Later On

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

Archive for the ‘Healthcare’ Category

How healthcare is delivered in the US

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Nicholas Kristof provides an example in the NY Times:

For a man who needed 18 teeth pulled, Daniel Smith was looking chipper.

Anxious, too, for he was facing a pair of forceps. But Smith, 30, a contractor with no health or dental insurance, who hadn’t seen a dentist in more than 20 years, was looking forward to an imminent end to the pain and rot in his mouth.

“I’ve always worked, since I was 14, but I’ve never had dental insurance,” Smith told me. After his teeth are out, he has a lead on low-cost dentures.

“I’d like to have a straight smile,” he said. “I’ve never had one in my life.”

All around Smith were uninsured patients receiving free dental or medical care, including dozens of men and women in side-by-side dental chairs in the open air. Organizers mercifully arranged the long line of people waiting to have teeth pulled so that they were facing away from those currently enduring extractions.

The patients swamped the county fairground here for a three-day health extravaganza of free care organized by Remote Area Medical, an aid group that holds these events across the country. This one involved about 1,400 volunteers serving 2,300 men and women who needed care of every kind.

Some patients camped out for three days at the fairground gate before the clinic opened to make sure they would be treated.

The health fair reminded me of scenes I’ve witnessed in refugee camps in South Sudan. But here in America?

The sight is a wrenching reminder of how many Americans slip through the cracks. No other advanced country permits this level of suffering — and if the G.O.P. health care plan goes through, millions more will lose their health coverage.

“Walking around, listening to people, it breaks your heart,” said Gov. Terry McAuliffe, a Democrat, whom I encountered on the fairground. “We need a healthy work force, and this is a disgrace.”

“Shame on us as a nation,” McAuliffe added. “This is an embarrassment to our country.”

That’s what I feel, too: humiliation that Americans need to be rescued by a group originally intended to help people in the world’s poorest countries (mixed with pride at the altruistic spirit that attracted so many volunteers, paying their own expenses to come here). To me, the fundamental lesson is that even under Obamacare, too many people don’t have coverage, and we urgently need a single-payer universal health care system along the lines of Medicare for all.

Remote Area Medical is the brainchild of Stan Brock, 81, a onetime British cowboy who in the 1950s managed one of the world’s biggest ranches, overseeing 50,000 cattle in Guyana in South America.

When he was badly injured by a wild horse, Brock was told it would be a 26-day hike to the nearest doctor. So he recovered on his own — but began to think about supplying health care to deprived areas.

Brock ended up founding Remote Area Medical to work in places like the Amazon, Haiti and Uganda. But then one day he had a call from Sneedville, Tenn., where the hospital had just closed and the dentist moved out. “Can you come here?” the caller asked.

Brock loaded a dental chair on the back of a pickup truck and brought in a dentist as well — and 150 people lined up, desperate for oral care. The result is that while it continues some international work, Remote Area Medical also treats people in the world’s superpower.

Brock is a character: He discovered a species of bat that is named for him, and today he has no home but unrolls a pad each evening and sleeps on the floor of Remote Area Medical’s permanent offices in Tennessee. At 5 a.m. on the first day here, Brock opened the gate and began admitting people eager for care.

As they surged past, many stopped to thank him; one man had tears in his eyes as he did so.

“I wish Mr. Trump would come,” Brock told me. “The health of these people is appalling.” . . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 11:59 am

A Longtime Republican Senate Staffer, on John McCain

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James Fallows has an interesting post with remarks by Michael Logren:

I’ve had my say about John McCain’s decision to support the rushed consideration of the Republican drive to repeal Obamacare. Installment one was here, and two was here. The theme of both was that McCain missed a historic opportunity to match the scolding-and-uplift of his much-praised words, about the need to avoid simple fights for partisan victories, with the weight of his actual votes, which in the crucial showdown this week supported just such partisan warfare.

Now Mike Lofgren, who spent 28 years as a Congressional staffer mainly working for Republicans, and has since then become a noted author of The Party Is Overand The Deep State, writes in about the McCain he came to know from long observation on Capitol Hill. I’ve learned over the decades to take what Mike Lofgren says seriously, and in that spirit I invite close reading of what he has chosen to say:

Let us respectfully acknowledge John McCain’s past sacrifice to the United States and his present health struggles. Still, the media’s fawning over both his return to the Senate and his sanctimonious jeremiad against partisanship is difficult to bear. He rightly excoriated a grotesquely unfair Senate process, but then became the deciding vote allowing that process to move forward. Compounding his duplicity, he claimed he could not support the underlying legislation, but a few hours later voted in its favor—although nine of his Republican colleagues found the courage not to, defeating the measure.

Regardless of his vote on subsequent health care measures, should one of them pass and deprive millions of Americans of health insurance, McCain will have been the key enabling factor. The “Conscience of the Senate” would deny to those Americans the blessing which he takes for granted. But this chasm between his pretenses and his behavior has been a consistent feature of his Senate career.

His rhetorical denunciation of torture during the Bush years was loud and long—yet he never followed up, despite the fact that his moral prestige as a former POW would have carried great legislative weight. A ban on torture came only with Obama’s executive order. Likewise, a persistent feature of his career has been to bitterly scold pork-barrel spending in defense bills.

Yet, invariably, he fails to offer amendments to remove those offending provisions; nor does he vote against the underlying bill. As a staffer, I recall that almost all Senate Republicans, hardly a sensitive and swooning lot, really couldn’t stand his moral preening. But his tactics were a mechanism by which McCain got cheap credit from a lazy press looking for the One Righteous Republican they could lionize.

None of us vain creatures can bear scrutiny of the gap between our words and our deeds—but few, I fear, would suffer from that scrutiny more than John McCain.

His present obeisance to the reptilian Mitch McConnell, his strange non-reaction to Trump’s sliming of his wartime service, and his curious passivity towards the Bush campaign’s scurrilous attack on his family (later supporting Bush’s reelection as he stood by while Karl Rove defamed fellow Vietnam vet John Kerry), are all inexplicable incidents if one believes the standard narrative about McCain. The man who inflicted Sarah Palin on our suffering country and started us on the inevitable slide to the nightmare of Donald Trump is a far more complex, interesting, and fraught human being than the heroic caricatures depicted in the establishment media. . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 10:20 am

John McCain Makes His Choice: To Eat the Cake, But He Wants to Have It, Too

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In the Atlantic James Fallows has an excellent column on McCain’s smokescreen to hide his actions behind a tapestry of words:

The effort to repeal Barack Obama’s health-care bill is not over, and neither presumably is the public career of John McCain. But each crossed an important threshold yesterday, and Senator McCain gave us a clearer idea of who he is and what he stands for.

The repeal effort isn’t over, because debate and further voting is now under way to determine whether the bill will pass and, more basically, to define what it would actually do. McCain will have more votes to cast, on this measure and others, and it’s possible that in the end he will turn against this bill because of its provisions (whatever they turn out to be) or because of the rushed and secretive process that led to it. Just this afternoon, McCain voted No on a “straight repeal” bill that would eliminate Obamacare without any replacement.

If in the end John McCain makes as decisive a stand against this proposal as he did in favor of it last night, then the historical verdict on this stage of his career will be more complex than it would be right now. As of the moment the story would be that McCain, soon after his diagnosis and treatment for aggressive brain cancer, responded to this memento mori by flying back to Washington to help take medical coverage away from other people.

There’s still time. But yesterday was important, for the bill and for McCain.

* * *

Not even U.S. senators are often in a position where just one of them, strictly on his or her own, can directly affect the welfare of tens of millions of people. John McCain was in that position yesterday. By definition, in a vote this close, every vote is the “decisive” one. But McCain built drama by holding his vote until the very end. He wanted to take center stage. And he did so—by voting Yes, to let this bill proceed.

He voted to keep alive a bill opposed not by some but by all major medical-professional and health-related groups. A bill that an organization of nuns called “the most harmful legislation to American families in our lifetimes.” A bill with absolutely no across-the-aisle Democratic amendments, as compared with well over 100 Republican amendments in the original Obamacare plan, and with virtually no open hearings or debates. A bill whose support level in opinion polls is roughly half that of Donald Trump himself. A bill—well, the litany is familiar, all leading up to the point that it’s a bill that John McCain could have chosen to stop yesterday, and didn’t.

If he had stayed home in Arizona, the bill would have died. If he had voted No, at least this effort at repeal would have ended. Of course, perhaps Senate Majority Leader Mitch McConnell could have squeezed either Susan Collins or Lisa Murkowski, the two Republican defectors, to switch their votes, so he could still eke out a 50-50 tie, allowing Mike Pence to make it 51-50. Perhaps if McConnell had failed yesterday, he would have kept looking for some other way to get an anti-Obamacare “win,” despite the distortion the crusade is causing in everything else the Senate has to do. Perhaps McCain thought he was saving his influence within the GOP for later—later stages of deliberation on this bill, later encounters with Trump. Perhaps, perhaps. For certain, McCain made a choice yesterday, and he did something no one looking back on this moment will admire.

(Whenever I hear about politicians saving influence “for later,” I cannot help thinking of the unfortunate Ricky Ray Rector, the man whose name is a shorthand for the most heartless thing Bill Clinton did in his drive for the presidency. Rector was a murderer who tried to blow his own brains out when about to be captured by police. He survived but with profound mental disabilities. An Arkansas jury nonetheless convicted him and sentenced him to death; the U.S. Supreme Court declined to hear his case. Young Arkansas governor Bill Clinton, then in a very tight contest in the Democratic primaries of 1992, and all too aware that only four years earlier Michael Dukakis had been badly hurt by a “soft on crime,” Willie Horton race-baiting campaign, approved the execution and went to Little Rock to be in the state when it occurred. When Rector was offered a last meal before being put to death, he told the jailers that he wanted to save his dessert “for later.” When politicians talk about “saving” their influence, this for later is what I hear.)

* * *

John McCain himself went out of his way to highlight why his choice was so sad, and so hypocritical. As David Graham noted yesterday, McCain immediately followed his vote with one of his trademark speeches on the need to take the high road in politics—the need to stop doing things in a rushed and secretive way, to stop simply looking for partisan wins. Elevated words, of the kind McCain is accustomed to being complimented on. But the words were entirely at odds with his actions of just minutes before—when he had the chance to stop a rushed and secretive push toward a partisan win, and he whiffed. Later that same evening, just hours after he somberly declared that “I will not vote for this bill as it is today,” McCain went right ahead and voted for that bill as it was yesterday, one of only 43 Republicans to do so.

And he didn’t need to do this, any of it.  . .

Continue reading.

McCain is a Republican. That is significant, and tells us a lot.

Written by LeisureGuy

26 July 2017 at 4:10 pm

A clear-eyed view of the Republicans in Congress

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Jennifer Rubin concludes a column today with this pointed remark:

In sum, the consolation for a meltdown in legislative order, rationality and responsible government is that we now know just how incapable the GOP is of governing. Years of antagonism toward government have made them cavalier about the harm they can do to ordinary citizens in their quest to avoid blame. What a shabby group they are. Let’s hope they don’t do real damage before they lose their majority.

Written by LeisureGuy

26 July 2017 at 10:39 am

Kevin Drum comments: Blame Hospitals for the Big Spike in Out-of-Network ER Charges

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Drum describes the big scam hospitals are running these days to screw patients. For-profit hospitals and medical care are a big mistake just waiting to happen.

Written by LeisureGuy

24 July 2017 at 7:06 pm

Medicaid Expansion Had a Huge Impact on the Finances of the Poor

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Kevin Drum has an interesting post with this chart:

He notes:

In states that didn’t expand Medicaid, nothing much happened. In states that didexpand Medicaid, medical debt fell nearly 40 percent by the end of 2015. As a check, they also examined overall debt, and found that it varied by only a small amount between expansion and non-expansion states.

Note that this is a 40 percent reduction in total medical debt. Since Medicaid is available only to the poor, it’s a good bet that it’s reduced the medical debt of the poor by considerably more than 40 percent.

Read his post, which includes links.

Written by LeisureGuy

22 July 2017 at 2:10 pm

Quote of the Day: “I can’t even remember why I opposed it”

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Kevin Drum posts:

From Patrick Murphy, owner of Bagel Barrel in Doylestown, Pennsylvania, on why he doesn’t want Obamacare repealed:

I can’t even remember why I opposed it. Everybody needs some sort of health insurance.

I also was struck by the comment. You’d think that if something was so important to a person that they actively opposed it, they would remember their reasons for opposing it. It was a big deal, and the opposition was bitter—and they don’t know why they opposed it?!

Drum provides one answer in his post:

Answer: he opposed it because movement conservatives in the richest country in all of human history created a hysterical atmosphere of cultural doom and fiscal annihilation surrounding the idea of providing a minimal level of health coverage for everyone. Why did they do it? Why do they continue to do it? Even after seven years, I’m not sure I truly know.

Truly I cannot understand the conservative “mind,” using the term loosely. It seems quite obvious that a country has a strong interest in ensuring that its people are healthy and educated, and to that end a sensible country provides healthcare and education, figuring that these, if done well, will provide benefits (including national productivity) far beyond their cost. But the opposition was clearly irrational and driven in part by a hatred of the poor.

Drum includes the results in Oregon of the modest step toward universal healthcare that Obamacare made:

Why would anyone oppose this?

 

 

Written by LeisureGuy

21 July 2017 at 10:38 am

Posted in Government, Healthcare

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