Later On

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Healthcare nightmares

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Paul Krugman has an excellent column on the nightmare of Obamacare—for the GOP. It’s worth looking at the comments to see how mean-spirited some of the commenters are. There are people who really don’t want the poor to get any assistance at all. Very ugly. His column begins:

When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.

Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.

But while Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.

Let’s start with the good news about reform, which keeps coming in. First, there was the amazing come-from-behind surge in enrollments. Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage. Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress.

But wait: What about all the people who lost their policies thanks to Obamacare? The answer is  . . .

Continue reading.

It should be noted that the GOP totally opposes pay equity—that is, paying men and women the same amount for doing the same work. The GOP unanimously voted against a measure to remedy pay equity.

Written by LeisureGuy

11 April 2014 at 10:49 am

Posted in GOP, Government, Healthcare

Vermont working to provide single-payer healthcare

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Amazing to see something so well established and working so well in other countries being seriously considered in the US. But indeed the states are supposed to be the laboratories of democracy, so I hope this effort comes to fruition so we can see here what it would be like. (Of course, insurance companies and medical profession will undoubtedly do all they can to undermine and sabotage the effort: that’s the American way!)

Written by LeisureGuy

9 April 2014 at 12:16 pm

Two good takes on the GOP response to Obamacare

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First Paul Krugman’s excellent post, “Three Legs Good, One Leg Bad.”.

Next Kevin Drum lists the options and picks the one to bet on.

Written by LeisureGuy

8 April 2014 at 2:43 pm

Posted in GOP, Healthcare

Useful background reading regarding the Hobby Lobby lawsuit

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Nina Martin of ProPubica has compiled an excellent set of annotated links. Check out the article at Pacific Standard. Interesting how a corporation believes that it has the right to decide medical questions between a woman and her doctor, overriding the doctor’s authority (and mission). And it’s the corporation, not the owners, who would pay for contraception: a distinction whose utility is more appreciated in the other direction, in which it is the corporation, not the owners, who is held liable, fined, and otherwise punished for breaking the law. In that case, the owners are quick to draw a sharp distinction between owner and corporation. Well, that sharp distinction cuts both ways.

Written by LeisureGuy

29 March 2014 at 12:44 pm

‘We Have Criminalized Mental Illness In This Country’

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Sy Mukherjee writes at ThinkProgress:

Cook County Sheriff Tom Dart isn’t mincing words when it comes to his frustrations with Chicago’s — and America’s — broken and underfunded mental health care system.

“Every single day, I am faced with the mental health crisis in this county,” said Dart during testimony before the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigation on Wednesday. “The unfortunate and undeniable conclusion is that because of dramatic and sustained cuts in mental health funding, we have criminalized mental illness in this country, and county jails and state prison facilities are where the majority of mental health care and treatment is administered.”

Illinois made the fourth-largest cuts to mental health services of any state in the country between 2009 and 2012, including the shuttering of two state-run psychiatric facilities. Combined with a lack of affordable housing units, those cuts have propagated a system wherein Americans with mental illnesses wind up in jails rather than clinics.

Dart said that the Cook County Jail houses approximately about 3,500 inmates with serious mental illnesses on any given day (about a third of its total inmate population), making it the largest de facto mental health provider in the nation.

To be clear, these inmates shouldn’t be in a jail setting. The most common illnesses that Dart encounters are mood and psychotic disorders, including severe depression, bipolar disorder, and schizophrenia. And many wind up in jail because they’re simply trying to grapple with a mental health safety net riddled with holes. “While some mentally ill individuals are charged with violent offenses, the majority are charged with crimes seemingly committed to survive, including retail theft, trespassing, prostitution and drug possession,” said Dart.

Keeping the inmates in jail is a pricey endeavor, as caring for a prisoner with mental illness is “easily” two or three times as expensive as the $143 per day that it costs to keep an average person in jail, according to Dart. The care isn’t particularly effective, either. Dart told ThinkProgress that the doctors who treat inmates with mental illnesses are more focused on simple triage rather than holistic care. “Their mission is to get [the inmates] stabilized, make sure they’re on their meds, and when they’re on their way out, [the doctors] give them a plastic baggie with two weeks’ worth of meds,” he said.

Dart also recounted several tragic stories about sick prisoners who were released into a society where they had little recourse for medical care or even simple housing during Wednesday’s hearing. “We’ve had inmates get released and try to break back into the jail so they can keep getting treatment,” he told the House committee. He then urged the committee to consider legislation that would make it easier to keep track of severely mentally ill patients’ cases.

One bill that might go a long way toward achieving that goal has actually . . .

Continue reading.

Written by LeisureGuy

26 March 2014 at 2:27 pm

Media prefer false horror stories about Obamacare to true success stories

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Michael Hiltzik reports in the LA Times:

If there were fairness in this world, Rita Rizzo would be a media star.

Rizzo, 60, owns a management consulting firm for nonprofit groups and government offices in Akron, Ohio, with her husband, Lou Vincent, 64. Vincent, who suffers from Type 2 diabetes and high blood pressure, has gone without health insurance for 10 years. “We got 30 denial letters,” Rizzo told me last week.

Three years ago, Rizzo got a hip replacement. Her own insurance premiums were going to rise by $500 a month, to about $800, so she chose instead to triple her deductible to $6,000 to keep the increase to a mere $150 a month.

The couple used a $5,000 tax-deductible health savings account to cover her out-of-pocket expenses; Vincent’s medication, which ran to $178 a month; and his blood work-ups, at $2,400 a year.

In December, Rizzo signed up for Obamacare. She now has a policy that covers her and Vincent together, including all his meds and lab work, for $379 a month, with a $2,000 family deductible.

“I feel like I died and went to insurance heaven,” she says.

But you haven’t heard Rizzo’s story unless you tuned in to NBC Nightly News on New Year’s Day or scanned a piece by Politico about a week later. In the meantime, the airwaves and news columns have been filled to overflowing with horrific tales from consumers blaming Obamacare for huge premium increases, lost access to doctors and technical frustrations — many of these concerns false or the product of misunderstanding or unfamiliarity with the law.

While Rizzo was working her way to thousands of dollars in annual savings, for example, Southern California Realtor Deborah Cavallaro was making the rounds of NBC, MSNBC, CNBC, CBS, Fox and public radio’s Marketplace program, talking about how her premium was about to rise some 65% because of the “Unaffordable” Care Act. What her viewers and listeners didn’t learn was that she hadn’t checked the rates on California’s insurance exchange, where (as we determined for her) she would have found a replacement policy for less than she’d been paying.

With the March 31 deadline for 2014 enrollment in individual health insurance just days away, more questions are being asked about the mismatch in publicity about the Affordable Care Act by its opponents and supporters.

The millions of beneficiaries of the measure — families excluded from insurance because of high premiums or preexisting medical conditions, low-income individuals made newly eligible for Medicaid, seniors receiving a new subsidy for prescriptions, women granted the legal right to affordable maternity coverage for the first time — seem to be absent from the news media or political ad campaigns. But you can’t turn on your TV without seeing a well-produced 30- or 60-second spot featuring a purported tale of woe.

“Why aren’t Democrats taking this simple approach to defending Obamacare?” asked Slate.com in a recent headline.

It’s a good question, but the answer is that the approach isn’t all that simple.

“This is a difficult environment to sell this product,” says Robert J. Blendon, an expert on policy marketing at the Harvard School of Public Health. “There’s lots of anti-government feeling; the IRS is at the lowest point in its public standing, and people are asking if it’s going to be checking up on them. People are very cynical.”

Indeed, Rizzo says that when she tries to tell her story online, including through items on the Huffington Post, “I hear in response, ‘You’re a media plant’ or ‘You’re an Obama plant’ or ‘You’re not a real person.’ I’ve heard some really crazy stuff.” . . .

Continue reading.

Written by LeisureGuy

24 March 2014 at 10:36 am

Posted in Healthcare, Media

Healthcare Suit Against Catholic Bishops

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The Catholic Bishops are loath to address the central issue of the lawsuit and are working hard to get the suit dismissed on procedural grounds. Nina Martin reports at ProPublica:

The story of Tamesha Means and her miscarriage three years ago, if it happened the way her lawyers claim it did, is truly awful: Means was 18 weeks pregnant when her water broke and she was rushed to a hospital in Muskegon, Mich. The fetus wasn’t viable, and the pregnancy — Means’ third — was doomed.

But doctors at the hospital, part of the Catholic healthcare network knows as Mercy Health Partners, didn’t tell her that, Means’ lawyers say. Instead of the normal course of treatment — inducing labor and terminating the pregnancy to stave off potentially risky complications — Means was allegedly kept in the dark about her condition, given painkillers, and sent home.

Bleeding and wracked with pain, she returned to Mercy twice over the next day or so and received more or less the same response, her lawyers claim. Just as she was about to be sent home a third time, by now feverish from a severe infection, she began to deliver. The baby died.

The case has received an enormous amount of attention because of who Means’ attorneys at the American Civil Liberties Union chose to sue last November: not her doctors or the hospital but the U.S. Conference of Catholic Bishops (USCCB).

Means’ lawyers claim that she was subjected to dangerously substandard treatment, that her own health was placed in peril, and that she was deprived of information about her condition because of rules issued by the bishops conference that govern all Catholic health care in the U.S. The rules — which Mercy and its staff are required to follow — prohibit abortion, and as a result, according to Means’ lawyers, doctors would not give up on the pregnancy.

The move to sue the bishops was unprecedented, and everyone from the New York Times to the National Catholic Register heralded the case as a new front in the culture war over religious liberty, gender equality and reproductive care — a version of the same raging conflict that will play out before the Supreme Court next week when it hears arguments in the Hobby Lobby/Conestoga Industries contraception cases. Those cases challenge the Affordable Care Act’s rules requiring employers to provide birth-control benefits to their workers, even if the employers have religious objections.

When the Means suit was filed, the bishops called the allegations “baseless” and “misguided” and defended Catholic health care’s “stellar history of caring for mothers and infants.” Otherwise, though, they were silent. [Because they could simply not address the facts of the case. Their approach to this case reminds one of the way that for decades they approached the problem of pedophiles in the church.- LG]

Now, the bishops and their attorneys have followed up with a motion to dismiss the case, and ProPublica has taken the first sustained look at their arguments.

The bishops, for the most part, have chosen to avoid sweeping language about constitutional rights and freedoms, instead focusing on the nitty-gritty procedural issues that are basic to high-stakes civil litigation. They argue, essentially, that the ACLU has chosen the wrong venue — federal court in Detroit — to sue (the USCCB is based in Washington D.C.) and is mistaken in blaming the USCCB for decisions made by individual bishops in their own dioceses. . .

Continue reading. Clearly the bishops do not want to face the outcomes from their senseless and unyielding decision.

Read the entire article. A little later, Martin writes:

. . . Some background: The ACLU and women’s groups have been voicing concern since the 1990s about the growing role of Catholic health care operations around the country and what they see as the resulting threats posed to women’s reproductive rights. Those complaints have grown louder in recent years as Catholic facilities have moved aggressively to merge with secular hospitals and reports have surfaced about the challenges – some say contortions — that doctors and nurses have sometimes had to face to comply with church teachings on abortion, birth control, and end-of-life care while fulfilling their duty to patients.

Catholic hospitals now account for about 16 percent of hospital beds in the U.S. And in eight states — including Washington, Oregon, Iowa, and Missouri — they control more than 30 percent of beds. Ten of the 25 largest health-care networks in the country are Catholic-sponsored.

The Means case touched a nerve because it seemed to bring together many of the issues that have worried women’s advocates the most. Indeed, if the allegations are true, what happened at Mercy Health Partners was even worse than has been reported at the time of the initial filing of the lawsuit.

According to the suit, Means’ alleged mistreatment came to light in late 2012 or early 2013 when an unidentified researcher working on a federally funded project at Mercy uncovered what she said were not one, but five instances in which doctors there failed to terminate the pregnancies of women who were clearly miscarrying.

When the researcher asked hospital officials to explain, they allegedly told her that they were following the Ethical and Religious Directives for Catholic Health Care, or ERDs — guidelines that govern medical treatment at every Catholic hospital and health system in the United States.

The ERDS — which are issued and regularly updated by the bishops council — ban abortion and limit many other medical options, including sterilization and birth control, and apply to patients and medical staff no matter what their religion.

Their impact, the advocates say, is greatest in places like Muskegon, where the only hospitals in the county are Catholic. Doctors who fail to comply with the ERDs risk losing their admitting privileges; other employees who similarly fail to abide by the ERDs face losing their jobs. (In Colorado recently, a cardiologist at a Catholic facility was reprimanded for merely mentioning abortion as a treatment option for a woman for whom pregnancy could have been deadly.)

“The bishops aren’t doctors, and yet they issue rules that tie doctors’ hands, preventing them from giving their patients full information about their health care options and, in some cases, preventing them from providing medically appropriate care,” the ACLU’s deputy legal director, Louise Melling, blogged on the organization’s website in December. “That’s not right.” . . .

Written by LeisureGuy

20 March 2014 at 12:59 pm

Posted in Healthcare, Law, Religion

Odd but intriguing: California bases reproductive rights law on actual science

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Using evidence to determine the fate of legislation! What an innovative and potentially fruitful idea!

Irin Carmon reports at MSNBC:

EUREKA, Calif. – It did not look particularly like a history-making day in the Redwoods. The jars of condoms and the pinned-up primer on the HPV vaccine at the Six Rivers Planned Parenthood were undisturbed, and the waiting room was no more taxed than any other Saturday. The usual lone protester, loosely referred to as “the pastor,” had come early, before the clinic even opened, and gone home.

But inside the employee kitchen, there was proof of something special about this January morning, days after the anniversary of Roe v. Wade. “Well-behaved women rarely make history,” read a note affixed to some irises. “Today we make history!!!” Another card thanked one nurse practitioner by name for “blazing the trail.”

Thanks to a law passed last year, California is actually adding abortion providers – nearly fifty nurse practitioners, nurse midwives, and physicians’ assistants, trained to provide aspiration abortions in the first trimester –with more to come.

The state is bucking a nationwide trend as a wave of new restrictions is forcing abortion providers across the country to shut their doors. In Texas, the second-largest state after California, initial enforcement of a law passed last year initially put a third of the clinics of the state out of commission, and when new regulations go into effect in September, all but a half-dozen clinics are expected to close.

Meanwhile, in California, a Eureka nurse practitioner – who worried about the safety of being named in the press – had just officially become one of the new providers of vaccuum aspiration abortion, the most common procedure.

“I am used to being in a place where we are talking about all the options for birth control and for pregnancy,” she said simply. “It was just a no-brainer, a logical next step.”

The fact that it was an ordinary day – boring, even – was the whole point. The most radical move of all wasn’t just passing a law to expand abortion access. It was treating the termination of a pregnancy like any other medical procedure, and seeing if that changed women’s lives.

“I don’t really see the need for this bill here,” said Assemblyman Don Wagner, an Orange County Republican, at a committee hearing last April for AB154, which would eventually make the nurse practitioner’s day possible. He wondered why there were no women testifying that they had been unable to access an abortion.

“Where is the evidence that there are underserved populations out there?” Wagner asked.

Evidence was something of a magic word to Tracy Weitz, testifying that day in her capacity as a medical sociologist at the University of California, San Francisco. Weitz had overseen a massive peer-reviewed study, published in the American Journal of Public Health, that had trained the Eureka nurse practitioner and dozens of other advanced-practice clinicians on providing aspiration abortions. Armed with a waiver from the state, the study set out to determine whether such clinicians could provide early aspiration abortions as safely as physicians. Eleven thousand abortions later, there was no meaningful difference.

Weitz doesn’t perform abortions, but her colleagues at San Francisco General Hospital do, and they specialize in later ones. And over the years, they’d noticed something.

“We were serving an extraordinarily high number of women later in gestation who were coming from throughout California,” Weitz told Wagner.

The later in pregnancy an abortion occurs, the more expensive it is. And though abortion remains an extremely low-risk procedure – the study had actually shown it was even safer than previously believed – complications rise too. Someone who doesn’t want to be pregnant anymore likely isn’t interested in drawing out the process, either.

“When you talk about, where’s the evidence of lack of access,” Weitz continued, “it’s in the disparity in the number of low-income women geographically located in [remote areas]…who do not access their abortion until later in the second trimester.”

In other words, lifting the barriers would make it easier for women to get abortions earlier in pregnancy. . .

Continue reading.

In other news, Michael Meved spoke at the conservative CPAC conference to say, ““There has never been a state in this country that has ever banned gay marriage. That is a liberal lie.”

For the record, this article lists 30 states that have banned same-sex marriage.

I think perhaps Mr. Medved was going for the Big Lie, but picked one a little too big: instead of a size 2 or 3, he went for size 8, and it was just too big to fly (cf. elephants, symbol of the GOP).

Written by LeisureGuy

7 March 2014 at 3:42 pm

First medical marijuana commercial on major TV

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Via ThinkProgress:

Ian Millhiser notes at ThinkProgress:

A company called Marijuana Doctors, which connects medical marijuana patients with doctors who can prescribe the drug, claims that it is airing what it claims is the “first ever marijuana commercial on a ‘Major Network.’” The ad, which “draws a parallel between a ‘shady’ street dealer attempting to push ‘unsafe’ sushi to unsuspecting buyers, and medical marijuana patients being forced to obtain their medication in a similar fashion,” airs in New Jersey on several national networks — including A&E, Fox, CNN, Comedy Central, Food Network and the History Channel. . .

Although medical marijuana is legal in New Jersey — the state started issuing medical marijuana identification cards in 2012 — adult patients currently have greater access to the drug than children. Indeed, one family recently decided to move from New Jersey to Colorado to ensure their daughter would have access to the liquefied marijuana she uses to stave off potentially fatal seizures. Child marijuana patients in New Jersey are technically allowed to access edible marijuana, but marijuana in this form isn’t generally available at New Jersey dispensaries.

Gov. Chris Christie (R-NJ) recently rejected a bill that would have permitted families in a similar situation to buy marijuana in other states and transport it home to New Jersey.

Written by LeisureGuy

3 March 2014 at 10:56 am

Who is being helped by a restrictive medical marijuana stance?

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Certainly not the patients. Tara Culp-Pressler writes at ThinkProgress:

Brian and Meghan Wilson don’t want to leave their home state of New Jersey. They would prefer to remain near their families and friends — and they want their two-year-old daughter to be able to keep seeing her nationally renowned neurologist, who’s an expert at treating her rare form of epilepsy.

But, since progress on New Jersey’s medical marijuana policy has stalled, the family is beingforced to relocate anyway. They’re going to Colorado to seek out treatment for their daughter, Vivian, who needs a liquefied marijuana strain in order to prevent her potentially fatal seizures.

The Wilsons have been fighting for policy reform in New Jersey for the past year. Although the state began issuing medical marijuana cards back in 2012, there were stringent limits for minors that prevented kids like Vivian from being able to take edible marijuana. “Please don’t my daughter die,” Vivian’s dad implored Gov. Chris Christie (R) in August, pressuring the governor to approve legislation that would have expanded access to several strains of marijuana.

Christie ended up approving a weakened form of that legislation. But it wasn’t enough. Although kids with conditions like Vivian’s are now legally allowed to access edible marijuana, the dispensaries in the state aren’t producing those type of products, and the state’s health department has no plans to begin testing them. Christie says he’s “done expanding the medical marijuana law,” and recently rejected a bill that would have allowed families like the Wilsons to buy edible strains in other states and transport them home to New Jersey.

The Wilsons have tried to navigate New Jersey’s restrictive medical marijuana law. But they say the state laws don’t go far enough to help two-year-old Vivian — who must wear an eye patch, avoid direct sunlight, and stick to a special low-carb diet in an attempt to prevent potentially deadly seizures — and they can’t afford to wait it out. Treatment for Vivian’s condition still remains out of reach.

“I’m just ready to start the next chapter. If we get medicine that helps Vivi, that’s great. Who the hell cares we had to move?” Meghan Wilson told the Star-Ledger as her family prepared to board their flight to Colorado.

The Wilsons will join a growing number of “medical refugees” who have moved to Colorado to seek a so-called “miracle strain” of marijuana that can help treat pediatric epilepsy. About 180 other children like Vivian are currently receiving treatment from the same dispensary in Colorado Springs. More than 100 families have moved from 43 states to pursue this optionfor their severely ill children.

The so-called “Charlotte’s Web” strain is named after Charlotte Figi, the first child who tried the treatment after her parents exhausted all of their other medical options. After she started taking this strain of medical marijuana, Charlotte’s seizures immediately stopped, and the seven-year-old is now feeding herself, walking, and riding her bike. Her case helped convince CNN Chief Medical Correspondent Sanjay Gupta to reverse his position on the medical benefits of marijuana, admitting that he was “too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.”

Written by LeisureGuy

2 March 2014 at 9:01 am

The PTSD Crisis That’s Being Ignored: American Casualties in America

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Lois Beckett has a good article in Pacific Standard:

Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings, and other violent injuries.

So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.

They just didn’t know how many: Fully 43 percent of the patients they examined—and more than half of gunshot-wound victims—had signs of PTSD.

“We knew these people were going to have PTSD symptoms,” said Kimberly Joseph, a trauma surgeon at the hospital. “We didn’t know it was going to be as extensive.”

What the work showed, Joseph said, is, “This is a much more urgent problem than you think.”

Joseph proposed spending about $200,000 a year to add staffers to screen all at-risk patients for PTSD and connect them with treatment. The taxpayer-subsidized hospital has an annual budget of roughly $450 million. But Joseph said hospital administrators turned her down and suggested she look for outside funding.

“Right now, we don’t have institutional support,” said Joseph, who is now applying for outside grants.

A hospital spokeswoman would not comment on why the hospital decided not to pay for regular screening. The hospital is part of a pilot program with other area hospitals to help “pediatrics patients identified with PTSD,” said the spokeswoman, Marisa Kollias. “The Cook County Health and Hospitals System is committed to treating all patients with high quality care.”

Right now, social workers try to identify patients with the most severe PTSD symptoms, said Carol Reese, the trauma center’s violence prevention coordinator and an Episcopal priest.

“I’m not going to tell you we have everything we need in place right now, because we don’t,” Reese said. “We have a chaplain and a social worker and a couple of social work interns trying to see 5,000 people. We’re not staffed to do it.”

A growing body of research shows that Americans with traumatic injuries develop PTSD at rates comparable to veterans of war. Just like veterans, civilians can suffer flashbacks, nightmares, paranoia, and social withdrawal. While the United States has been slow to provide adequate treatment to troops affected by post-traumatic stress, the military has made substantial progress in recent years. It now regularly screens for PTSD, works to fight the stigma associated with mental health treatment, and educates military families about potential symptoms.

Few similar efforts exist for civilian trauma victims. Americans wounded in their own neighborhoods are not getting treatment for PTSD. They’re not even getting diagnosed.

Studies show that, overall, about eight percent of Americans suffer from PTSD at some point in their lives. But the rates appear to be much higher in communities—such as poor, largely African-American pockets of Detroit, Atlanta, Chicago and Philadelphia—where high rates of violent crime have persisted despite a national decline.

Researchers in Atlanta interviewed more than 8,000 inner-city residents and found that about two-thirds said they had been violently attacked and that half knew someone who had been murdered. At least one in three of those interviewed experienced symptoms consistent with PTSD at some point in their lives—and that’s a “conservative estimate,” said Dr. Kerry Ressler, the lead investigator on the project.

“The rates of PTSD we see are as high or higher than Iraq, Afghanistan, or Vietnam veterans,” Ressler said. “We have a whole population who is traumatized.” . . .

Continue reading.

If the US is going to continue to make guns freely available to everyone, then it has a responsibility to ameliorate the resulting human damage.

Written by LeisureGuy

28 February 2014 at 9:43 am

The reason Obamacare horror stories turn out to be false

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It’s a structural reason, explained well by Paul Krugman.

Written by LeisureGuy

27 February 2014 at 12:03 pm

Posted in Healthcare

A good look at the GOP mindset

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I continue to believe that, judging by actions, the GOP actively hates lower-income people. Tara Culp-Ressler reports in ThinkProgress:

During a political fight over Medicaid expansion in Arkansas on Tuesday, one Republican lawmaker admitted that he doesn’t want to educate uninsured residents about their new health care options because it’s simply too expensive to provide them with insurance.

State Rep. Nate Bell (R), who offered an amendment to Arkansas’ proposed Medicaid expansion bill that would prevent the state from using federal funds to promote Obamacare, acknowledged that his policy would result in fewer people signing up for health care. He noted that “without active marketing, you probably get declining enrollment.” But in his mind, that’s not a problem — that’s the whole point.

“We’re trying to create a barrier to enrollment,” Bell explained, noting that lower enrollment ultimately translates to lower costs. “In general, as a conservative, if I have the opportunity to reduce government spending in a program from what’s projected… I’m probably going to take that deal.”

Bell’s amendment would prohibit Arkansas from advertising Obamacare plans through television, radio, print, or online ads. It also prevents the state from using federal funds to conduct direct mailing campaigns — which, as the Arkansas Times’ David Ramsey notes, has been critical in getting out the word about the state’s Medicaid expansion. Since Arkansas is pursuing a “private option” for Medicaid, which essentially gives residents a subsidy to purchase private insurance, the process for enrolling in a Medicaid plan is very similar to the process for signing up for a plan on Obamacare’s new state-level exchange.

Preventing Americans from getting all the facts about the health reform law is a popular method of undermining Obamacare, particularly in red states. Republicans have repeatedly targeted “navigators,” the people tasked with helping Americans enroll in new plans, to prevent them from being able to easily do their jobs. And conservative states that are opposed to Obamacare have allocated considerably less money to promote it. It’s no surprise, then, that the people who live in GOP-led states are less likely to understand how to sign up for health care.

Those states are also more likely to have higher populations of low-income people who lack insurance. In Arkansas specifically, the uninsurance rate is among the highest in the nation. Efforts to expand health care in the state are actually projected to save money in the long run because they’ll cut down on the cost of uncompensated care; the Medicaid expansion could save taxpayers as much as $90 million this year.

Nonetheless, Arkansas lawmakers are currently debating whether to kick thousands of low-income people off of their new Medicaid plans. Even though the state began implementing its “private option” last year, and an estimated 83,000 people have already enrolled, the legislature is currently debating whether to approve the policy. And if lawmakers like Bell have their way, even the move to preserve Medicaid expansion may still come at a significant cost.

Written by LeisureGuy

18 February 2014 at 12:35 pm

Posted in GOP, Healthcare

Fascinating and obviously good idea for institutional care of those with dementia

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This sort of facility seems like an excellent idea, and apparently it results in improved happiness and health for its residents. I bet it’s a more pleasant place to work than the usual assisted-living home. With Baby Boomers aging, this would be a good thing to initiate as publicly-owned (taxpayer-supported) facilities. This is exactly the sort of thing you do NOT want to run on a profit motive, which inevitably leads to cuts in quality of service and higher prices over time due to the inexorable drive to grow profits.

Written by LeisureGuy

18 February 2014 at 10:52 am

The French way of cancer treatment

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What happens when you use a good single-payer healthcare system. Note that the US hospital contrasted is Memorial Sloan Kettering, no slouch of a (US) hospital.

Written by LeisureGuy

17 February 2014 at 2:21 pm

Can the GOP learn?

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Interesting blog post by Paul Krugman pointing out the deja vu of watching the GOP once again declare that reports are skewed—first, it was polls and reports showing that Obama would win over Mitt Romney, now it’s reports showing that Obamacare is working. The problem with denying reality is that reality is always around and thus, in effect, patient.

Written by LeisureGuy

14 February 2014 at 8:25 am

Posted in GOP, Healthcare

Quality Forum’s CEO is in on the scam

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Fascinating. Corporate greed seems to have a corrupting effect.

Written by LeisureGuy

12 February 2014 at 2:37 pm

How Tim Armstrong, CEO of AOL, is a contemptible human being

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A very good look at Tim Armstrong’s obliviousness by Amy Davidson in the New Yorker:

How does one define “distressed”? Anxious, worried, upset in a slightly old-fashioned way, and somehow ragged. Damsels can be in distress, without being distressed ladies—blithely awaiting rescue, without a ribbon out of place. Fashionably scuffed dressers or jeans are said to be “gently distressed.” When the word is modified that way, it also calls to mind a baby, half woken up and wiggling, darting out a hand to see if someone is there.

When Tim Armstrong, the C.E.O. of AOL, talked about “distressed babies” a few days ago, though, there was nothing gentle added, in either the language or the intent. He was explaining, in a conference call with employees, why the company was making their 401(k) plan worse. “In 2012,” he said, in a transcript that Capital New York got first,

We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs, we made the decision, and I made the decision, to basically change the 401(k) plan.

In other words, don’t blame us for cutting back on retirement benefits; it was two babies we had to keep alive who took your money.

But what did Armstrong mean when he said “we paid a million dollars”? This does not represent an act of charity on the part of a struggling company. AOL is profitable, and just had a very good quarter; it has done well enough to pay Armstrong twelve million dollars, a number that does not seem to distress him. And, as Deanna Fei, the rightly distressed mother of one said baby, wrote in a piece for Slate, she and her husband, who works for AOL, had paid their premiums for the company’s health-insurance plan. This is what they bought, with that money and her husband’s labor: an agreement that, in the event that something bad happened with their health or that of their child, they would be able to go to the doctor, and that they wouldn’t be bankrupted.

Something very bad did happen. Fei woke up with sudden pains when she was only five months pregnant with her second child. She was rushed to the hospital, and her baby girl was rescued with an emergency Caesarean section—one pound nine ounces, her skin all purple and blue the way no baby’s should be. (One doctor, Fei said, was “visibly shaken.”) She was put on a ventilator. “That day, we were told that she had roughly a one-third chance of dying before we could bring her home. That she might not survive one month or one week or one day,” Fei wrote.

For longer than I can bear to remember, we were too terrified to name her, to know her, to love her. In my lowest moments—when she suffered a brain hemorrhage, when her right lung collapsed, when she stopped breathing altogether one morning—I found myself wishing that I could simply mourn her loss and go home to take care of my strapping, exuberant, fat-cheeked son.

Except that the baby girl wouldn’t give up: “over the next weeks, she fought for every minute of her young life, as did her doctors and nurses, and we could only strive to do the same.” She was in distress, that baby, but she wasn’t going to wait like some damsel.

Fei doesn’t doubt that all of this—“blood transfusions, head ultrasounds, the insertion of breathing tubes, feeding tubes, and a central line extending nearly to her heart”—could have cost a million dollars. That is the point of insurance. AOL, which is apparently self-insured (while using Cigna as one of its plan administrators) made a bet that it wasn’t going to get the employees it needed without a decent health-care plan, and that this was the way to provide it. (It also, as some commentators have noted, appears not to have opted for a reinsurance policy as a hedge against big claims.) Armstrong also complained about Obamacare, which he said would cost the company millions; as Ezra Klein pointed out in a Bloomberg column, this suggests only that he and AOL haven’t looked closely at the law, and figured out how the company can now join a larger risk pool and protect itself from big swings. Or was his problem with Obamacare that it won’t let insurers tell people like Fei’s daughter that they’ve reached some “lifetime cap” before their first birthday, or keep her father looking for a job with a more sane employer because he’s worried that a “preëxisting condition” will keep her from finding a new insurer?

But wasn’t this about 401(k)s—retirement plans—and not about health care? Armstrong’s rationale is really just a riff on how much higher profits would be if you didn’t have to hire human beings. As Fei wrote, Armstrong “exposed the most searing experience of our lives, one that my husband and I still struggle to discuss with anyone but each other, for no other purpose than an absurd justification for corporate cost-cutting.” (She says she is doing so now because her husband starting getting queries from co-workers minutes after the conference call.) The change to the 401(k) plan was this: instead of matching contributions quarterly, the company would only pay its share for employees who were active on December 31st of a given year. If you were left or passed away or were fired on December 30th, you would get nothing, despite three hundred and sixty-four days as an AOL-er. With the “distressed baby” move, Armstrong removed the presumption that the company wouldn’t use this in bad faith. If someone complains to the entire company about how much trouble it is that a couple of babies were gravely sick, would you put it past him to fire employees who were about to be due a big contribution? Maybe in his next speech he’d be complaining about AOL-ers who had the temerity to die from heart attacks on New Year’s Day, instead of on Christmas.

That speech won’t be given now; Armstrong’s speech was so blatantly oblivious, so cheap in every sense of the word, that he has had to apologize (after a false start, in which he said he’d just been trying to show how much he cared) and also reverse the 401(k) change.

But we’re not done with this. There is more to be distressed about, on behalf of babies, parents, and the people who work with them.

For one thing, Fei pushed back at Armstrong from what was, within the terms of our discussions about parenting, an unassailable position. Armstrong, in his first non-apology, had referred to her pregnancy as “high-risk”:

But there was nothing high-risk about my pregnancy. I never had a single risk factor for a preterm birth, let alone one as extreme as this one. Until the morning I woke up in labor, every exam indicated that our daughter was perfectly healthy.

Her first pregnancy had been “normal”; this one had appeared to be, too. She is absolutely right to remind Armstrong that life itself is riskily uncertain, and of the shallowness of acting as if we make our own luck entirely, picking our circumstances from a store shelf.

But if there had been risk factors—so what? What if she had been older, or had her own health problems or struggles with infertility, or maybe even was single? What if she’d had a wife, rather than a husband? She should have just as much right in any of those circumstances not to be exposed and blamed, and for her baby to not be treated like a beggar.

Armstrong might have assumed there was some such factor at work, and that he had more resentment to play with—including his own. One item that emerged this week was . . .

Continue reading.

Written by LeisureGuy

11 February 2014 at 10:55 am

Jails and Emergency Rooms Are Our De Facto Mental Health Clinics

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I think it would be more efficient and save money overall if the mentally ill could go or be taken to a local mental health clinic and get expert treatment by a staff trained in and knowledgeable about mental health illnesses and treatments, thus taking a burdensome and inappropriate responsibility from the police and ERs.

But I don’t think that will happen because, much as with the poor, the controlling powers (Congressional majorities, business interests) simply do not care about people in that category, and so no government money is released to provide the resources. Instead, the problem is to a great degree simply ignored. Somehow we avert our gaze.

But services for this group very much are aligned with promoting the general welfare.

Lauren Kirchner writes in Pacific Standard:

The last time Virginia state senator Creigh Deeds made national headlines, the occasion was a shocking family tragedy. In November, Deeds’ son Gus, who had been on and off medication for bipolar disorder and crippling paranoia, repeatedly stabbed Deeds, before ending his own life. Now, a recovered but visibly scarred Deeds is back in the news, publicly urging his colleagues in Richmond to help him reform the state’s mental health laws.

On the night before his son attacked him, Deeds told Scott Pelley in a 60 Minutes interview, the family had taken Gus to an emergency room and tried to place him in a psychiatric facility, because they worried that he might hurt himself or someone else. Under Virginia state law, Gus could only be hospitalized against his will for six hours, or until an available bed in a psychiatric facility could be located. But no bed was free, and so Gus went home. Deeds is now working to get Virginia to extend the length of those emergency stays, and to build a state-wide computer database that would make finding open psychiatric beds easier.

Deeds’ story was just one part of the 60 Minutes segment, called “Nowhere to Go: Mentally Ill Youth in Crisis.” Scott Pelley interviewed a number of parents who have had to repeatedly bring their children and teens to the hospital for short-term stays and unsatisfying, piecemeal mental healthcare, for things like bipolar disorder, schizophrenia, and major depression disorder. Long-term psychiatric care is just so much harder to come by. Pelley explains that their experiences today illustrate the result of a half-century-long systemic deinstitutionalization of mental health care in America:

In the decades after the 1960s most large mental institutions were closed. It was thought that patients would get better treatment back in their communities. But adequate local facilities were never built. The number of beds available to psychiatric patients in America dropped from more than half a million to fewer than 100,000. That leaves many kids in crisis today with one option: the emergency room.

But what if those people suffering from mental illness aren’t minors, and they don’t have parents or support systems to bring them in to emergency rooms? If those people are adults, and they’re out in the world, disturbing people with antisocial behavior, then chances are that at some point, they’re going to have a brush with the law.

In a recent NPR report from the nation’s largest jail, Cook County in Illinois, Laura Sullivan described the spare, padded cells that many of the inmates are housed in. At least a third of the 10,000 inmates in Cook County are mentally ill, and the jail’s staff sounded absolutely overwhelmed.

Staff members called the situation they’re facing “staggering” and the policies that caused it “ridiculously stupid.” Sullivan reported that in the past three years, budget shortfalls caused Chicago to cut funding to six of the area’s 12 mental health clinics, and three nearby state hospitals. Those clinics and hospitals had provided mentally ill patients in the community with counseling and medication; without them, many of those patients tend to end up in jail.

Cook County is doing what it can to process the flow, and provide medicine and help to the people who need it—and this help, in turn, attracts more people who need it. Sullivan interviewed one inmate/patient who told her that after his local mental health clinic closed, he started relying on the jail to get regular access to the medication he has been taking for decades to manage his illness. In fact, he regularly commits small crimes just to get sent to jail, where he’ll then stay, until he goes before a judge to receive his sentence. This situation is not only incredibly ineffective in serving the community’s needs, it’s also incredibly expensive, as Sullivan describes: . . .

Continue reading.

Written by LeisureGuy

5 February 2014 at 11:31 am

The full story on Bette of Spokane and her healthcare insurance

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Rep. Rodgers acted consistently with her earlier performance (of saying that she strongly supported equal pay for women after voting 4 different times against equal pay for women)—that is, she again has taken the path of lying.

Full details here, in a story that develops through several updates.

Written by LeisureGuy

1 February 2014 at 6:32 pm

Posted in GOP, Healthcare

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