Archive for the ‘Health Care’ category

Why I Hate The NY Times, Part [n]*

March 24, 2017

This paragraph:

There is most likely a middle way. Republican lawmakers might be comfortable with a system that shifts more of the costs of care onto people who are sick, if it makes the average insurance plan less costly for the healthy. But making those choices would mean engaging in very real trade-offs, less simple than their talking point.

“Republican lawmakers might be comfortable…”  Think of the assuptions not in evidence required to write that phrase.  Think also of the cluelessness in what comes next:  those who buy insurance are seen here in the Republican frame, as two binary populations, the healthy and the sick.

That would be  the “virtuous”  healthy paid less than the molly-coddled, feckless sick.  That the same people might occupy both identities at different points of their lives seems not to have occured to this Times writer, Margot Sanger-Katz — whom I’ve noted before has an odd willingness to couch her Upshot explainers in weighted and coded language.

As seems to be hers and several Times-folk’s penchant, much of the story from which I extracted above is perfectly fine, an actual explainer of what Essential Health Benefits do and why they’re important. She even notes that in a system without a required benefit package–

…the meaning of “health insurance” can start to become a little murky.

Well, yeah, as it doesn’t actually insure against unanticipated risks.  I’d take issue with the meekness of her critique here, that is, but at least she suggests to the fragile sensibilities of her tender readers that perhaps a minor problem might result here.

Which makes the passage I quoted up top both weird and revealing: cheap insurance for the healthy and soak-the-sick policies for those with the misfortune to suffer the ails that impinge on just about every human being, sometime or other is a pretty damn good example of a murky notion of health insurance.

That is: the habit of mind, the reflexive and seemingly unconscious acceptance of a right wing tropes that lead both to conclusions unsupported by the evidence and an inability to grasp what one has actually just said.  This happens a lot at The New York Times. Happened a lot there too, over the crucial months of 2016.  Which goes a long way, IMHO, to accounting for the predicament we’re in now.

*Where [n] is an arbitrarily large number.x

Image:  Codex Aureus Epternacensis, Christ Cleansing Ten Lepers, c. 1035-1040.

Paying To Be Cruel

October 22, 2015

Balloon Juice’s own presidential aspirant, ¡Baud! 2016, reminded me of something I meant to FP yesterday:  how red state Republicans have chosen to pay — hugely — for the privilege of denying their fellow Americans access to health care.  Let me turn the mic over to Kevin Drum:

In 2015, according to a survey by the Kaiser Foundation, spending by states that refused to expand Medicaid grew by 6.9 percent. That’s pretty close to the historical average. However, spending by states that accepted Medicaid expansion grew by only 3.4 percent.

In other words, the states that have refused the expansion are cutting off their noses to spite their faces. They’re actually willing to shell out money just to demonstrate their implacable hatred of Obamacare. How much money? Well, the expansion-refusing states spent $61 billion of their own money on Medicaid in 2014. If that had grown at 3.4 percent instead of 6.9 percent, they would have saved about $2 billion this year.

Two billion eh?  Pocket change!  Take it away, Kevin:

The residents of every state pay taxes to fund Obamacare, whether they like it or not. Residents of the states that refuse to expand Medicaid [22 of them — map here] are paying about $50 billion in Obamacare taxes each year, and about $20 billion of that is for Medicaid expansion. Instead of flowing back into their states, this money is going straight to Washington DC, never to be seen again.

So they’re willing to let $20 billion go down a black hole and pay $2 billion extra in order to prevent Obamacare from helping the needy.

V0017593 A surgeon extracting the stone of folly. Oil painting by Pie Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org A surgeon extracting the stone of folly. Oil painting by Pieter Huys. By: Pieter HuysPublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Ladles and Jellyspoons!  Your modern Republican party!  Ready to fork over handsomely to make sure the wrong people suffer.

PS:  Let me call out the could-be great state of Texas for vicious derp on a grand scale:

Statewide, Texas hospitals had to eat 5.5 billion dollars in uncompensated care last year. The reason is this – after the Affordable Care Act passed, the amount of money the federal government provides to hospitals for uncompensated care was significantly reduced. It’s cause and effect; if 9 out of 10 Americans have health insurance, the amount of uncompensated care hospitals have to provide goes down. But when the U.S. Supreme Court gave the individual states the option to opt out of part of the Affordable Care Act, then-Texas Governor Rick Perry could not opt out fast enough.

Vote, folks, as if your life depends on it.  ’cause it very well may.

Image: Pieter Huys, A surgeon extracting the stone of folly, before 1584.

Republicans Are Bad For Your Health

October 29, 2014

This is just a drive-by sidelight on Richard Mayhew’s brief over at Balloon Juice — but its worth taking a look at this explainer from the Upshot.

The good news:  Obamacare is doing what it set out to do.  Kevin Quealy and Margot Sanger-Katz write that

The biggest winners from the law include people between the ages of 18 and 34; blacks; Hispanics; and people who live in rural areas. The areas with the largest increases in the health insurance rate, for example, include rural Arkansas and Nevada; southern Texas; large swaths of New Mexico, Kentucky and West Virginia; and much of inland California and Oregon.

Each of these trends is going in the opposite direction of larger economic patterns. Young people have fared substantially worse in the job market than older people in recent years. Blacks and Hispanics have fared worse than whites and Asians. Rural areas have fallen further behind larger metropolitan areas.

Women are the one modest exception. They have benefited more from Obamacare than men, and they have received larger raises in recent years. But of course women still make considerably less money than men, so an economic benefit for women still pushes against inequality in many ways. [all links in the original]

Rembrandt_Christ_Healing_the_Sick

The bad news:  it sucks to be ruled by the Republican cabal.  Or rather, it’s great if your state government actually managed to get used to the idea of Free Money! (h/t the indispensable Charles Pierce):

Despite many Republican voters’ disdain for the Affordable Care Act, parts of the country that lean the most heavily Republican (according to 2012 presidential election results) showed significantly more insurance gains than places where voters lean strongly Democratic. That partly reflects underlying rates of insurance. In liberal places, like Massachusetts and Hawaii, previous state policies had made insurance coverage much more widespread, leaving less room for improvement. But the correlation also reflects trends in wealth and poverty. Many of the poorest and most rural states in the country tend to favor Republican politicians. Of course, the fact that Republican areas showed disproportionate insurance gains does not mean that only Republicans signed up; there are many Democrats living in even the most strongly Republican regions of the country.

But for the rest…

There are still a lot of uninsured people remaining, many in the places that had high uninsured rates last year.

Where would those folk be?  Check out the last map in the piece.  No one here will be surprised.

Image: Rembrandt van Rijn, Christ Preaching (Christ Healing the Sick — the hundred guilder print)1646-50.

Your Daily Apocalypse, Outsourced Antibiotic Edition

November 21, 2013

Go read this piece by Maryn McKenna — who is, in my never humble opinion, one of the handful of very best reporters on matters of infectious disease, global health, and really scary stuff.

I was born in 1958, fifteen years into the era of clinically-available antibiotics.  I was my mother’s third child.  Had we shifted that timeline back a few years, that would have meant that there would have been a measure of luck in mom simply making it to and not through her third lying in.  As Maryn writes, before antiobiotics, five out of 1,000 births ended with the death of the mother.  No worries by the time I popped my head out into the maternity floor at Alta Bates.

But this a must read not because of any remembrance of the pre-antibiotic era, but because Maryn plausibly analyzes a post-antibiotic future.

Plaguet03

Here’s a sample:

Doctors routinely perform procedures that carry an extraordinary infection risk unless antibiotics are used. Chief among them: any treatment that requires the construction of portals into the bloodstream and gives bacteria a direct route to the heart or brain. That rules out intensive-care medicine, with its ventilators, catheters, and ports—but also something as prosaic as kidney dialysis, which mechanically filters the blood.

Next to go: surgery, especially on sites that harbor large populations of bacteria such as the intestines and the urinary tract. Those bacteria are benign in their regular homes in the body, but introduce them into the blood, as surgery can, and infections are practically guaranteed. And then implantable devices, because bacteria can form sticky films of infection on the devices’ surfaces that can be broken down only by antibiotics

Dr. Donald Fry, a member of the American College of Surgeons who finished medical school in 1972, says: “In my professional life, it has been breathtaking to watch what can be done with synthetic prosthetic materials: joints, vessels, heart valves. But in these operations, infection is a catastrophe.” British health economists with similar concerns recently calculated the costs of antibiotic resistance. To examine how it would affect surgery, they picked hip replacements, a common procedure in once-athletic Baby Boomers. They estimated that without antibiotics, one out of every six recipients of new hip joints would die.

As Maryn reports, the problem is tangled and complex — but there are clear actions that could be taken and aren’t, most obviously ending the reckless use of antibiotics in agriculture, which consumes something like 80% of the total produced.  But don’t waste time here: go read the whole thing. Get scared; get mad; call your congressfolk.

Image: Josse Lieferinxe, St. Sebastian prays for plague victims, 1497-99.

Ted Cruz’s Texans Are Getting The Democracy They Want…

October 3, 2013

And so are we…getting it good and hard, as my man Mencken preached it so long ago.

An_Election_Entertainment

This is just a quick addendum to my recent posts on the connection between the Republican party’s passion for denying millions of Americans access to health insurance coverage.

As everyone not resident at Bag End knows, the self-anointed leader of those who think that providing health care for millions is the gateway to the dictatorship of the usurper is  “Tailgunner” Ted  Cruz, R-TX.

That made me wonder — how many of his own constituents is the freshman Senator trying to roger?

The Texas Medical Association has the goods:

One quarter of the Texas population is uninsured (compared with a US proportion of 15.7% as of 2009). 17% of Texan kids are without insurance, compared to 10% nationwide. One third of Lone Star adults 19-64 lack insurance; the national total is 22%…and so it goes.

Don’t lose sight of what all this means.  Folks are dying now in Ted Cruz’s Texas when they shouldn’t — and he’s aiming to make sure that moral outrage continues.

Texans and, alas, the rest of us are stuck with Senator Cruz for another four years and change.  Let’s make sure we do whatever we can to see that his BFFs in the House pay the price much sooner than that for conspiring before the fact in the deaths of American citizens.  And let’s help our countrymen and women in the great state of Texas rid themselves of this noxious pest at the first opportunity.

Image: William Hogarth, An Election Entertainment,  1754

The Difference Between Democrats and Republicans

October 1, 2013

In California, a Democratic Party-run state:

Dozens of workers at a call center in the Sacramento suburb of Rancho Cordova began fielding calls after a countdown to 8 a.m. Tuesday, the time the state’s health exchange opened for business. The agency that runs the exchange, Covered California, reported on Twitter that more than 30,000 telephone calls were received during the first 90 minutes of operations. Another 1,200 were on hold and about 4 percent had hung up.

Peter Lee, executive director of Covered California…said Tuesday was just the starting point, and it was evident that exchange officials had work to do after the website and phone system were hit with a crush of inquiries.

Gov. Jerry Brown, meanwhile, announced he had signed a package of bills to help implement the new law and expand the state’s Medi-Cal program for those who are too poor to pay for the subsidized insurance.

“While extreme radicals in Washington shut down our government, here in California we’re taking action to extend decent health care to millions of families,” Brown said in a statement, referring to the impasse in Congress that has led to a partial shutdown of federal government operations.

Meanwhile, as a result of the government shut down triggered by those GOP extremists, there’s this news:

Cecil_Beaton_Photographs-_General;_China_1944,_Canadian_Mission_Hospital_in_Chengtu_IB2569C

At the National Institutes of Health, nearly three-quarters of the staff was furloughed. One result: director Francis Collins said about 200 patients who otherwise would be admitted to the NIH Clinical Center into clinical trials each week will be turned away. This includes about 30 children, most of them cancer patients, he said. (From behind the WSJ paywall via the Atlantic) (h/t a tweet from science writer extraordinaire Steve Silberman aka @stevesilberman.)

So there you have it:  Democrats strive to get sick people care (and the well, protected), and labor to fix  the bits that don’t work.

Republicans leave kids with cancer on the street.

Update:  H/t commenter Baud, it turns out   that Americans in those (GOP-led) states that have chosen to abandon their responsibility to their citizens actually do twant healthcare from the Feds (via TPM):

Nearly three million people have visited the federal health insurance marketplace created by Obamacare on its first day, according to the U.S. Department of Health and Human Services.

Since midnight, 2.8 million people have visited the website, which will serve consumers in more than 30 states, and 81,000 have called the marketplace’s call center. Those numbers were current as of late Tuesday afternoon.

Image:  Cecil Beaton, A mother resting her head on her sick child’s pillow in the Canadian Mission Hospital in Chengtu, 1944.

One Dares Call It Murder

September 30, 2013

It’s not just this DFH anymore.  Senator Angus King (I-ME) goes there:

….he [King] doesn’t mince words with those who’d take risks with other people’s health security.

“That’s a scandal — those people are guilty of murder in my opinion,” Sen. Angus King, a Maine Independent who caucuses with Democrats, told me in a Friday interview. “Some of those people they persuade are going to end up dying because they don’t have health insurance. For people who do that to other people in the name of some obscure political ideology is one of the grossest violations of our humanity I can think of. This absolutely drives me crazy.” (h/t TPM)

Thetriumphofdeath_3051x2161

 

Just to go over the ground once again:  health insurance saves lives.  When you deny our fellow citizens coverage — well take it away, Senator:

…ACA opponents are loathe to grapple with the life-or-death nature of their advocacy and tend to lash out when confronted with it. As such, the debate over the law tends to center around other moral questions. But King doesn’t think they should be let off the hook.

“That’s bunk. You can’t wish that reality away because you don’t like the policy outcome,” he said.

…“To me it boils down to a moral question, and that is would you allow someone sitting in front of you on the subway to die, or would you take some action — call 911 or a doctor or do CPR yourself. Most people would say no I would not allow someone to die. You have to realize that as a society we’re answering ‘yes’ to 25,000 a year who are dying before our eyes and saying we don’t care.”

The House Republican caucus and their allies in the Senate and in the Koch et al. penumbra are demanding those deaths everytime they attempt to defund or “delay” Obamacare as the price for keeping government open.  I’ve tried, but I just don’t have any polite words to describe those actions or those actors.  King dares call it murder — and he’s right.

Good for him for saying so.  May others pick up the message.

Image: Pieter Breughel the Elder, The Triumph of Death, c. 1562