Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Healthcare’ Category

Best healthcare system in the world

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Canadian mother finds what US medicine is like when she gets a $1 million bill for a childbirth. (Had she been in Canada, her bill would have been $0: socialized medicine.) You’ll note that the insurance company found a way to avoid paying anything: that’s what insurance companies try to do. They’re in business to make money, not help the insured. They will help if there’s no way around it, but if there is a way, you won’t see them for dust.

Written by LeisureGuy

19 November 2014 at 9:42 am

Posted in Business, Healthcare

Why Uber loves Obamacare

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Jason Millman has an interesting article in the Washington Post:

As Obamacare’s second-ever enrollment period getsunderway, the program has a big cheerleader in Silicon Valley: the chief executive of Uber, the ambitious ridesharing company that lets private car owners overnight become professional drivers.

Travis Kalanick, also a co-founder of Uber, said the health-care law has been “huge” for his business. By creating a functioning individual market for health insurance, people have more flexibility to pursue the jobs they want, Kalanick said.

“The democratization of those types of benefits allow people to have more flexible ways to make a living,” Kalanick said during a Friday night dinner for reporters, according to Buzzfeed. “They don’t have to be working for The Man.”

More than half of insured Americans still get their coverage through the workplace, though the rate has been declining over the past decade. Drivers for Uber are classified as independent contractors, so the company does not offer them insurance. 

Kalanick’s comments highlight one of the arguments that supporters of the Affordable Care Act make for the law. By making it easier and more affordable for people to buy health insurance coverage on their own, people won’t have to stay in jobs they don’t want just for the health benefits.

This concept is known as “job lock,” and we have some idea just how prevalent it is. About 27 percent of employees cited workplace health insurance as the main reason for staying in their jobs or not retiring, according to 2004 survey from the Employee Benefit Research Institute.  A 2008 Harvard Business School study found about 11 million people stayed in their jobs just for the health insurance.

For a company like Uber, this also isn’t just about people not having to stay in jobs they don’t like to get health care. It’s also about people being able to jobs they do like that don’t provide health care.

But there’s also flipside to Kalanick’s argument. . .

Continue reading.

Written by LeisureGuy

17 November 2014 at 10:45 am

Posted in Business, Healthcare

Two important notes for anyone renewing Obamacare coverage

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Actually important information, from Kevin Drum. Bottom line: don’t just hit “Renew”; shop around again: things may have changed. More at the link.

Written by LeisureGuy

15 November 2014 at 10:14 am

Posted in Government, Healthcare

People Who Use Obamacare Sure Do Like It

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Kevin Drum posts the good news on Obamacare.

Written by LeisureGuy

14 November 2014 at 12:21 pm

Posted in Government, Healthcare

What the Ebola failures reveal about the culture of America hospitals

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The common approach of American hospitals to errors is to deny and to defend—not an environment conducive to learning or continuous improvement. Bruce Lambert and Timothy McDonald write at Talking Points Memo:

Sometimes, when errors are egregious or there is intense media scrutiny, as in the case of the misdiagnosis and death of Texas Ebola patient Thomas Eric Duncan, hospitals eventually apologize and make financial settlements. But without media attention, routine harm resulting from errors still typically receives the “deny and defend” response.

Such behavior has failed to make the U.S. health care system safer or more humane for patients and families. The good news is better alternatives may now be available.

This past week’s announcement of President Barack Obama seeking $6.2 billion for Ebola-related funds from Congress — including $2.4 million for the U.S. Department of Health and Human Services — demonstrates that many feel the Ebola crisis will likely continue to stress the US healthcare system. In doing so, the situation will reveal many of its flaws and weaknesses.

Every day in every hospital in America, health professionals make mistakes that harm patients. The frequently cited estimate from the Institute of Medicine’s 1999 report on medical error was that 98,000 Americans die each year from medical errors. A 2013 estimate from the Journal of Patient Safety put the number of deaths due to preventable harm at 400,000, with perhaps 10-20 times more people being seriously but not fatally harmed.

From the perspective of patients and families, the typical hospital response prevents access to the truth. It also denies them a chance to tell their stories, denies them an apology when they deserve one, and denies them an opportunity to reach rapid and equitable out of court settlements.

Such an approach is anathema to learning and improving. It promotes secrecy about the individual and systemic causes of medical errors and substandard care, makes it impossible to identify and learn from patterns of error, and leaves us defenseless against present and looming health threats.

A 2010 study in the New England Journal of Medicine showed that . . .

Continue reading.

And contracts that that require binding arbitration (with the arbitrators selected and paid by the company—so guess how they rule) extend this “deny and defend” policy to nursing homes. Nicole Flatow writes in ThinkProgress:

Evan Press’ father was in a Fayetteville, Arkansas, nursing home for three months when he died. Press said he had a bed sore the size of his fist, and that an attendant says he was so dehydrated that he appeared not to have been given any liquid or food for four or five days, according to a report from local news station KARK.

The nursing home may dispute these allegations. But Press will never be able to hash it out in court, because his contract contained a boilerplate clause. The advent of contractual terms known as “arbitration clauses” seem particularly dry and obscure on their face. They’re about procedure, and contract law. But what they mean is that people like Press can’t hold companies accountable. Nursing homes are one of a number of industries in which arbitration clauses have become a standard for those pages-long contracts that customers and employees believe they have no choice but to sign. What they do is bind customers to take their case to a private arbitrator, rather than to court.

The arbitration hearing is private, so the nursing home won’t necessarily receive public reprisal for its actions. The arbitrator is not a government service, and has to be paid by somebody. Usually, it’s paid for by the company to handle its entire roster of cases, which could be one of several explanations for why arbitrators overwhelmingly side with these companies. Even when arbitrators do side with individuals, they are likely to get a much lower judgment than they would in court. And arbitration doesn’t come with any of the procedural protections that exist in court, including the right to appeal. So whatever they come up with is binding.

Clauses like this give companies such as a nursing home significantly less incentive to quash bad behavior. The same sort of disincentives apply to cell phone contracts, cable contracts, and others that you sign with large companies just to be their consumer. They also frequently apply to employees, who are denied judicial recourse for workplace abuse.

Couch went public with his case, because he wants others to know what the real-world effect is when individuals are unknowingly signing these contracts, even in cases where you are trusting a business with a relative’s live. “People just need to know when they’re signing that initial paperwork if something happens it’s going to arbitration. That’s the way the facilities want it, that’s not how it should be,” he told KARK.

Unfortunately for Press, the U.S. Supreme Court has been one of the greatest friends to these clauses. California tried to make its own state law saying some arbitration clauses are unconscionable and should not be enforced. The Roberts Court struck it down. Even small businesses tried to challenge an an arbitration clause that prevented them from challenging the alleged monopolistic practices of American Express. The Roberts Courtstruck that, too, over a dissent by Justice Elena Kagan that called the ruling a “betrayal of our precedents, and of federal statutes.”

A Consumer Financial Protection Bureau study found that arbitration clauses are even worse than they seemed. Because even though companies claim going to arbitration is easier and faster than filing a lawsuit, almost nobody goes to arbitration.

Congress could have reformed arbitration clauses with a bill known as the Arbitration Fairness Act. But that bill is even less likely to go anywhere in a Republican-controlled Congress.

There’s one other avenue for reform. . .

Continue reading.

Your credit card agreement, your telecom agreement—all dote on mandatory binding arbitration as the only allowable avenue. And company-paid arbitrators are standing by, ready to rule against you (regardless of the merits or facts of the case).

Written by LeisureGuy

14 November 2014 at 9:29 am

“The American Dream” as envisaged by Scott Walker: No healthcare

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Scott Walker has a peculiar idea of the American Dream: Tara Culp-Pressler writes at ThinkProgress:

Defending his fellow Republican governors’ decision to block Medicaid expansion in their states, Wisconsin Gov. Scott Walker (R) on Friday suggested that denying health coverage to additional low-income Americans helps more people “live the American Dream” because they won’t be “dependent on the American government.”

Walker has recently leveled some criticism at other GOP leaders for accepting Obamacare’s optional Medicaid expansion, saying they shouldn’t necessarily trust the government to come through with the federal funds to cover the policy. During an appearance on MSNBC’s Morning Joe on Friday, Walker was asked whether his position stemmed from an “ideological criticism,” and if he believes the handful of Republican governors implementing this provision of the health law are not “genuine conservatives.”

The governor didn’t explicitly answer that question, pointing out that every state has different needs. But he did offer a broader criticism of the public health program.

“Beyond that, I just ask the basic question: Why is more people on Medicaid a good thing?” he said. “I’d rather find a way, particularly for able-bodied adults without children, I’d like to find a way to get them into the workforce. I think ideologically, that’s a better approach, not just as a conservative, but as an American. Have more people live the American dream if they’re not dependent on the American government.”

In reality, however, the majority of people who stand to benefit from the Medicaid expansion are already in the workforce. According to the Kaiser Family Foundation, which has been closely tracking the policy effect of states’ decisions on this Obamacare provision, most of the people in this coverage gap are part of a demographic group known as the “working poor.” Two thirds of them are part of a family where someone is working, and more than half of them are working themselves — often in sectors like the agricultural and service industries, which have a history of failing to provide insurance benefits to their workers.

Last fall, the New York Times analyzed the data about the coverage gap and confirmed that the Americans being denied Medicaid are cashiers, cooks, nurses’ aides, waiters and waitresses, and janitors. Most of them are people of color, and many are single mothers. They don’t fit the conservative trope of the lazy individual who is overly dependent on the government programs — and, as the New York Times reported at the time, they are actually “the very kinds of people that the [Medicaid] program was intended to help.”

Nonetheless, 20 states have refused to move forward with the expansion. According to Kaiser’s latest estimates, about four million low-income people across the country currently fall into the coverage gap. If every state accepted the Medicaid expansion, the national uninsurance rate would be two percentage points lower.

Although Walker has maintained his resistance to Obamacare’s traditional Medicaid expansion, there isn’t a coverage gap in his state. Even before the passage of the health reform law, Wisconsin had a generous Medicaid program that allowed people with incomes up to 200 percent of the federal poverty line to qualify. But the threshold varies for each state, and low-income people living in other places aren’t so lucky. In Louisiana and Texas, for instance, a family of three with an annual income over $5,000 makes too much money to receive any Medicaid assistance.

Written by LeisureGuy

14 November 2014 at 8:38 am

Posted in GOP, Healthcare

Kevin Drum gets exasperated

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Venting a little. And check out those comments.

Written by LeisureGuy

12 November 2014 at 5:53 pm

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