significant portions of such records requested as a matter of agency discretion”.

Uh huh. Experts in such matters were shocked. Kannon Shanmugam, a veteran of the SG’s office now with Williams & Connolly, stated (subscription may be required):

…the documents represent “an unusual if not unprecedented” look at the office’s operations. “It raises concerns about chilling lawyers in the office in the conduct of their work, and gives an incentive not to put things down in emails.

Indeed that would be seemingly very sound analysis. So, why did the Obama Administration give up the goods? For that, a quick look at what the emails depict, and what the FOIA asked for is necessary. As the FOIA search terms and parameters indicate, CNSNews was looking for instances of Elana Kagan’s Read more

Chris Smith Opposes IRS Enforcement on Undeclared $$, But Supports IRS Enforcement on Undeclared Babies

Chris Smith co-sponsored HR 4, which would overturn the provision of health care reform that required all businesses to issue 1099 forms for goods and services in excess of $600. The whole point of the 1099 provision was designed to crack down on unreported business income. Given Smith’s support for overturning the provision, we have to assume that he opposes the use of IRS to track and police undeclared business income.

Yet Smith authored HR 3, which deputizes the IRS to police abortion funding.

In testimony to a House taxation subcommittee on Wednesday, Thomas Barthold, the chief of staff of the nonpartisan Joint Tax Committee, confirmed that one consequence of the Republicans’ “No Taxpayer Funding for Abortion Act” would be to turn IRS agents into abortion cops—that is, during an audit, they’d have to detemine, from evidence provided by the taxpayer, whether any tax benefit had been inappropriately used to pay for an abortion.


“Were this to become law, people could end up in an audit, the subject of which could be abortion, rape, and incest,” says Christopher Bergin, the head of Tax Analysts, a nonpartisan, not-for-profit tax policy group. “If you pass the law like this, the IRS would be required to enforce it.”

No wonder our government has such a big deficit. Republicans want to alter our entire tax code to police wombs, but not pocketbooks.

Why Not Monopolize the Term “for Prevention”?

Eight years ago I went to a conference for young breast cancer survivors. It was pretty useful to be around a bunch of other women who, like me, had been diagnosed with breast cancer in their twenties and thirties. It was also useful to hear doctors who had actually thought about things like long term survival and fertility.

But the most memorable–and creepy–part of the conference was the way they referred to us, the survivors, as “customers.” They explained they did it to emphasize the active role we had in deciding our own treatment. But since the conference was sponsored, in part, by a bunch of drug companies selling a bunch of obscenely expensive drugs, I found the term really disturbing.

In addition to the drug companies, Susan G. Komen Foundation sponsored the conference.

And so it is with great interest that I read HuffPo’s report on Susan G. Komen foundation beating up smaller non-profits–at a price tag of almost a $1 million a year–for using the phrase “for the cure.”

In addition to raising millions of dollars a year for breast cancer research, fundraising giant Susan G. Komen for the Cure has a lesser-known mission that eats up donor funds: patrolling the waters for other charities and events around the country that use any variation of “for the cure” in their names.

So far, Komen has identified and filed legal trademark oppositions against more than a hundred of these Mom and Pop charities, including Kites for a Cure, Par for The Cure, Surfing for a Cure and Cupcakes for a Cure–and many of the organizations are too small and underfunded to hold their ground.


“It’s never our goal to shut down a nonprofit,” [Komen General Counsel Jonathan Blum] said, “and we try very hard to be reasonable, but it’s still our obligation to make sure that our trademarks are used appropriately so there’s no confusion in the marketplace over where people’s money is going.”

Blum told HuffPost that legal fees comprise a “very small part” of Komen’s budget, but according to Komen’s financial statements, such costs add up to almost a million dollars a year in donor funds.


Michael Mercanti, an intellectual property lawyer, said he is surprised by the large number of oppositions Komen has filed against other charities–a number he would expect from a company like Toys”R”Us or McDonalds, but not a charitable fundraising organization. [my emphasis]

It’s perverse enough that Komen is wasting donor money on protecting its brand from other people trying to combat cancer.

Think about the even more perverse aspect of this: if you wanted a really superb brand, wouldn’t it be better to own “preventing” cancer rather than “curing” it? Wouldn’t the really noble goal be preventing women, people generally, from having to undergo the life-threatening “cures,” along with all the other unpleasantness, in the first place?

But I guess that wouldn’t leave open all the lucrative partnerships with drug companies. I guess that wouldn’t be compatible with selling women on the idea that to survive cancer they must be savvy customers.

Team Auto Never Talked to Team Healthcare Reform

In Steven Rattner’s book, he describes newly elected Barack Obama asking his advisors “Why can’t [the US automakers] make a Corolla?” Implicitly, of course, he was asking “why can’t they make a Corolla in the United States.” His economic advisors, according to Rattner, admitted they didn’t know: “We wish we knew.”

The correct answer to the question would point to a number of things. Executive stupidity would be one important cause. Legacy costs would be another. Market structure and profitability requirements would be another. Weak branding would be another. You could even–pointing to the Ford Focus–argue that one of “them” can make a Corolla, or something reasonably competitive.

But one of the factors that partially explains why American manufacturers can’t make a Corolla would be healthcare costs. (With Toyota’s move of the Corolla-based Matrix production to Canada, you could even argue that Toyota can’t make a Corolla anymore, not here, anyway, even putting aside the quality problems the Corolla has had of late.)

Now, back on the campaign trail, Obama admitted that healthcare is one of the things that makes our companies less competitive. And in his big address to Congress on healthcare on September 9, 2009, Obama even singled out the auto industry as one which our exorbitant healthcare costs made less competitive internationally.

Then there’s the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren’t any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It’s why so many employers – especially small businesses – are forcing their employees to pay more for insurance, or are dropping their coverage entirely.

It’s why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally – like our automakers – are at a huge disadvantage.

Which is why I was surprised to see no discussion about healthcare (as opposed to VEBA, the fund the UAW now uses to pay for retiree healthcare) in Rattner’s entire book.


It seemed odd to me that, at a time when our country was rethinking our healthcare system, and at a time when the government was spending a boatload of money to try to make our auto companies competitive again, the teams pursuing those initiatives wouldn’t at least touch base, to test whether healthcare even addressed the problems that contributed to the automakers difficulties.

So I asked Rattner during the book salon.

emptywheel: Aside from a technical discussion of VEBA (for those not familiar, that’s the fund that the Big 2.5 negotiated with the UAW, which the UAW now uses to pay health benefits for retirees, which was a critical issue during negotiations), there was virtually no discussion of health care costs and the way that contributes to profitability (or lack thereof) for car companies that manufacture in the US, as reflected most obviously in Toyota’s repeated decisions to source from Canada because it offers the best mix of highly skilled workers and affordable health care.

Is that in fact right? No one talked about the burden health care costs put on manufacturing in his country during the bailout? I find that particularly shocking given that the bailout took place at the time when all the policy decisions on health care reform took place, and if anything, health care reform will make manufacturing health care costs worse.

Rattner: I wasn’t involved in the broader discussions about health care reform, nor am I a health care expert. We were certainly aware of the burden that health care costs put on the Detroit 3, but the creation of the VEBA’s solved that problem with respect to the retirees.

emptywheel: Right. But in all your coversations [sic] with Geithner and Summers and Rahm, was there honestly never a discussion about health care? No comment about ways the health care reform could have been formulated to contribute to the success of the bailout (and, more importantly, make sure that the effort ended up keeping the jobs that were saved in the US).

Rattner: No. There simply wasn’t time.

I understand the time constraints of all this. Though one of the parts of healthcare reform that will most directly affect the automaker healthcare costs, in a bad way, is the excise tax, and that wasn’t finalized until months after Rattner left government, which left five months for him to remind his buddies in the White House that their plan for healthcare was not going to bring down costs for US manufacturing companies, and it might well make them higher. Furthermore, it seems like an important enough issue–given the investment in both programs–to make time to address this issue.

Then again, I guess the healthcare team was too busy talking to Pharma to make time to talk to manufacturing.

“You Lie!”

I spent a good part of a book beating up on George Bush for lying in an address to Congress in an effort to generate support for a policy that was being challenged on the merits.

So while I’m not suggesting that protecting a secret deal with health insurance companies is as despicable as starting a war of choice by crafting careful lies to Congress–it’s nowhere close–when I read BT’s piece…

We now know that the White House, in secret negotiations with industry lobbyists, quietly killed the public option in July 2009. But when the President gave a nationally-televised, joint address to Congress on September 9, 2009, he implied that the public option was still on the table.

…an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up. […]

It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight.

… I couldn’t help but remember Joe Wilson’s accusation, right in the middle of that address to Congress, “You lie!” Wilson got the individual assertion wrong, but he called the theater for what it was.

All of which, in turn, reminded me of discussions noting that the bloggers who were most supportive of Obama’s health care reform were the same bloggers who had been most credulous about Bush’s claim for the necessity of war with Iraq.

Again, just on the basis of expanding Medicaid to millions of new people and smart changes to Medicare, there’s absolutely no comparison between Obama’s health care reform with the merits of the war Bush was pushing with his lies.

But it does make me wonder why this theater ever works at all anymore, as Presidents continue to taint their once-cherished soap boxes with false statements that quickly become exposed as such.

About that “Fuck the UAW” Tax

In honor of Steve Rattner’s revelation that Rahm Emanuel wandered around during the auto bailout saying “fuck the UAW,” I’ve renamed the “Cadillac tax” the “Fuck the UAW” tax.

Which is appropriate timing given that the Kaiser Family Foundation is out with a study today they should have done during the health care debate, showing that employers have been shifting health care costs onto employees.

The premiums that employees pay for employer-sponsored family coverage rose an average of 13.7 percent this year, while the amount that employers contribute fell by 0.9 percent, the survey found.

For family coverage, workers are paying an average of $3,997, up $482 from last year, while employers are paying an average of $9,773, down $87, according to the survey by the Kaiser Family Foundation and the Health Research & Educational Trust.

The best part of the WaPo coverage, though, are the quotes from KFF President Drew Altman playing dumb.

“Many employers looked into their recession survival kit and seem to have concluded that one way to make it through the recession and hang on to as many employees as possible was to pass on their health premium increases to their employees this year,” Kaiser Family Foundation President Drew Altman said by e-mail.

How much, if at all, the federal health-care overhaul enacted in March will restrain cost increases over the long run remains to be seen. While experts debate its likely impact, the legislation is “the only thing we have coming on line as a country to control costs other than what now seems like the primary default strategy in the private sector – shifting costs to people,” Altman said.

You see, the trend of employers shifting costs onto employees was readily apparent last year, when Jonathan Gruber and the Administration and health care reform boosters were using MagicMath to claim that not only would the “Fuck the UAW” tax save money, but that workers would end up with higher wages.

In fact, this behavior has been going on for decades, and it is precisely what the Fuck the UAW tax is designed to incent: boosters—some funded by the KFF–routinely argued that if employers passed more costs onto employees, they would become more sensitive to cost, and use less care (the entire debate sidestepped the question of whether incenting less care was useful, particularly for those with chronic conditions), thereby lowering health care costs overall. And this hocus pocus logic is–aside from laudable changes to Medicare delivery–the biggest cost “savings” in the health care reform bill. But the KFF poll appears to undercut the assumptions that went into the bill (notably, that employees would benefit from this scam).

And KFF President Drew Altman has the audacity to say that the health insurance reform bill is “the only thing we have coming on line as a country to control costs other than what now seems like the primary default strategy in the private sector – shifting costs to people,” without admitting that one of the biggest cost control strategies in the health insurance reform bill is to shift costs to people!

Ah well. An Administration whose Chief of Staff wanders around saying “Fuck the UAW” probably doesn’t consider union members real people anyway.

Former WellPoint VP Liz Fowler to Implement Health Care Oversight

Remember Liz Fowler? The former WellPoint VP whom William Ockham noted was the literal author of the health care reform bill?

I’m sure you’ll be thrilled to learn that WellPoint’s former VP will be in charge of consumer issues and oversight as our country implements the WellPoint/Liz Fowler health insurance bill. (h/t Glenn Greenwald)

Liz Fowler, a key staffer for U.S. Sen. Max Baucus who helped draft the federal health reform bill enacted in March, is joining the Obama administration to help implement the new law.Fowler, chief health counsel for the Senate Finance Committee, which Baucus chairs, will become deputy director of the Office of Consumer Information and Oversight at the U.S. Department of Health and Human Services.

“Liz Fowler is an extremely knowledgeable and dedicated adviser, and while I’m very proud of her new position, she will certainly be missed at the committee,” Baucus said in a statement Tuesday.


Obama and fellow Democrats have been promoting what they say are positive aspects of the reform bill, while the Health and Human Services Department is drafting many rules to implement to complex measure.

So Liz Fowler, WellPoint’s gal, will be writing the rules implementing the law (the rules that will determine whether this is a worthless bill or a decent one), particularly those designed to protect (cough) consumers and oversee companies like…WellPoint.

This is the kind of “oversight” that resulted in the BP disaster.

And remember Obama’s lobbyist restrictions? The ones that prevent someone from working in the Executive Branch on an issue that they’ve lobbied Congress on for two years? Fowler was not a registered lobbyist; rather, she was the VP of Public Policy and External Affairs. But in any case, it appears that Fowler returned to MaxTax Baucus’ staff on March 4, 2008, so nothing prevents the former VP of WellPoint from writing the “consumer and oversight” rules that are the only thing protecting Americans from policies — like WellPoint’s — that screw consumers.

It’s a nice trick: send your VP to write a law mandating that the middle class buy shitty products like yours, then watch that VP move into the executive branch to “oversee” the implementation of the law. What could go wrong?!?!

Cancer, Chemicals, and Corporations

As you might know, my family is a walking cancer cluster: three out of five of us had some form of cancer. What has frustrated me as I’ve lived through three bouts of cancer in my family was the cancer industry’s focus on “curing cancer,” with very little attention on preventing it. Particularly given how dangerous the “cures” for cancer are, it’s high time we focused more attention on how we avoid it.

Which is why I’m happy that this report from the President’s Cancer Panel is getting a good deal of attention. It talks about all the environmental hazards that may contribute to cancer, devoting an entire chapter exploring each of six kinds of exposures that may contribute to cancer:

  • Exposure to Contaminants from Industrial and Manufacturing Sources
  • Exposure to Contaminants from Agricultural Sources
  • Environmental Exposures Related to Modern Lifestyles (things like automobile pollution, airplane travel, and cell phones)
  • Exposure to Hazards from Medical Sources
  • Exposure to Contaminants and Other Hazards from Military Sources (pointing to 900 abandoned military sites that are Superfund sites)
  • Exposure to Environmental Hazards from Natural Sources (things like radon and naturally occurring arsenic)

But as the report notes, one of the reasons Americans are exposed to so many potentially carcinogenic materials is that our regulatory system doesn’t work.

The prevailing regulatory approach in the United States is reactionary rather than precautionary. That is, instead of taking preventive action when uncertainty exists about the potential harm a chemical or other environmental contaminant may cause, a hazard must be incontrovertibly demonstrated before action to ameliorate it is initiated. Moreover, instead of requiring industry or other proponents of specific chemicals, devices, or activities to prove their safety, the public bears the burden of proving that a given environmental exposure is harmful. Only a few hundred of the more than 80,000 chemicals in use in the United States have been tested for safety.

U.S. regulation of environmental contaminants is rendered ineffective by five major problems: (1) inadequate funding and insufficient staffing, (2) fragmented and overlapping authorities coupled with uneven and decentralized enforcement, (3) excessive regulatory complexity, (4) weak laws and regulations, and (5) undue industry influence. Too often, these factors, either singly or in combination, result in agency dysfunction and a lack of will to identify and remove hazards. [my emphasis]

It elaborates in the expanded section on regulation to talk about regulatory capture.

Like many other industries, the U.S. chemical, manufacturing, mining, oil, agriculture, transportation/shipping, and related industries are substantial political contributors and actively lobby legislators and policymakers on issues that affect their operations and revenue. For example, corporations aggressively block proposed chemical manufacturing, use, and disposal regulation, both through lobbying activities and in some cases, by manipulating knowledge about their products (e.g., industry-funded research).115,116 Although the Doll and Peto assessment of attributable fractions of the national cancer burden related to specific causes has been largely abandoned by the scientific community, it remains the basis of many existing chemical regulations and policy. The chemicals industry in particular likewise continues to use the notion of attributable fractions to justify its claims that specific products pose little or no cancer risk. As a result of regulatory weaknesses and a powerful lobby, the chemicals industry operates virtually unfettered by regulation or accountability for harm its products may cause.

This report came from the President’s Cancer Panel, in a report telling Obama the shortcomings of our National Cancer Program. And it said that while there are a number of other controllable factors contributing to cancer (most notably smoking), we’re simply not doing enough to even investigate these other possible causes of cancer.

With the BP spill, we’re entering into a big discussion about whether our oil and gas habit is really safe and–more importantly–whether we even try to regulate it effectively. But at the same time, we ought to be having a wider discussion of the many ways (including our oil and gas addiction) that our modern lifestyles lead to cancer.