Later On

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Archive for the ‘Healthcare’ Category

Bret Baier of Fox News gets a surprise at Bernie’s town hall

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It’s worth clicking to watch the 20-second video:

 

Written by LeisureGuy

16 April 2019 at 7:30 pm

Is the Republican party really the healthcare party?

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Written by LeisureGuy

11 April 2019 at 2:49 pm

Apparently Republicans don’t like sick Americans

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Kevin Drum writes at Mother Jones:

Apparently we are going to have to endure a 2020 presidential campaign in which Donald Trump, yet again, promises that Republicans will pass the awesomest health care plan the world has ever seen—just as soon as they’re returned to power. Back in the real world, here’s what’s actually happening:

There used to be a lot of health insurance horror stories like Charley Butler’s.

After the Montana truck driver was diagnosed with testicular cancer in 2016, his insurer balked at paying tens of thousands of dollars in medical bills and then moved to cancel his coverage over a preexisting medical condition. These practices were largely banned by the Affordable Care Act, or Obamacare, which set new national health insurance standards to protect consumers and bar discrimination based on preexisting conditions.

But as the Trump administration has pushed to relax many of these rules, skimpier short-term health plans like the one Butler bought are roaring back, threatening to subject consumers to many of the ordeals patients endured before the healthcare law.

Short-term health plans, a creature given new life recently by Republicans, are basically a scam:

In many cases, consumers don’t even think to ask if plans cover preexisting medical conditions, said Dania Palanker of the Georgetown University Center on Health Insurance Reforms. “We are at a point now where people assume that all health insurance covers preexisting conditions,” Palanker said. “In the same way, you wouldn’t think to ask if a new car you are buying has seat belts.”

Thanks to Obamacare, everyone just assumes that every health plan covers preexisting conditions. Republicans, of course, all swear on their mothers’ graves that they, too, want every plan to cover preexisting conditions. They’re practically insulted if anyone suggests otherwise. And yet, they’re hellbent on killing Obamacare. Short of that, they’re hellbent on undermining it, ensuring that crappy, short-term health plans don’t have to cover things like preexisting conditions. What a bunch of assholes.

Written by LeisureGuy

2 April 2019 at 4:17 pm

The Worse Things Are, the Better They Are for Trump

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All who work for him say that Donald Trump loves chaos. David Graham looks at what happens when Trump takes that love into the White House:

President Donald Trump has spent time recently attacking socialists, which makes it all the more peculiar how closely his recent moves on immigration and health care echo Vladimir Lenin.

Not in their specifics, of course. The Bolshevik leader would have favoredgreater government control of health care, and in 1913 he delighted in that era’s equivalent of Latin American immigration to the United States: “American capitalism is tearing millions of workers of backward Eastern Europe out of their semi-feudal conditions and is putting them in the ranks of the advanced, international army of the proletariat.”

But Trump and Lenin share a strategic instinct. Lenin reportedly said, “The worse, the better”—meaning that conditions that were more miserable for the people were likely to help his political aims. Trump’s approach to immigration and health care, both in the past few days and throughout his presidency, evince a similar understanding of power. My colleague Adam Serwer has argued that the cruelty of many of Trump’s policies is the point. In some cases, however, the point may be making things worse to his benefit.

Last week, the president announced plans to end assistance to the Northern Triangle countries of Guatemala, Honduras, and El Salvador. “No money goes there anymore,” Trump said Friday. “We’re giving them tremendous aid. We stopped payment.” The move affects about $450 million, according to The New York Times, including money to support law-enforcement efforts against gangs. The actual cash is a minimal amount—a little less than 8 percent of the $5.7 billion Trump demanded for his border wall when he shut down the government in December, and less than 2 percent of the $25 billion the administration estimates the wall would cost overall.

The fact that the aid numbers are small doesn’t justify spending them per se, but there’s a strong consensus among Latin America experts that these cuts are counterproductive. It’s common to talk about push and pull factors in immigration. Pull factors are things that draw migrants to a new country: the promise of better work, for example. Push factors are those things that drive migrants to leave home: unstable politics, high crime, poor economies. Trump has worked to reduce one pull factor by trying to make it harder to get asylum, but he has limited options beyond that, because no president wants to make the economy worse in order to deter immigration (though Trump has been willing to risk hurting the economy to install protectionist tariffs).

But Trump’s decision to cut aid to countries that are major sources of immigrants to the United States seems likely to only increase the push factors, driving more people to attempt the journey as conditions in their home countries stagnate or worsen. As my colleague Peter Beinart writes, push factors have been badly overlooked in the U.S. political debate over immigration. There’s not much to suggest that Trump disagrees about the likely effects of cutting aid. Maybe he doesn’t care, or maybe he’s neglected to learn, which would fit with his general approach to policy.

Perhaps more likely is that increasing push factors is the point. Many of Trump’s decisions on border issues seem designed not to solve any problem. This includes Trump’s standing threat to close the border with Mexico; his decision to end DACA, a program that he has said achieves goals he favors; and most prominently, his decision to separate unauthorized immigrant familiesarriving at the border. None of these do anything to solve or reduce what Trump has called a crisis at the border. In fact, they are likely to only worsen the crisis. Separations, for example, became a costly and distracting circus, taking up already short space in detention centers and then necessitating a major effort to reunite families and restore the status quo ante when courts predictably rejected the policy.

Along similar lines, it’s more politically useful for Trump to be in a lengthy fight about building a border wall than it is to have actually built it. If and when the wall is built, it will become clear that it isn’t a panacea for immigration, but in the meantime, it’s a useful political wedge. The more migrants are coming toward the United States, the more Trump can warn of an “invasion” and inflame nativist fears that he thinks will help him win reelection. Trump isn’t really interested in solving immigration. A permanent crisis is more useful to him.

The same dynamic holds true on Obamacare. Last week, the White House told a federal appeals court that the Affordable Care Act should be thrown out entirely. Trump then announced that he was calling on Congress to produce a replacement for the law. The decision was reportedly made over the objectionsof Trump’s attorney general and secretary of health and human services, and it has received a chilly reception from Senate Majority Leader Mitch McConnell.

When the GOP controlled Congress in 2017 and 2018, it tried at length to repeal Obamacare and failed, and there’s no chance a Democratic House will be amenable to rescinding or replacing the law. In the absence of legislative movement, Trump has worked to weaken the ACA throughout his presidency. He has cut back on outreach and advertisement, slashed subsidies, supported repeal of the individual mandate, and enabled so-called association health plans, which a judge struck down last week, calling them “clearly an end-run” around the law.

The cynicism of Trump’s latest move on the ACA runs deep. The administration still doesn’t have any plan for what it actually wants to do on health care. Meanwhile,  . . .

Continue reading.

Written by LeisureGuy

1 April 2019 at 3:12 pm

Portugal’s Path to Breaking Drug Addiction

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Rob Waters has a very interesting article in Craftsmanship magazine. It begins:

For the past 50 years, Italy, Portugal and the United States have taken radically different approaches to drug enforcement and to the epidemics of drug use and addiction that have afflicted each country. One, the U.S., has emphasized punishment. It leads the world in incarcerating people—and at burying them after drug overdoses. Another, Portugal, has decriminalized drugs and created a model for effective drug treatment. Italy, meanwhile, has veered wildly between these two poles, never settling on a clear approach.

This is the story of how Portugal has dealt with its drug problems and largely succeeded, while the U.S. and Italy, despite pockets of success—like the San Patrignano rehabilitation community in northern Italy described in another article in this issue—have mostly failed.

For all three countries, the modern epidemic of hardcore drugs began with a dramatic rise in the use of heroin. In the U.S., heroin use surged during the Vietnam War, as American soldiers experimented with Southeast Asian heroin and many became addicted. When they came home, drug syndicates saw a market and filled it, putting large quantities of heroin onto the streets of U.S. cities.

Heroin came to Italy in the mid-1970s and its use grew rapidly, striking all social classes. By the late 1980s, Milan alone had an estimated 100,000 heroin users, according to a 1989 article in the New York Times, which noted that in 1988,  809 Italians died of overdoses.

At its peak in the late 1990s, Portugal had one of the highest rates of heroin addiction and fatal overdoses in the world. About one percent of Portugese people were using heroin and one person a day was dying of an overdose—in a country of just 10 million. Then Portugal changed course and took a radical step, eliminating criminal penalties for drug use and possession and making a commitment to provide treatment to all who want it. Today, Portugal has arguably the world’s most enlightened set of drug policies.

As in the U.S., Portugal’s heroin experience began with war. Throughout the 1960s and early 1970s, Portugal deployed hundreds of thousands of soldiers to suppress uprisings in the country’s African colonies. Like the Americans’ experience in Vietnam, these soldiers were exposed to marijuana and other drugs. Then, in 1974, a military coup struck Portugal, followed by a peaceful popular uprising (the “Carnation Revolution”). Almost overnight, decades of rule by a right-wing dictatorship were brought to an end.

A young doctor named João Goulão was then working in the Algarve area of southern Portugal. He had a front-row seat to what happened next.

“Suddenly almost a million soldiers and settlers came back to the mainland, bringing literally tons of cannabis, and there was an explosion of experimentation,” Goulão, who now runs the country’s drug agency, told me in a recent interview. Portugal at the time was going through an extraordinary upheaval, creating a new government and new laws. Young people and returning soldiers savored their new freedom by experimenting with drugs as marijuana, heroin, cocaine and LSD flooded in. “We were completely naïve about drugs,” says Goulão, “and completely unprepared to deal with it.”

FROM BAD TO WORSE

In a flash, Portugal went from having one of the lowest rates of drug use among European countries to having perhaps the highest. The biggest problem was heroin.

“Heroin spread very fast and among all social groups,” says Goulão. “It was not something that happened only among marginalized people and minorities, or in ghettoes. Suddenly everybody knew someone who had problems with drugs.”

As heroin use grew, so did overdoses. Doctors and public health professionals throughout the country began setting up treatment programs. After his daughter died of an overdose, the Minister of Justice set up treatment centers in three large cities. Private programs popped up as well, but Goulão says most were of poor quality and many ripped off the patients and families who came to them for help.

These efforts amounted to Band-Aids, not a concerted national policy. The number of providers and treatment programs kept growing but heroin use grew even faster. The sharing of needles also spread AIDS, adding to the death toll. With drug possession and sales seen as crimes, the prison population soared. And since drugs circulated widely within prisons, it had little effect on the underlying problem.

“People could spend two or three years in jail and come back worse than when they went there,” says Goulão. “The situation was getting worse every day.”

STEP ONE: DECRIMINALIZATION

In 1998, Portugal Prime Minister António Guterres, (now secretary-general of the United Nations) convened a group of nine experts—judges, psychologists and health professionals including Goulão—to develop a national strategy for addressing the crisis. The group visited other European countries, interviewed professionals and researched different approaches. In the end, they concluded they could do relatively little to address the supply of drugs—but could do a lot to address the demand.

The committee developed a set of concrete proposals focused largely on “prevention, treatment, harm reduction, and the reintegration of people,” Goulão says. “All of it was based in the idea that we were dealing with a health and social condition rather than a criminal one.”

The committee’s most radical proposal was to eliminate criminal penalties for the use and possession of drugs. Government leaders accepted the proposal but it also required the approval of Parliament. So Goulão and his colleagues took their case to the public and spent the next year presenting their plan in dozens of forums and discussions.

Their proposal was opposed by right-wing parties and Goulão remembers their arguments: “Portugal will become a paradise for drug addicts and drug users from all over the world. We will have planes coming to Lisbon every day with people to use drugs. Our children will start using drugs at early ages.”

But support from the public and, surprisingly, from the Catholic Church carried the day—in 2001, Parliament passed the sweeping changes. “Using drugs in Portugal was no longer a crime,” Goulão says.

STEP TWO: MULTIPLE OPTIONS FOR TREATMENT

Today, some 40 programs in Portugal provide detoxification and long-term treatment, with 1600 beds in residential treatment programs known as “therapeutic communities,” Goulão says. Most are run by nonprofit agencies, under contract with the government. They employ a variety of treatment approaches, but all must provide  . . .

Continue reading.

Written by LeisureGuy

29 March 2019 at 4:58 pm

The human cost of the Republican party and the Trump administration

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From today’s “Daily 202” in the Washington Post:

— Two rulings issued last night by the federal district court in D.C. illustrate the human dynamics that make it so incredibly difficult to cut holes in the safety net. Judge James Boasberg threw sand in the gears of the Trump administration’s campaign to compel poor people who depend on Medicaid to hold jobs in exchange for health benefits. For the second time, he rejected Kentucky’s work requirement program and declared the rules that recently took effect in Arkansas “cannot stand.”

Boasberg, an Obama appointee, said Health and Human Services Secretary Alex Azar behaved in an “arbitrary and capricious” manner when he signed off on the plans without considering the human impact and the intent of Congress when it established Medicaid. While his rulings technically apply only to the two states, they could also impact six other states that have received permission from the Trump administration to begin work requirements and seven other states that have applications pending.

The judge opened his 35-page Arkansas decision with an anecdote about one of the approximately 18,000 people who were denied coverage between September and December for failing to comply with the state’s new requirements.

“Adrian McGonigal is 40 years old and lives with his brother in Pea Ridge, Arkansas,” Boasberg wrote. “He used to have a job working in the shipping department of Southwest Poultry, a food-service company located nearby, although he received no medical insurance through his employer. Like many Americans, he has several serious medical conditions. Beginning in 2014, McGonigal was able to receive medical care — including regular doctor visits and numerous prescription drugs — through the state’s expanded Medicaid program. In mid-2018, however, McGonigal learned that he would be subject to new work requirements. …

“Despite his lack of access to, and difficulty working with, computers, he was able to report his employment in June 2018, but he did not know he needed to continue to do so each month. As a result, when he went to pick up his prescriptions in October, the pharmacist told him that he was no longer covered, and his medicines would cost him $800. In the absence of Medicaid, he could not afford the cost of the prescriptions and so did not pick them up. His health conditions then flared up, causing him to miss several days of work, and Southwest Poultry fired him for his absences. He thus lost his Medicaid coverage and his job.”

— My colleague Amy Goldstein, coincidentally, published a powerful piece yesterday morning from the small town of Marianna, Ark., about how hard it is for poor people in a job-starved region to comply with rules that may sound easy to you but turn out to be quite onerous: “Computers are so scarce that even the public library has a sign out front saying it does ‘not offer the Internet’ — a problem for the work requirement’s first several months, when people could not yet phone in their monthly reports.” Amy’s story includes these two particularly evocative examples:

Elizabeth Cloinger, 47, who lives in a trailer next to her cousin’s house just outside town, thought she was complying with the new rules. She has been on Medicaid for years and already had a job, working seven days most weeks as a home health aide. Her wages — 9.25 an hour, with 50 cents more for hospice patients — and her hours met the new rules. Yet she received a June letter saying she needed to verify that her income made her eligible, or she would be cut off.

“She called the listed phone number and faxed information to a state employee in Pine Bluff. She was told that, like many people, she was exempt from the work requirements — in her case, because she was caring for her 20-year-old daughter recovering from a car accident and her 3-year-old granddaughter. But on Aug. 18, she received another letter, saying she had been terminated because she had not verified her income. In December, four letters arrived saying she needed to update her email address, then 11 more in January. Each letter told her to create an online account. She doesn’t have a computer and didn’t realize that the program requires everyone to get an email address.

“In all these months, Cloinger hasn’t seen a doctor for the swelling in her right foot, which makes it hard to stand for long. Nor has she addressed the throbbing around the scar from her hysterectomy two years ago. ‘I won’t go’ to the doctor, she said, having just finally paid off — in $10 monthly installments — a hospital bill for the X-rays she needed for a torn tendon before she got onto Medicaid. ‘I am just putting it in God’s hands,’ Cloinger said. ‘He is going to let me stay on this Earth to see my grandbaby be raised.’”

Conisha Gatewood, 31, also got caught up in the confusion. She was referred to an obstetrician-gynecologist for nonstop menstrual bleeding caused by ovarian cysts: “But when she arrived for a September checkup, she was told she no longer had insurance. ‘I was like: ‘Yes, I do. They sent me the papers in June.’’’ She thought she had done everything right, creating a password and an online account. The state had used an automated system to fill in her child-care job and work hours. A letter from the state confirmed that, she thought, telling her she did not need to search for a job because she already worked. But then another letter came, telling her she needed to do a job search after all. ‘I was so confused,’ Gatewood said. ‘I already had a job. No one could tell me what I needed to do.’

“By the time she was cut off, she had found a better-paying position, selling cellphones inside a Walmart. In January, she reapplied to Arkansas Works — and was rejected because her December phone sales, high for the holidays, put her just over the income limit. She should go to her doctor this month, but she hasn’t made an appointment. She has also stopped filling prescriptions, including for the birth control pills that correct her bleeding.”

Written by LeisureGuy

28 March 2019 at 1:49 pm

I think it’s starting to dawn on Republican Senators that President Trump is batshit crazy

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Alexander Bolton reports in The Hill:

Republican lawmakers were caught completely off guard by President Trump’s renewed push to repeal and replace ObamaCare and privately complain it’s a dumb political strategy heading into the 2020 election.

Senate Finance Committee Chairman Chuck Grassley (R-Iowa), whose panel has jurisdiction over health care, said he received no heads-up from Trump or the White House that the president would call Tuesday for the GOP to become “the party of health care.”

“I don’t think there was any heads-up on anything that he was going to say,” said Grassley, who added that he didn’t even know Trump was meeting with the GOP conference on Tuesday until Monday night.

Sen. Lamar Alexander (R-Tenn.), the chairman of another key panel that handles health care, said he didn’t know about Trump’s new health care push until the president tweeted about it at 11:58 a.m. Tuesday, shortly before he walked into a Republican conference lunch to announce it in person.

If Trump had told GOP senators of his plans, they say they would have sought to convince him not to throw their party back into a war over health care — the issue Democrats believe was instrumental to their takeover of the House in last year’s midterms.

A safe 2018 Senate map that had Republican incumbents defending just a handful of seats and Democrats trying to protect senators in deep-red states helped the GOP overcome the blue wave in the House. Republicans actually gained two seats in the Senate.

But the 2020 map is seen as more challenging, and many in the GOP can’t understand why Trump would plunge them into a fight over health care just as he was surfing a wave of good news brought by the end of special counsel Robert Mueller’s investigation.

“It doesn’t seem to make sense politically,” said one Republican senator, who questioned why Trump would give Democrats a new avenue of attack.

Another Republican senator said, . . .

Continue reading.

Later in the article, the bit that justifies my use of “batshit crazy” terminology:

The lawmaker said Trump is “throwing down a challenge in advance of the elections which makes it even more difficult,” describing the current politic environment as “toxic” for passing ambitious legislation.

“If you look at past history, we don’t really know how to do it,” the senator added, referring to broad health care legislation.

McCarthy urged Trump in a phone call to drop his administration’s effort to have the law struck down in the courts, arguing the strategy makes little sense after Democrats won control of the House in November after campaigning on health care, according to reports Wednesday by Axios and The Washington Post.

Trump, nevertheless, doubled down on his position Wednesday. He defended the Justice Department’s argument for striking down the law he called a “disaster,” arguing that it had sent premiums soaring and has turned out to be “far too expensive for the people, not only for the country.”

“If the Supreme Court rules that ObamaCare is out, we’ll have a plan that is far better than ObamaCare,” the president promised at the White House on Wednesday.

Written by LeisureGuy

27 March 2019 at 4:52 pm

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