Later On

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

Archive for the ‘Healthcare’ Category

Very interesting puzzle, equally interesting plan

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Kevin Drum explains all, with his usual flair. He’s the Fred Astaire of blog posts.

Written by LeisureGuy

14 March 2017 at 4:02 pm

Sen. Tom Cotton (R-AR) makes a lot of sense—never thought I’d write that.

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Jennifer Rubin’s post in the Washington Post is a must-read, but I’ll quote just the opening (and it gets better). And I always like to point out that Ms. Rubin is a conservative Republican (but with intelligence and principles):

If you think politicians should make cogent argument for their proposals, not cherry-pick facts; recognize economic and political realities, not lie about what they and their opponents say; and own up to the defects in their own proposals, you are probably very distressed — or cannot bear to watch the day’s events.

We’ve heard all sorts of nonsense from GOP leaders and White House press secretary Sean Spicer on Tuesday:

  • The Congressional Budget Office can predict the budget but not coverage numbers. (Actually, the coverage helps determine the budget numbers.)
  • The president never promised to cover everybody. (He did.)
  • There will be 60 votes for follow-on legislation that the GOP acknowledges is essential. (No Democrat in the Senate shows any interest whatsoever in any part of this.)
  • Then-House Speaker Nancy Pelosi (D-Calif.) said you’d have to pass the bill to find out what’s in it. (She in essence said you’d have to get away from the political noise to appreciate it.)
  • The Obamacare process was less transparent than the GOP’s has been. (The reverse is true. By a lot.)
  • The CBO number is ridiculous — except for the parts we like. (Need we say more?)
  • It’s the GOP bill or nothing. (Actually, not even Republicans agree, as we discuss below.)

The reason for the higher level of incoherence than normal is not hard to figure out. The Post reports:

Continue reading.


Written by LeisureGuy

14 March 2017 at 2:37 pm

They ain’t seen nothing yet: Remember the People America’s Healthcare System Has Already Killed

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Jason Koebler reports at Motherboard:

We’ve heard brave stories from people whose lives have been saved by health insurance, but thousands of Americans have already died because of lackluster coverage.

It struck me as normal, somehow, to watch my girlfriend enter an online sweepstakes that would help decide whether or not she would be able to afford to buy medicine. Only now, watching the Republican establishment dismantle the Affordable Care Act, has this struck me as cruel.

I don’t remember the specifics of the promotion, but I remember that it was a monthly trivia contest run by an online cystic fibrosis pharmacy. Answer the questions right, and your name was entered to receive $500 toward your meds. I’d ask Katelin about it now, but she is dead.

The Republican plan to repeal Obamacare and replace it with something that offers more “choice” has inspired thousands of people to confront lawmakers with their stories about how the law—and health insurance more generally—has saved their lives or prevented financial ruin. Their courage should be applauded, their voices amplified.

We should remember, though, that we are hearing from the fortunate ones. The ones who were repeatedly fucked by insurance companies before Obamacare? They are dead.

If Jason Chaffetz, Paul Ryan, and Donald Trump want to offer Americans more healthcare choice, they’re on the right track. Obamacare closed many of the loopholes insurance companies used to keep the chronically ill from purchasing coverage, but any system that treats healthcare as a luxury rather than a basic human need is going to afford people plenty of options as their insurance lapses or benefits are suddenly changed.

Katelin was afforded the choice to do fewer breathing treatments to preserve her medicine until her insurance company would pay for more. For a few months, she made the choice to take generic nebulized albuterol because she couldn’t afford the more effective Xopenex out of pocket. She had regular battles with her insurance company about when it was appropriate to refill her prescription for digestive enzymes, which she needed to take in order to eat almost anything. She chose to enter insane online sweepstakes to pay for medicine and wake up before dawn to ride multiple buses to get to work on time and to act in plays.

Three years after she died, I cannot piece together a timeline of when she had coverage, when she did not, and the varying quality of that coverage. There were times when she had excellent doctors and excellent insurance, and times when she had next to nothing thanks to a clerical error or benefits changes.

What I do know, though, is that she was constantly engaged in some bureaucratic battle about whether she was allowed to buy medicine, go to the doctor, or refill a prescription. About whether she should be allowed to live. A pre-Obamacare study found that lack of health insurance killed roughly 45,000 Americans annually. A study published Monday found that Canadians with cystic fibrosis have a life expectancy of roughly 10 years longer than Americans with CF. The discrepancy is attributed to Canada’s universal healthcare.

Somehow, through all of this, most people didn’t know that Katelin was sick, that she had been sick since the day she was born, and that she was slowly getting weaker because skipped treatments were beginning to take a toll on her lungs. . .

Continue reading.

Written by LeisureGuy

13 March 2017 at 4:19 pm

NOT the “best healthcare in the world”: Canadians With Cystic Fibrosis Live 10 Years Longer Than Americans

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Kate Lunau reports in Motherboard:

Canadians had a 77 percent lower risk of death over the course of this study than US patients with no health insurance.

There’s no cure for cystic fibrosis, a fatal genetic disorder, but better treatments mean that people with the disease are living longer. Still, Canadians with CF can expect to live nearly 10 years longer than Americans, according to a new, wide-ranging study in Annals of Internal Medicine. Given the life expectancy of those who have the disease (median age of survival was 50.9 years in Canada, 40.6 years in the US), getting an extra 10 years is a lot.

The study doesn’t draw any firm conclusions about why there’s such a discrepancy between Canada and the US, but it does offer some insights. Health insurance status, among other factors, seems to have an impact. Canadians have universal and publicly funded healthcare coverage, whereas Americans with no insurance (or unknown insurance) fared worst of all in this study.

Under the GOP’s new legislation, and following the repeal of the Affordable Care Act, an estimated 14 million Americans stand to lose coverage by next year alone. It’s another stark reminder—if we needed one—that a patient’s insurance status has a real impact.

Dr. Anne Stephenson, lead author of the paper, is a respirologist at St. Michael’s Hospital in Toronto, where she works with CF patients. “It’s the largest adult centre [for CF patients] in Canada,” she told me, with over 450 patients in treatment.

In the study, she and collaborators in the US looked at data from national cystic fibrosis registries, where patients are tracked. (It included 5,941 in Canada and 45,456 in the US, from 1990 to 2013.) Even after adjusting for other characteristics, like age and how severe the disease was, the risk of death for CF patients was 34 percent lower in Canada. . .

Continue reading.

With Trumpcare, Canadians will move even further ahead in cystic fibrosis survival.

Written by LeisureGuy

13 March 2017 at 4:12 pm

Denial is the most primitive defense: Trump official slams CBO score: It’s ‘just not believable’

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The CBO score is calculated. They use numbers. All assumptions are explicit. Trump should not just say it’s not believable, he should show where it’s wrong. But he cannot. Same reason he cannot produce the evidence that convinced him that Obama had had his phones tapped.

Jordan Fabian reports in The Hill:

The Trump administration on Monday slammed a Congressional Budget Office (CBO) estimate that millions of people would become uninsured under the Republicans’ plan to repeal and replace ObamaCare.

“We disagree strenuously with the report that was put out,” Health and Human Services Secretary Tom Price told reporters at the White House.

Price said the analysis released Monday afternoon does not take into account the entirety of the GOP plan to repeal and replace the Affordable Care Act, which he said would cover more people while lowering costs.

The long-awaited report has roiled the debate over the GOP’s bid to overhaul the healthcare system, which would include repealing many elements of the Affordable Care Act and creating a new tax credit to help people buy insurance.

The plan, formally titled the American Health Care Act, is already facing resistance from conservatives who say the bill doesn’t go far enough, while more moderate Republicans have expressed concern about the bill’s defunding of Planned Parenthood and the rollback of expanded access to Medicaid.

The CBO, an independent scorekeeper for Congress, found that 14 million people would lose their insurance coverage by next year under the bill, with the number rising to 24 million over a decade.

Of the 14 million figure, Price said, “it’s virtually impossible to have that number occur.”

“It’s just not believable, is what we would suggest,” he added.

The health secretary said the nonpartisan budget office only looked at the House bill and not the two other parts of the administration’s three-phase healthcare plan, which includes regulatory changes and additional legislation. . .

Continue reading.

Show where it’s wrong, Price.

Written by LeisureGuy

13 March 2017 at 3:29 pm

“If someone set out to devise a plan to hit Trump voters the hardest it would be difficult to come up with something to match House Republicans’ plan”

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Jennifer Rubin, the conservative Washington Post columnist has a very good column on the Republican effort to destroy the Affordable Care Act. From the column:

. . . using the Kaiser Family Foundation figures, the Los Angeles Times found: “Most affected by the Republican health plan would be parts of Alaska, Arizona, Nebraska, Tennessee and Oklahoma, where Obamacare insurance subsidies have been crucial in making high-priced insurance affordable. All five states went for Trump. Also hit hard would be parts of key swing states that backed Trump, including Pennsylvania, North Carolina and Michigan.” If someone set out to devise a plan to hit Trump voters the hardest it would be difficult to come up with something to match House Republicans’ plan:

In 27 Nebraska counties — all of which backed Trump — a 60-year-old shopper with a $30,000 income would see financial aid drop by $12,950 a year under the House Republican legislation.

The annual subsidy in 22 counties in Oklahoma, another Republican stronghold, would plummet by $11,970. Trump won all but one of the counties by more than 28 percentage points. . . .

In Berks and Lancaster counties, west of Philadelphia, subsidies would drop by $9,500. Trump narrowly won both Pennsylvania counties.

And in western North Carolina, which helped power Trump’s victory in that state, subsidies would fall by more than $10,000.

Read the whole thing. The GOP seems to really dislike people who vote Republican, at least based on their efforts regarding healthcare—but they do love to give tax cuts to the wealthy, who will see the changes the GOP is pushing as highly profitable for them.

See also: “Republicans are now paying the price for a years-long campaign of Obamacare lies,” by Matt Yglesias in Vox.

Written by LeisureGuy

13 March 2017 at 12:43 pm

This shows why the Affordable Care Act is important and why the GOP is heartless

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Jessica Contrara reports in the Washington Post:

Another morning, another list of patients and problems in the hands of 35-year-old Keisha Saunders. Diabetes, depression, heart disease. Robert needs lower blood pressure. Buffy needs prescriptions filled. Mary needs to lose 50 pounds, so she can get what she really needs, a new hip.

Again, the list extends to the bottom of Keisha’s notepad, as it has so many days since the Affordable Care Act mandated that everyone have health insurance. Unlike in Washington, where health care is a contentious policy debate, health care where Keisha is a nurse practitioner is a daily need to be filled. The high rates of chronic diseases in McDowell County have made it the county with the shortest life expectancy in the nation.

It’s also a place that voted overwhelmingly for President Trump, whose promise to repeal the ACA will soon affect nearly every patient Keisha treats at the Tug River health clinic in Northfork, including the one waiting for her in exam room No. 2.

“How are you doing?” she asks Clyde Graham, who is 54 and has been out of work for four years.

“I ate a sandwich from Arby’s,” he says. “And it jumped me out for like, three days. I mean it just burnt.”

Heartburn is just the latest problem for Clyde, a patient Keisha sees every three months. Like so many in this corner of Appalachia, he used to have a highly paid job at a coal mine. Company insurance covered all of his medical needs. Then he lost the job and ended up here, holding a cane and suffering not only from heartburn but diabetes, arthritis, diverticulitis, high blood pressure and high cholesterol.

Because of the ACA, Clyde’s visit is covered by Medicaid. Before the law, most West Virginians without children or disabilities could not qualify for Medicaid, no matter how poor they were. The ACA — better known here as Obamacare — expanded the program to cover more people, such as Clyde, who can depend on Keisha to fix his heartburn without having to worry about the cost.

As for the other problems in his life, he has put his hopes in Trump, who came to West Virginia saying he would bring back coal and put miners back to work. When Trump mentioned repealing Obamacare, Clyde wasn’t sure what that might mean for his Medicaid. But if he had a job that provided health insurance, he reasoned, he wouldn’t need Medicaid anyway, so he voted for Trump, along with 74 percent of McDowell County.

Tug River Health Association treats about 8,700 patients, resulting in some 20,000 visits a year to its five clinics. In 2016, 12,284 of those visits were from patients on Medicaid, up from 5,674 in 2013, before the ACA took effect here. Without the ACA, many of those patients wouldn’t be able to afford care. Will they soon lose their coverage? Will they stop coming to the clinic? Lately, Tug River’s chief executive has been telling his staff, “The key word going forward is uncertainty.”

To Keisha, all is uncertain beyond this moment, in which she prescribes Nexium for Clyde’s heartburn, examines him from head to toe and sends him to the lab across the hall for blood work.

“I’ll see you in three months,” she says, hoping that will be true, and heads to exam room No. 1, where another patient is waiting. “What’s going on today?” she asks, and walks in the room to find out.

Meanwhile in the front of the clinic, more patients are coming in through the heavy doors and up to a glass window where a receptionist is waiting.

“Hi honey, how are you?” Tammy McNew says to each one. Over the past four decades, McDowell County has lost 60 percent of its population, so she rarely needs to ask their names. Instead, she asks what seems like the most important question in health care these days:

“Got your insurance card with you?”

If the answer is no, she will send them back to Keisha anyway, and the clinic will depend on federal grants to make up the cost. But more often in recent years, the answer is what a middle-aged woman with springy curls says as she passes her Medicaid insurance card through the window: “Yes, ma’am,” she tells Tammy, who slides it into a scanning machine.

In other parts of the country, the primary impact of the ACA has been requiring people to have private health insurance, but in poor and sick communities like McDowell County, the law’s dominant effect has been the Medicaid expansion, which has given more people access to the kind of health care that wasn’t widely available or affordable to them before. With an insurance card in her pocket, the patient at Tammy’s window can venture into the realms of medical care that are typically out of reach to those without one: blood work, immunizations, specialized doctors, surgery, physical therapy.

If she needs mental health counseling, the clinic no longer sends her to the next county over; last July, Tug River was able to hire a psychologist, who is now treating 180 people, many of whom are trying to overcome opioid addictions.

If she needs medication, the nurses won’t go digging in a closet of samples left by drug reps as they used to do for the uninsured. The medication will come from a pharmacy and cost no more than a few dollars.

“All right sweetie, I got you,” Tammy tells her, and the patient retreats to a chair to wait for her name to be called. The routine is repeated dozens of times a day as the phone rings behind the front desk. “For appointments, press one,” the callers hear. “Black lung, two.”

This clinic is in Northfork, a community of a few hundred people along the railroad that carries coal through the mountains. Keisha, who is black, was raised in this predominantly white county, in a home overlooking the cinder-block church where her father, a coal miner, serves as pastor. She attended the middle school beside the clinic parking lot, which now has busted windows and gaping holes in its brick facade. There weren’t enough children to fill it, as every year the closing of more mines drove job-seekers out of the county.

Eventually, Keisha was one of them. After graduating high school and becoming a mother at 18, she realized that if she wanted to become something more for her daughter, she would have to leave.

She moved 45 minutes away, to Princeton, W.Va., where she got a nursing assistant certification and a job in a nursing home. But every Sunday, she strapped her daughter Kiana in her car and drove back to McDowell County, checking in on her always-fading town. Bulldozed, shuttered or abandoned: the grocery store, beauty salon, florist and furniture store. Still open: the dollar store, medical equipment store, funeral home and her father’s church, where Keisha would usually sit with her brother Derrick. . .

Continue reading. And do keep reading. The article shows why we must keep and expand the Affordable Care Act, and make it more affordable by using some additional tax revenue from those can most afford to contribute to the common welfare. As God intended, in fact, according to Jesus—just a thought for the Christians among them.

I consider this a hopeful story because it shows how greatly Obamacare helped people, and spent taxpayer dollars taking care of those who most need help rather than all the benefits of government going to the middle class and above. It shows the government doing what the government should be doing: improving the general welfare of the American people.

Written by LeisureGuy

12 March 2017 at 1:55 pm

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