Archive for the ‘Healthcare’ Category
David Epstein of ProPublica explains the idea of the SRSLY series:
Welcome to SRSLY, an (experimental) newsletter highlighting under-exposed accountability journalism. We’ll distill the important information from investigative reporting you probably missed, and deliver it to you in three-minutes-or-less worth of reading. Sign up to have it delivered to your inbox. (You can, of course, unsubscribe at the first whiff of a bad joke.)
This one is worth reading:
Pearl S. Buck said that “our society must make it right for old people not to fear the young or be deserted by them, for the test of a civilization is in the way that it cares for its helpless members.” Hubert Humphrey put it differently, suggesting that “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life.” Figures from Gandhi to Winston Churchill weighed in similarly. Point being: a lot of people who are super good at quotes think we ought to treat the elderly with special respect. And, in a nice break from election news, there is some evidence we’re doing a bit of that. According to the Dallas Morning News, infractions for deficient care in nursing homes decreased by 8 percent nationally between 2010 and 2014. In Texas, however, infractions increased 20 percent over that same period. Your four Ws:
… the heck is going on with Texas?? (And I’m not just asking because the Washington Post reported that it’s now a swing state. If you saw that one coming, time for a vacay to Vegas.) The Dallas Morning News reported that Texas’s 1,200 nursing homes also reported 3 percent more “severe deficiencies” in nursing home care from 2010 to 2014 — the kind that might lead to serious injury of residents — while the national number declined 16 percent.
The usual suspect: money. The new figures come from a report commissioned by the Texas Health Care Association, a trade group for nursing homes, which is concerned about a “crisis” in state funding. The Morning News reported that this is particularly notable, given the association’s “traditional reticence” to openly discuss nursing home inspections. Nearly 70 percent of the state’s nursing home residents are on Medicaid and Texas Medicaid reimbursements “are near the bottom in the U.S.” The lack of funding has left Texas nursing home residents with less attention from staff than is the case in other states. Texas nursing home residents get 3.59 hours of attention from staff per day, compared to 4.64 hours in Florida, which has far fewer “immediate jeopardy” infractions, the kind that “if unabated, will cause serious harm or death,” the Morning News says.
What now? . . .
Daniel Denvir reports in Salon:
What liberal media? Nowhere is the false balance of mainstream media reporting more apparent than in coverage of the relentless Republican obstruction in Congress.
The latest episode: Republicans are refusing to pass a $1.1 billion package to fight the Zika virus unless it blocks Planned Parenthood from receiving funding. Yesterday’s New York Times print headline? “Senate Democrats Again Stymie Funding for Zika.”
This is false. Democrats are happy to support funding the Zika fight, which might soon run out of money for crucial measures like mosquito-control programs in Puerto Rico. It is Republicans who have made Zika funding the latest hostage to their crusade to defund Planned Parenthood.
Balance is often false because facts have a bias. Sometimes, reporters try to split the baby, suggesting that both parties have equal blame for gridlock even when this is untrue. (From June: “Whichever side is more to blame, it was clear that no new government funds would be approved to fight the Zika . . .”). In this case, however, The Times is apparently accepting the Republican premise that stigmatizing reproductive health as something other than a basic part of medicine is somehow related to Zika. It’s not.
According to the relevant experts at the American Congress of Obstetricians and Gynecologists, reproductive health should be considered a basic feature of normal health care. What’s holding up the passage of Zika funding is that Republicans want to ensure that it’s not.
As has been long the case with the news coverage of issues like global warming, government shutdowns and voter identification, reporting on the politics of reproductive health shoves expert opinions to the sidelines. Instead, it not only gives readers the false impression that all sides are putting forth an opinion that has equal empirical weight but also fails to honestly evaluate the nature of the conflict at hand. I get that the Times can’t assert as fact that the anti-abortion movement is a wrongheaded and religiously inspired effort to control women’s bodies in its news section. But the Times can make it clear that it is Republican opposition to abortion and Planned Parenthood that is holding up Zika funding and not Democrats.
Journalism about politics becomes reduced to theater criticism.
That’s a damn good question and I would say that as the Democratic Party becomes increasingly dependent on the economic elites, the economic elites have an ever stronger voice in setting policy. In other words, Bernie Sanders really was an anomaly and Hillary Clinton and the Democratic Establishment are Republican Lite.
That was my initial take, but it turns out that I was completely wrong in this case. Read Edwar Zelinsky’s explanation in the OUP Blog:
The Democratic Party platform for 2016 repudiates a major provision of Obamacare – but no one has said this out loud. In particular, the Democratic Party has now officially called for abolition of the “Cadillac tax,” the Obamacare levy designed to control health care costs by taxing expensive employer health plans.
Tucked away on page 35 of the Democratic platform is this enigmatic sentence: “We will repeal the excise tax on high-cost health insurance and find revenue to offset it because we need to contain the long-term growth of health care costs, but should not risk passing on too much of the burden to workers.”
Even by the problematic standards of current political rhetoric, this statement is equivocal. This sentence avoids the popular term for the levy imposed by Internal Revenue Code 4980I, the excise tax on “Cadillac” health plans. This sentence does not disclose that President Obama advocated the Cadillac tax “on high-cost health insurance” as an important provision to control health care costs. This sentence promises to replace the revenue to be raised by repeal of the tax without specifying how that replacement will happen. This sentence pays nominal obeisance to the need to control health care costs even as it calls for repeal of the provision of Obamacare most directly designed to control such costs.
The only unambiguous thought expressed in this sentence is that the Cadillac tax on high cost health plans must go.
Since the Republican Party opposed the tax all along (and managed to delay implementation of the tax until 2020), the Democratic platform makes clear that there is now a bi-partisan consensus to abolish the Cadillac tax.
What neither party wants to admit is the larger implication of their opposition to the Cadillac tax: Neither party is willing to adopt serious, practical measures to confront the problem of our nation’s continually rising health care costs.
The background to the Cadillac tax is now well-known. Section 106 of the Internal Revenue Code excludes from employees’ gross incomes the value of their employer-provided health care insurance. Section 106 was adopted in an earlier age, before health care costs became a major national problem.
Conservative and liberal commentators alike agree that Section 106 stimulates health care outlays by sheltering employees from the costs of their employer-provided health care coverage. These commentators generally acknowledge that the correct solution is to repeal Section 106, so that employees will report as income the health care premiums paid by their respective employers. This would sensitize employees to the costs of employer-provided health care coverage and thus force employees and employers to confront and control those costs.
Repealing or limiting Section 106 is a political nonstarter, the classic case of good policy which no elected official is willing to embrace. . .
Well worth reading: a blog post by Kevin Drum at Mother Jones.
Michael Winship writes at BillMoyers.com:
Cash and carry has become nothing more than standard operating procedure in politics and government, and it’s wrecking the republic. The whole system is rotten to the core, corrupted by big business and special interests from the seventh son to the seventh son.
Or daughter, as we learned these past few days when the news introduced us to Heather Bresch, CEO of a drug company called Mylan and daughter of Democratic US Sen. Joe Manchin III, who’s also the former governor of West Virginia.
Mylan manufactures and sells EpiPen, the emergency delivery system for an allergy drug, epinephrine, that can make the difference between life and sudden death. The cost for a two-pack of the devices has soared nearly 550 percent to $608.61. That’s a price far beyond the means of most families with kids threatened by possibly fatal allergic reactions.
At the same time, Bresch has seen her own compensation increase a whopping 671 percent, from $2,453,456 in 2007 (the year that Mylan bought EpiPen) to $18,931,068 in 2015.
She should resign for price gouging rather than get a raise, but like so many of her fellow executives Bresch sails serenely on as her fellow Americans drown in health care debt. Her career and the success of her company epitomize everything that so enrages every voter who believes that the fix is in and that the system is weighted in favor of those with big money and serious connections.
According to reports, Bresch got her first job at Mylan working in the factory basement, when her well-connected dad asked the company’s then-CEO, Milan Puskar, for a favor. Later, a scandal erupted when it was discovered that West Virginia University, which had received a $20 million donation from Puskar and whose president was a Manchin and Bresch family friend, had awarded her an MBA although she had not completed the required coursework.
The school president and other administrators were forced to resign, but Bresch survived the controversy and has done very well indeed in the pharmaceutical business, rising through the ranks and at the same time learning how to adroitly manipulate government and its regulations — lessons for which life in a successful political family with its network of friends and colleagues prepared her well.
For a time, she was Mylan’s chief lobbyist (working to help pass the 2003 Medicare prescription drug bill, among other legislation) and Anna Edney at Bloomberg Politics writes that “Mylan spent about $4 million in 2012 and 2013 on lobbying for access to EpiPens generally and for legislation, including the 2013 School Access to Emergency Epinephrine Act, according to lobbying disclosure forms filed with the Office of the Clerk for the House of Representatives. Mylan also was the top corporate sponsor of a group called Food Allergy Research & Education that was the key lobbyist pushing for the bill encouraging schools to stock epinephrine auto-injectors, of which EpiPen is by far the leading product.”
The company also took advantage of what President Obama has called an “unpatriotic tax loophole,” making a deal in 2014 with Abbott Laboratories to incorporate in the Netherlands — one of those infamous “inversions” that allow companies to pay a much lower tax rate abroad than here at home — even as they rake in profits from US taxpayer-subsidized programs like Medicare, Medicaid and veterans’ benefits. Political expedience and maybe embarrassment saw Joe Manchin denouncing his daughter’s inversion deal. But no one stopped it.
Like so many businesses eager to purchase politicians all their own, Mylan has made significant cash contributions to both sides of the aisle. Emmarie Huetteman at The New York Times reports, “Mylan’s political action committee has given at least $71,000 to congressional candidates from both parties this election cycle, according to the Center for Responsive Politics, with about 72 percent of those contributions going to Republicans.”
Dad got a taste, too: “It has been one of the biggest donors to Mr. Manchin since he joined the Senate in 2010, giving more than $60,000 in total.”
Mylan also has brushed up against . . .
Later in the article:
. . . And even at half-price, the cost of an EpiPen remains an outrage. In fact, some estimate that the dose of epinephrine used in the injector may really cost as little as a dollar.
In other words, this is one more, big old scam — yet another case of big business trying to pull the wool over the citizens’ eyes and pick our pockets while the government and our politicians mostly look the other way.
The Mylan mess is the cozy relationship between regulators and the regulated in a nutshell. Throughout government, politics and business, cash contributions are made, connections are used, strings are pulled and favors are requested and returned. So the system wins again, corrupt as hell.
But take notice . . .
Jon Schwarz reports at The Intercept:
There have been dozens if not hundreds of news articles about Aetna leaving the Affordable Health Care Act’s online marketplaces in eleven states, and whether this signals serious problems for Obamacare down the road.
But none of them have truly explained that what’s happening with Aetna is the consequence of a flaw built into Obamacare from the start: It permits insurance companies to make a profit on the basic healthcare package Americans are now legally required to purchase.
This makes Obamacare fundamentally different from essentially all systems of universal healthcare on earth. (There is one tiny exception, the Netherlands, but of the four insurance companies that cover 90 percent of Dutch citizens, just one is for profit.)
Why does this matter? The answer is complicated but extremely important if Obamacare is going to avoid collapsing.
Insurance companies like Aetna complain that fewer young people than anticipated are buying insurance on the exchanges. The Obama administration was aiming at over 38 percent of the exchange pool being between 18 and 35 years old, but right now that number is just 28 percent. That means insurers have to pay more in health costs for customers who are older and sicker than anticipated, making those insurers more likely to abandon the exchanges. So a big swath of the U.S. now has just one insurance company offering Obamacare plans, and one county in Arizona has none.
The failure of young people to sign up in expected numbers is connected to the weakness of the Obamacare mandate. The amount that people who don’t buy health insurance must pay in penalties started off very low, and while it’s increased, it’s still usually significantly less than the cost of even the cheapest plan on exchanges.
By contrast, in other countries with private health insurance, the government response is ferocious if you don’t buy the basic package. Switzerland will seize your wages to pay for the necessary insurance. If you get sick in Japan without buying insurance you have to come up with all your back premiums before your insurer will pay your medical bills.
It is, of course, technically feasible to set up something similar in the U.S. But it will never be politically feasible. That’s because there would, rightfully, be an intense political backlash if the government started garnishing our paychecks and sending the money to Aetna, whose CEO made $28 millionlast year.
In Healing America, probably the best book ever written about how different countries provide universal healthcare, T.R. Reid explains that . . .