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Archive for the ‘Healthcare’ Category

Looking at healthcare, Bernie Sanders makes some good points

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Good points that the Washington Post derides, incorrectly labeling them false. Bernie writes:

The next great struggle that will take place in Congress is literally one of life and death. If the Republicans succeed in repealing the Affordable Care Act (ACA) without a replacement and throw some 20 million people off of their insurance, up to 43,000 Americans each year could die. That’s not Bernie Sanders talking. That’s the evidence from a well-researched study. Further, people with pre-existing conditions could be denied health insurance or be forced to pay unaffordable rates. There would be no cap as to what people with serious illnesses would have to pay. Women will be forced to pay higher rates because they are women. Prescription drug costs for seniors will go up.

The United States is the only major country on earth not to guarantee health care to all as a right. Our job is to move to a Medicare-for-all single payer system, not create a situation where up to 43,000 Americans die unnecessarily.

And then he links to this article by Jim Naureckas at FAIR (Fairness & Accuracy In Reporting):

With the New York Times finally agreeing to name politicians’ lies where they belong—in the headlines of the stories where they first occur—it’s time to end the failed experiment of factchecking columns. Not only do these projects give the false impression that checking facts is a sidelight rather than central to the journalistic mission, they are fatally compromised by  corporate media’s interest in maintaining the illusion of impartiality. As FactCheck.org’s Brooks Jackson (Time, 10/9/12) said, in an admission that should have put paid to the whole enterprise:

Even if we could come up with a scholarly and factual way to say that one candidate is being more deceptive than another, I think we probably wouldn’t just because it would look like we were endorsing the other candidate.

Unmoored for commercial reasons from any hard and fast standards for what constitutes a fact, media factologists are free to follow their own political whims (or those of their outlets). Which seems to be what’s going on in a recent Washington Post factchecking effort by Glenn Kessler, “Bernie Sanders’ Claim That ‘36,000 People Will Die Yearly’ if Obamacare Is Repealed” (1/14/17).

The Post, just to set the stage, is a paper with a serious animus against the junior senator from Vermont—once running 16 negative stories on Sanders in 16 hours, and on another occasion squeezing four separate Sanders-bashing articles out of one dubious study. So it isn’t surprising to see Kessler giving “four Pinocchios” (the highest score, reserved for “whoppers”) to Sanders’ warning that “as Republicans try to repeal the Affordable Care Act, they should be reminded every day that 36,000 people will die yearly as a result.”

Sanders’ number came from Think Progress (12/7/16), which in turn derived its forecast of how many people could lose insurance under Obamacare from an Urban Institute report, and its estimate of the effect of insurance on mortality from an Annals of Internal Medicine study (5/6/14). So—a pretty solidly grounded political claim? Ah, sorry, you don’t understand the rules of political speech—as applied by the Washington Post to Bernie Sanders.

You see, Sanders in his tweet didn’t include all the academic qualifiers that occurred in the original Annals study. (It was a study of Massachusetts, not the whole country!) And Sanders’ warning was based on the “pretty big assumption” that the ACA will not be replaced with a brand new GOP-designed program—the barest outlines of which have yet to be described.

This kind of “fuzzy math” generally merits three Pinocchios, Kessler said. What “tips this claim into four-Pinocchio territory,” though, was the fact that Sanders expressed a prediction in the future tense: He said that people “will die” rather than “could die.” I would remind Kessler that every statement about the future is necessarily uncertain, and therefore every use by a politician of the future tense should be awarded an extra Pinocchio. . .

Continue reading.

Written by LeisureGuy

28 January 2017 at 7:27 pm

How the Affordable Care Act’s provisions help everyone

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The text below is being posted on Facebook, and I thought it was worth sharing:

As his first order of business, the new president signed an executive order to repeal the ACA. Here’s what this means… even if you are safely covered behind employer-provided insurance, the protections set forth in the ACA (Affordable Care Act), apply to you too. And if those protections are repealed along with the rest (or any part) of the program, you will also be affected.

That means you may be trapped in a job, because your pre-existing condition may mean you will not qualify for new insurance offered by another employer, and the cost of private insurance would be prohibitive. If your employer shuts down, lays you off, or even changes insurers, well, you are out of luck. The Senate GOP voted this week that they would not require an eventual ACA replacement to protect against discrimination for pre-existing conditions, which was the standard before the ACA.
It means that you (a young adult under the age of 26) or your adult children (over 18) may find yourselves without the protection of insurance, as the Senate GOP voted last night that an eventual ACA replacement will not be required to allow young people to remain on their parents’ insurance up to the age of 26.

It means that if you have a high-risk pregnancy, or life-threatening illness such as cancer, you may not be able to afford all the care you need, because you may hit lifetime or annual caps. If you have an infant born with any kind of severe medical condition, or premature, they may hit their lifetime insurance cap before they are old enough to walk. The Senate GOP voted last night that an eventual ACA replacement program would not be required to prohibit lifetime insurance caps.

It means that if you are a struggling parent who is uninsured or under-insured, you will no longer be able to count on at least your kids getting the routine medical and dental care they need under the Children’s Health Insurance Plan (CHIP). The Senate GOP voted that CHIP is not required to be protected by an eventual ACA replacement.

These provisions of the ACA affect everyone in this country, not just those without insurance through their employers.

If you are not okay with these changes, call your representatives and let them know what’s important to you. Nothing has been set in stone yet, but our legislators have shown us a map of what they plan to do if constituents don’t make their voices heard loud and clear.

Written by LeisureGuy

26 January 2017 at 1:58 pm

How American health care kills people

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Ryan Cooper writes in The Week:

Matthew Stewart owes $62,668.78 for drugs, surgeries, and other treatment. With both bankruptcy and possibly fatal liver failure looming, he doesn’t even bother opening his bills anymore, he told The Week. “There was no point. They just upset everyone,” he says.

Stewart is 29 years old, and was pursuing his Ph.D in American history at Texas Christian University until ill health forced him to withdraw. He lives in Ft. Worth, Texas, with his wife of six years, who is a junior high school teacher in a low-income district. They own their home. Before he came down with complications from cirrhosis caused by autoimmune hepatitis, he says he led a scrupulously healthy lifestyle — he does not drink or do any other non-medical drugs, he says, and was a devoted hiker before disaster struck. And he was insured — indeed, he had a gold plan from the ObamaCare exchanges, the second-best level of plan that you can get.

But now he faces imminent bankruptcy and possibly death.

The incomprehensible brutality of Stewart’s story is an object lesson in how the American health care system mercilessly crushes American citizens when they are at their weakest and most vulnerable. With a liver transplant, Stewart might well live a full life. But before he can even be eligible for one, he must thread his way through a Kafkaesque labyrinth of private and public bureaucracy — and hope he doesn’t die before he makes it through.

With cirrhosis, it’s typically just a matter of time before your liver starts failing — and you usually run into very serious complications long before total shutdown happens. (Cirrhosis is most often caused by alcohol abuse, fatty liver, or viral hepatitis, but in Stewart’s case it was just an immune system gone haywire, he says.) The liver does an astounding variety of things, but first among them is cleaning the blood of toxins and metabolic byproducts. So when it stops working properly, about the first thing that happens is a blood backup. Veins from various parts of the digestive system come together into the portal vein, which feeds blood into the liver to be cleaned. But if the liver is damaged, the blood can’t get through properly, and pressure builds up in the portal system, causing what’s called portal hypertension. That in turn can lead to ascites, a huge build-up of fluid in the belly. (In a separate process, a failing liver can also cause hepatic encephalopathy, where unprocessed waste gets into the brain and damages it.)

But a more direct result of portal hypertension is dilation of veins in the portal system, most commonly in the esophagus — creating esophageal varices. These small veins can stretch significantly under the strain, and as one might expect, sometimes they rupture.

That’s what happened to Stewart on Sept. 24, 2016.

It began feeling like an intense flu, but soon he started vomiting blood. The varices in his esophagus had burst, and were pouring blood into his stomach. To avoid an hours-long wait at the emergency room, he went to an urgent care clinic to get a quick diagnosis, and when the seriousness of his situation became clear, he was transferred to the emergency room.

That is where Stewart’s billing problems started, he says. The clinic sent him to an out-of-network hospital, because it had the first available bed, despite the fact that his in-network hospital was only a block away. “At no time was I ever asked or given any choice in what hospital the ambulance was taking me to,” he says. By that time he was nearly dead from blood loss, so surgery to close up six different hemorrhaged varices had to be started immediately.

His claim list shows 13 separate charges on this date with a sticker price totaling $73,859.36, of which his insurance covered $9,695.87, leaving him with a bill of $46,020.36 (reduced somewhat by negotiation between the insurance company and the hospital). In an emailed statement, his insurance company said, “We value all of our members and are seeking to learn more — including this member’s name — so that we can review the circumstances surrounding this situation.” The hospital that provided his emergency surgery did not respond to a request for comment.

After the surgery, Stewart spent two days in the ICU at the out-of-network hospital, then was finally transferred to the in-network one. At some point, a social worker claimed that the transfer would allow him to bill the first hospital stay as in-network, but no: “Instead, we just got separate large bills from both hospitals,” he says. . .

Continue reading. And do read the entire article. There’s a lot more, and it’s chilling. The United States government is failing its people.

Later in the article:

. . . But wait, you might be thinking. Doesn’t ObamaCare have out-of-pocket limits that would prevent this sort of thing?

It does indeed. But there are numerous loopholes that medical providers can and do take advantage of.

The biggest is . . .

Not to worry: President Trump is already working to shut down Obamacare/Affordable Care Act, and he has already worked out a plan the covers all Americans with better coverage and at a lower cost. He has not yet revealed that plan, but he definitely said that he has it. However, I feel that this may be an “alternative fact” (aka “lie”). Still, as you see at the link, he does have a plan, and it will cover all Americans and cost less.

Written by LeisureGuy

23 January 2017 at 11:31 am

With executive order, Trump tosses a ‘bomb’ into fragile health insurance markets

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We shouldn’t be at all surprised at the “bull in a china shop” approach Trump is using, Indeed, Rex Tillerson, Trump’s nominee as Secretary of State, indicated in his hearing that he would not hesitate to go to war with China. A measured and thoughtful approach doesn’t cut it in a reality show, which requires constant excitement.

Juliet Eilperin and Sean Sullivan report in the Washington Post:

President Trump’s executive order instructing federal agencies to grant relief to constituencies affected by the Affordable Care Act has begun to reverberate throughout the nation’s health-care system, injecting further uncertainty into an already unsettled insurance landscape.

The political signal of the order, which Trump signed just hours after being sworn into office, was clear: Even before the Republican-led Congress acts to repeal the 2010 law, the new administration will move swiftly to unwind as many elements as it can on its own — elements that have changed how 20 million Americans get health coverage and what benefits insurers must offer some of their customers.

But the practical implications of Trump’s action on Friday are harder to decipher. Its language instructs all federal agencies to “waive, defer, grant ­exemptions from or delay” any part of the law that imposes a financial or regulatory burden on those affected by it. That would cover consumers, doctors, hospitals and other providers, as well as insurers and drug companies.

The prospect of what could flow from pulling back or eliminating administrative rules — including no longer enforcing the individual mandate, which requires Americans to get coverage or pay an annual penalty, and ending health plans’ “essential benefits” — could affect how many people sign up on the Affordable Care Act marketplaces before open enrollment ends Jan. 31 for 2017 coverage, as well as how many companies decide to participate next year.

Robert Laszewski, president of the consulting firm Health Policy and Strategy Associates, called the executive order a “bomb” lobbed into the law’s “already shaky” insurance market. Given the time it will take Republicans to fashion a replacement, he expects that federal and state insurance exchanges will continue to operate at least through 2018.

“Instead of sending a signal that there’s going to be an orderly transition, they’ve sent a signal that it’s going to be a disorderly transition,” said Laszewski, a longtime critic of the law, which is also known as Obamacare. “How does the Trump administration think this is not going to make the situation worse?” [They probably know it will make things worse: Trump like chaos because he can then say that “only he can save us.” That’s why he paints a picture of a grim and dystopian U.S. (“American carnage”). He thinks that the worse things seem, the more the public will turn to him as their savior. So it’s in his interest to make things bad, so he can be the hero to save us. I’ve in fact worked with people who thrive on a crisis—they work hard, they save the day, they are rewarded—who begin unconsciously to create crises because they have become addicted to the accolades. They find the reward of the accolades more than repays the (often substantial) effort to solve the crisis (of their own making). Plus there’s the reality-show imperative: never be boring—a crisis is exciting. – LG]

Teresa Miller, Pennsylvania’s insurance commissioner, said Saturday that several insurers on her state’s exchange “seriously considered leaving the market last year” and that Trump’s action could propel them to indeed abandon it in 2018. In fact, she added, some have raised the possibility of withdrawing from the ACA’s exchanges during 2017, which would mean consumers could keep their plans but no longer receive federal subsidies to help them afford the coverage.

“That would create a nightmare scenario,” Miller said.

As of this year, nearly a third of all counties nationwide have just one insurer in the federal marketplace, and almost two-thirds have two or fewer insurers.

The White House did not return requests for comment over the weekend. . .

Continue reading. There’s a lot more. Trump may have wrecked healthcare. Just two days in, and he’s wrecking things.

Written by LeisureGuy

22 January 2017 at 4:09 pm

What we know and don’t know about Trump’s healthcare plans

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Peter Sullivan reports in The Hill:

President Trump told Fox News last week that when it comes to ObamaCare, “we’re going to have a plan that’s going to be great for people.”

What that plan will actually be, though, remains unclear.

Trump has said that he will put forward an ObamaCare replacement plan shortly after Rep. Tom Price (R-Ga.) is confirmed, an announcement that caught lawmakers off guard.

If Trump actually follows through on putting forward his own plan, rather than letting Congress take the lead, it could provide some guidance to Republican efforts to come up with an ObamaCare replacement, though lawmakers are sure to want their own say on any plan as well.

Trump has dropped a few hints on his ideas for a replacement plan.

Here’s a guide to what we know and don’t know.

He wants to cover everyone

What we know: Trump made waves last week when he told The Washington Post he wants everyone to have insurance.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

This remark sounded more like Democrats’ goal of universal coverage than Republican’ usual focus on reducing costs and regulation in healthcare.

Republicans on Capitol Hill have been pivoting back to the idea of everyone having “access” to coverage. It is not entirely clear what the difference between universal “access” to coverage and universal coverage is. For one, Republicans don’t want to have a mandate for people to get coverage, so some people could choose not to buy it.

But Democrats fear that the emphasis on “access” over actually having coverage is code for not really providing enough financial help for people to have affordable insurance.

“I have access to buying a $10 million home,” Sen. Bernie Sanders (I-Vt.) said at Price’s confirmation hearing. “I don’t have the money to do that.”

What we don’t know: Trump has provided almost no details of how we would actually go about providing insurance for everyone, a lofty promise that would be extremely hard to fulfill, especially after repealing ObamaCare and rolling back its coverage gains for 20 million new people.

Trump did put forward a healthcare plan on his website during the campaign, but it consisted of standard Republican ideas like allowing insurance to be sold across state lines and creating a tax deduction for health insurance. The Committee for a Responsible Federal Budget estimated the plan would result in 21 million people losing coverage, largely due to the repeal of ObamaCare.

He wants block grants for Medicaid

What we know: One detail of health policy that Trump has repeatedly stressed is block grants for Medicaid. That means that the federal government would give states a set amount of money for the low-income health insurance program, rather than the current federal commitment that is more open-ended.

The expansion of Medicaid was a key part of ObamaCare’s coverage expansion, but that growth could now be repealed.

Republicans say block grants would limit federal spending and give more power to the states. But Democrats warn that limiting the spending would simply mean damaging cuts to the program, keeping people out of coverage or slashing benefits.

Block grants were one of the few healthcare specifics in Trump’s recent interview with Axios. “Whether it’s Medicaid block grants or whatever it may be, we have to make sure that people are taken care of and it’s going to be a very important part to me,” Trump said.

What we don’t know: It’s unclear how a replacement plan would treat ObamaCare’s expansion of Medicaid. Several Republican governors in states that have accepted the expansion are pushing to keep it.

Another key point that is unclear is . . .

Continue reading.

Written by LeisureGuy

22 January 2017 at 3:50 pm

An extremely ominous sign: Republicans are avoiding constituents angry about the Affordable Care Act repeal

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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. . .

Continue reading.

Written by LeisureGuy

19 January 2017 at 1:29 pm

Paul Krugman once again explains healthcare fundamentals

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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 . . .

Continue reading.

Written by LeisureGuy

18 January 2017 at 11:27 am

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