Archive for the ‘Healthcare’ Category
An extremely ominous sign: Republicans are avoiding constituents angry about the Affordable Care Act repeal
When Congress actively avoids the people that members of Congress are supposed to represent and whose interests the member of Congress is supposed to protect, the government becomes separated from the people. It’s no longer government for the people, and it’s no longer government by the people. I suppose it’s still a government “of” the people, but only some of the people: the wealthy and powerful and corporate, whose interests are primary to many members of Congress, and much more important than the interests of their constituents.
Matthew Rozsa writes in Salon:
The same Republican politicians who are planning to repeal the Affordable Care Act are doing everything they can to avoid potentially embarrassing confrontations with their constituents who will be affected by their actions.
Although 10 Republican legislators have held in-person town hall meetings since the start of the year, only one — Rep. James F. Sensenbrenner, R-Wisconsin — has scheduled any events for the future, according to The Washington Post.
“In this day and age, real-life town halls are very dangerous for all but the most seasoned politicians,” John Feehery, a former senior House Republican leadership aide, told the Post. “I think John McCain can get away with it and a few others, but most should stick to office hours, really good constituent service or tele-town halls.”
There are already signs that Republican congressmen would experience a major backlash if they faced their constituents. Rep. Mike Coffman of Colorado had to exit an event on Saturday from a backdoor due to chanting protesters. Rep. Cathy McMorris Rodgers of Washington faced shouts of “save our health care” during an event in her district on Monday. And — perhaps most memorable — on Friday House Speaker Paul Ryan of Wisconsin was confronted on a national cable show by a cancer survivor who insisted that the Affordable Care Act had saved his life.
Republicans have a great deal to lose if they repeal the Affordable Care Act without setting up a replacement plan to protect the 22 million Americans who would otherwise lose their health insurance. There are 6.3 million people in Republican-led districts who enrolled due to the marketplaces established by the Affordable Care Act — compared with only 5.2 million enrollees who reside in Democratic-led districts. . .
Paul Krugman blogs at the NY Times:
Another week of complete chaos on the health reform front. Dear Leader declares that he’ll give everyone coverage; Republicans explain that he didn’t mean that literally. CBO says the obvious, that repealing the ACA would lead to immense hardship for tens of millions; Republicans declare that this is wrong, because they will come up with an alternative any day now — you know, the one they’ve been promising for 7 years.
I’ve written about all of this many, many, many times. The logic of Obamacare — the reason anything aiming to cover a large fraction of the previously uninsured must either be single-payer or something very like the ACA — is the clearest thing I’ve seen in decades of policy discussion. But I don’t know if I’ve ever written out the fundamental principles that lie behind all of this.
So here we go: providing health care to those previously denied it is, necessarily, a matter of redistributing from the lucky to the unlucky. And, of course, reversing a policy that expanded health care is redistribution in reverse. You can’t make this reality go away.
Left to its own devices, a market economy won’t care for the sick unless they can pay for it; insurance can help up to a point, but insurance companies have no interest in covering people they suspect will get sick. So unfettered markets mean that health care goes only to those who are wealthy and/or healthy enough that they won’t need it often, and hence can get insurance.
If that’s a state of affairs you’re comfortable with, so be it. But the public doesn’t share your sentiments. Health care is an issue on which most people are natural Rawlsians: they can easily imagine themselves in the position of those who, through no fault of their own, experience expensive medical problems, and feel that society should protect people like themselves from such straits.
The thing is, however, that guaranteeing health care comes with a cost. You can tell insurance companies that they can’t discriminate based on medical history, but that means higher premiums for the healthy — and you also create an incentive to stay uninsured until or unless you get sick, which pushes premiums even higher. So you have to regulate individuals as well as insurers, requiring that everyone sign up — the mandate, And since some people won’t be able to obey such a mandate, you need subsidies, which must be paid for out of taxes.
Before the passage and implementation of the ACA, Republicans could wave all this away by claiming that health reform could never work. And even now they’re busy telling lies about its collapse. But none of this will conceal mass loss of health care in the wake of Obamacare repeal, with some of their most loyal voters among the biggest losers.
What they’re left with is . . .
Jason Kottke blogs:
I posted earlier about Atul Gawande’s piece in the New Yorker on the importance of incremental care in medicine. One of the things that the Affordable Care Act did was to make it illegal for insurance companies to deny coverage to people with “preexisting conditions”, which makes it difficult for those people to receive the type of incremental care Gawande touts. And who has these preexisting conditions? An estimated 27% of US adults under 65, including Gawande’s own son:
In the next few months, the worry is whether Walker and others like him will be able to have health-care coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.
That’s 52 million people, potentially ineligible for health insurance. And that’s not counting children. Spurred on by Gawande, people have been sharing their preexisting conditions stories on Twitter with the hashtag #the27Percent.
The 27% figure comes from a recent analysis by the Kaiser Family Foundation:
A new Kaiser Family Foundation analysis finds that 52 million adults under 65 — or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act.
In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%).
36% uninsurable in West Virginia! You’ll note that all 11 of those states voted for Trump in the recent election and in West Virginia, Trump carried the day with 68.7% of the vote, the highest percentage of any state. The states whose people need the ACA’s protection the most voted most heavily against their own interest.
Oh and one last thing. . .
Atul Gawande suggests in his New Yorker article that medicine is barking up the wrong tree.
By 2010, Bill Haynes had spent almost four decades under attack from the inside of his skull. He was fifty-seven years old, and he suffered from severe migraines that felt as if a drill were working behind his eyes, across his forehead, and down the back of his head and neck. They left him nauseated, causing him to vomit every half hour for up to eighteen hours. He’d spend a day and a half in bed, and then another day stumbling through sentences. The pain would gradually subside, but often not entirely. And after a few days a new attack would begin.
Haynes (I’ve changed his name, at his request) had his first migraine at the age of nineteen. It came on suddenly, while he was driving. He pulled over, opened the door, and threw up in someone’s yard. At first, the attacks were infrequent and lasted only a few hours. But by the time he was thirty, married, and working in construction management in London, where his family was from, they were coming weekly, usually on the weekends. A few years later, he began to get the attacks at work as well.
He saw all kinds of doctors—primary-care physicians, neurologists, psychiatrists—who told him what he already knew: he had chronic migraine headaches. And what little the doctors had to offer didn’t do him much good. Headaches rank among the most common reasons for doctor visits worldwide. A small number are due to secondary causes, such as a brain tumor, cerebral aneurysm, head injury, or infection. Most are tension headaches—diffuse, muscle-related head pain with a tightening, non-pulsating quality—that generally respond to analgesics, sleep, neck exercises, and time. Migraines afflict about ten per cent of people with headaches, but a much larger percentage of those who see doctors, because migraines are difficult to control.
Migraines are typically characterized by severe, disabling, recurrent attacks of pain confined to one side of the head, pulsating in quality and aggravated by routine physical activities. They can last for hours or days. Nausea and sensitivity to light or sound are common. They can be associated with an aura—visual distortions, sensory changes, or even speech and language disturbances that herald the onset of head pain.
Although the cause of migraines remains unknown, a number of treatments have been discovered that can either reduce their occurrence or alleviate them once they occur. Haynes tried them all. His wife also took him to a dentist who fitted him with a mouth guard. After seeing an advertisement, she got him an electrical device that he applied to his face for half an hour every day. She bought him hypnotism tapes, high-dosage vitamins, magnesium tablets, and herbal treatments. He tried everything enthusiastically, and occasionally a remedy would help for a brief period, but nothing made a lasting difference.
Finally, desperate for a change, he and his wife quit their jobs, rented out their house in London, and moved to a cottage in a rural village. The attacks eased for a few months. A local doctor who had migraines himself suggested that Haynes try the cocktail of medicines he used. That helped some, but the attacks continued. Haynes seesawed between good periods and bad. And without work he and his wife began to feel that they were vegetating.
On a trip to New York City, when he turned fifty, they decided they needed to make another big change. They sold everything and bought a bed-and-breakfast on Cape Cod. Their business thrived, but by the summer of 2010, when Haynes was in his late fifties, the headaches were, he said, “knocking me down like they never had before.” Doctors had told him that migraines diminish with age, but his stubbornly refused to do so. “During one of these attacks, I worked out that I’d spent two years in bed with a hot-water bottle around my head, and I began thinking about how to take my life,” he said. He had a new internist, though, and she recommended that he go to a Boston clinic that was dedicated to the treatment of headaches. He was willing to give it a try. But he wasn’t hopeful. How would a doctor there do anything different from all the others he’d seen?
That question interested me, too. I work at the hospital where the clinic is based. The John Graham Headache Center, as it’s called, has long had a reputation for helping people with especially difficult cases. Founded in the nineteen-fifties, it now delivers more than eight thousand consultations a year at several locations across eastern Massachusetts. Two years ago, I asked Elizabeth Loder, who’s in charge of the program, if I could join her at the clinic to see how she and her colleagues helped people whose problems had stumped so many others. I accompanied her for a day of patient visits, and that was when I met Haynes, who had been her patient for five years. I asked her whether he was the worst case she’d seen. He wasn’t even the worst case she’d seen that week, she said. She estimated that sixty per cent of the clinic’s patients suffer from daily, persistent headaches, and usually have for years. . .
The first time the sugar industry felt compelled to “knock down reports that sugar is fattening,” as this newspaper put it, it was 1956. Papers had run a photograph of President Dwight D. Eisenhower sweetening his coffee with saccharin, with the news that his doctor had advised him to avoid sugar if he wanted to remain thin.
The industry responded with a national advertising campaign based on what it believed to be solid science. The ads explained that there was no such thing as a “fattening food”: “All foods supply calories and there is no difference between the calories that come from sugar or steak or grapefruit or ice cream.”
More than 60 years later, the sugar industry is still making the same argument, or at least paying researchers to do it for them. The stakes have changed, however, with a near tripling of the prevalence of obesity in the intervening decades and what the Centers for Disease Control and Prevention figures reveal to be an almost unimaginable 655 percent increase in the percentage of Americans with diabetes diagnoses. When it comes to weight gain, the sugar industry and purveyors of sugary beverages still insist, a calorie is a calorie, regardless of its source, so guidelines that single out sugar as a dietary evil are not evidence-based.
Another way to say this is that what we eat doesn’t matter; it’s only how much — just as the sugar industry would have us believe. A 2014 article in an American Diabetes Association journal phrased the situation this way: “There is no clear or convincing evidence that any dietary or added sugar has a unique or detrimental impact relative to any other source of calories on the development of obesity or diabetes.”
The absence of evidence, though, as the saying goes, is not necessarily evidence of absence. If the research community had been doing its job and not assuming since the 1920s that a calorie is a calorie, perhaps we would have found such evidence long ago.
The assumption ignores decades of medical science, including much of what has become textbook endocrinology (the science of hormones and hormone-related diseases) and biochemistry. By the 1960s, researchers in these fields had clearly demonstrated that different carbohydrates, like glucose and fructose, are metabolized differently, leading to different hormonal and physiological responses, and that fat accumulation and metabolism were influenced profoundly by these hormones. The unique composition of sugar — half glucose, half fructose — made it a suspect of particular interest even then.
The takeaway is . . .
Paul Waldman looks back down memory lane:
At his CNN town hall yesterday, Paul Ryan met a man named Jeff Jeans, a lifelong Republican and small business owner who not long ago got a cancer diagnosis. He didn’t have insurance at the time and was told that without treatment he’d have only six weeks to live.
“Thanks to the Affordable Care Act, I’m standing here today alive,” he said. “I want to thank President Obama from the bottom of my heart, because I would be dead if it weren’t for him.”
Let’s not mince words: If Paul Ryan and the rest of the Republicans in Congress get their way, people like Jeff Jeans will die.
That sounds like hyperbole, like unnecessarily inflammatory rhetoric. But it’s the truth. These are literally life-and-death questions Congress is deciding.
There are a lot of reasons why repealing the ACA is going to be a disaster. But for now I want to focus on just one: what’s going to happen to the estimated 52 million Americans who have pre-existing conditions, like Jeff Jeans?
To begin, let’s remember what it was like before the ACA was passed. When you applied for insurance, you had to give a detailed accounting of every major medical procedure you’d ever had, every serious condition you’d ever had, every time you had sought treatment for anything for years prior. The insurer would comb over your application to see if there was any grounds on which they could reject you. That didn’t just apply to people with chronic conditions like diabetes or a major illness like cancer. In the bad old days, insurers could deny you coverage for anything. Tore some cartilage in your knee on the basketball court a few years ago? Denied. Had sinus problems? Denied. Carpal tunnel? Denied. If you were lucky, they’d cover you but just refuse to pay for anything remotely related to your old condition or that particular body part.
And when you did get sick, they’d sometimes undertake a “recission,” in which they went back through your records to see if there was any excuse they could use to cancel your policy now that you were going to cost them money. Check out this account from journalist Xeni Jardin, who was diagnosed with breast cancer before the ACA took effect. During one chemotherapy session, someone from the billing department pulled her aside and told her, “Your insurance company has opened a fraud investigation because they believe you had cancer as a pre-existing condition.” Imagine dealing with that while you’re fighting for your life.
Now here’s how getting insurance works today, with the Affordable Care Act in effect, if you have a pre-existing condition. See if you can follow along, because it’s pretty complicated:
You buy coverage. The insurer doesn’t ask you about your medical history. It’s covered. That’s all.
Here’s a list of some things that will return once they repeal the ACA: . . .
Continue reading. It’s pretty horrifying. And do read the whole thing. There’s quite a bit more.
This article ns the Observer is definitely worth reading. Ironically, the Observer is owned by Jared Kushner, Donald Trump’s son-in-law.