Archive for the ‘Health Care’ category

Stupid Idea For Readers To Destroy

September 12, 2017

David Anderson’s post at Balloon-Juice got me thinking on single payer vs. universal coverage — I’m with David (and Elie). Don’t care how we get to health care for all Americans, as long as we get there.

So here’s my stupid idea: a move in stages.*

Stage one: Medicare For All Kids.  Same program, just for every kid up to the age of 18–or 26, to match current ACA practice.

The reasoning in my wholly non-expert addled brain being twofold: first, kids are, as a group, cheap to cover, so the financial lift here is presumably manageable.  Second: this has an aspirational frame that can be used to persuade.  I don’t know about you, but I’ll take (I took) risks on my own behalf I would never have done had I my son to keep safe when I started my own small business.  I don’t know how many people have deferred or abandoned dreams because they couldn’t go insurance-naked for their kids.

That’s anecdata, but David Leonhardt made much the same argument way back in 2010 in defense of the bill that became Obamacare. Medicare For All Kids, presented as a way to unleash Americans’ entrpreneurial spirit, would be a proposition on which I think Democrats could go to town.

The next stage is to take the step that didn’t find our David’s 218-51-5 support in the last go-round:  Medicare (buy-in?) For All Over 55.  This is a form of public option, and it would expand the single-payer approach to more and more of those either utterly unable to take on health risk themselves (kids, the post-work elderly) and those whose age-adjusted risk is growing to the point where it threatens to become unmanageable.   Again, this would require persuasion, but the idea that older but not old folks who might face, say, a 2008-like crisis of employment should find a ready avenue to coverage is, again, a case that can be made (by a better political rhetorician than me).

That leaves 27-55 year olds on their own — or rather, within the existing Obamacare/expanded Medicaid universe.  But it establishes a template for a single payer form of coverage without requiring a wholesale change over of a system with tons of interested parties and rent-seekers eager to defend their turf.

So — to steal Ta-Nehisi Coates’ old line: talk to me like I’m stupid.

What’s wrong with a crabwise walk towards increasingly universal health care, along these lines or better ones? For both politics and policy, what would be wrong w. introducing, say a Medicare For All  Kids bill in this Congress, just to get that ball rolling?

David? Anybody?

*”We shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender.”

Image: Edvard Munch, The Sick Child, 1907

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It’s Baaaaacccckkkk (Sort Of, Maybe)

July 20, 2017

It is impossible to overstate the Republican commitment to ripping health care from millions, while taking a chainsaw to our medical system.

Rand Paul has just announced that he will vote “Yes” on the Trumpcare motion to proceed as long as he is given a clean vote on his amendment, which would simply repeal the ACA (which, given the CBO evaluation of a similar proposal, would lead to something on the order of 17 million without health care next year, and 32 million Americans left in the cold by 2026).

That’s still not enough to get Trumpcare to the floor if the other declared “Noes” hold out, but each senator McConnell can peel away significantly increases the pressure on those who remain opposed.  And certainly, Paul’s cave reminds us that counting on any Republican to maintain a party-base-unpopular position as a matter of principle is a mug’s game.

This won’t be over until the GOP loses its majority in one house or the other.

Image: Workshop of Lucas Cranach the Elder, Massacre of the Innocents, c. 1515

A Modest Proposal

July 20, 2017

Most people know of Senator John McCain’s diagnosis with glioblastoma, an aggressive brain cancer.  I have just a couple of thoughts I’d like to add.

First, obviously, best wishes to Senator McCain and his family. This is a very tough diagnosis, as we all know.  The next several months and years will demand an enormous amount of McCain and all those close to him, and I wish them well in that fight.

Second:  John McCain is receiving the best of care, as he should, and as I would wish anyone in his position could expect.  That health care comes to him through his job as an employee of the federal government.

The immediate context, of course, is that this particular federal employee is one of those Republican senators who was, by all accounts prepared to vote yes on a bill that would have pulled federally mandated and supported health care from tens of millions of his fellow citizens.

The larger context is that John McCain has throughout his life relied on the United States government for his medical care — from birth to now.  He was the son of a serving naval officer, then a cadet at the Naval Academy, then a serving officer himself, then briefly a veteran in private life.

Then, within a year of his retiring from the armed forces, elected as a member of the House of Representatives.  Four years later he won his Senate seat, to which he has been re-elected five times, which brings us to the present day.

A whole life, all 80+ years of it, and John McCain has never for a moment had to wonder what he would do if he became sick, or if his wife or his kids fell ill.  For the first half of his life, he had access to a single-payer system; as a member of Congress, he received his health benefits through the same benefit package available to federal workers; since the passage of the ACA, members and their staffs have access to on-exchange subsidized plans.

And that’s great!  John McCain should have had secure, guaranteed and persistent care.  The injuries he suffered in Vietnam and during his imprisonment there should never have been eligible to be pre-existing conditions. He should have been, as he was, free of the choice-crippling necessity of working a secure gig to ensure access to insurance, thus enabling him to pursue his life of military and public service.

The kicker though: so should we all.  The health-care life John McCain has led is the one that’s right not just for him and his family, but for all Americans.  I won’t rehash here the moral and the practical reasons why — we’ve done that before, David can do it better, and we will be back at that by nightfall at the latest.  All I want to do here is to make a modest proposal.

The Democrats should come to the next round of manouvering on health care legislation with a plan that repairs ACA’s current weak points and lays out a path to full coverage.  And they should name it after one of the great exemplars of the power of guaranteed health care to liberate Americans into lives of daring and service.

Here’s to the John Sidney McCain III Universal Health Care Act of 2017!

Image: Doris Zinkelson,  No 115 British General Hospital, Ostend – Unloading Wounded, 1945

It’s Working. Let’s Work More

June 27, 2017

Following up today’s news on the delay in the Senate health care vote…

Keep calling, and don’t restrict yourself to your senators’ DC offices.  Each and every senator has several in-state offices. They’re populated mostly by actual staffers, not interns.  Real people answer the phones — and if the one nearest you doesn’t pick up, you can call on down the line till you find someone at home.  They’re often less crazed and more ready to listen, even to opposing views.

My own experience:  my wife’s family has a place in the Bath-Boothbay stretch of the Maine coast, and several family members who live up around the Penobscot Bay area.  So I used that as the base from which I called Senator Collins’ Portland office, the one she lists as serving the county in which my in-laws hang.  I told the nice lady who answered that I was grateful to the senator for coming out in opposition to the bill, that I agreed with her that it was bad for Maine, and that I was calling both to thank her and to emphasize that cosmetic changes to the bill won’t alter its underlying effects, which will still be bad for Maine.  We talked about this for five or ten minutes and it was an actual conversation.

How much effect will it have? Not that much. She knew I was only partly attached to Maine, so that’s a discount right there.  But at least it lets that office and perhaps the senator know that we’re paying attention, and that we will continue to do so.  And the fact that this was a conversation, an actual accumulation of reasons to worry about the bill matters quite a bit, I think.

So the moral of the story:  you don’t have to bash down the front door to reach someone who can reach closer to power.  There are back doors, listed (with phone numbers) on every senators’ web page.

Use them.

Image:  Gerrit Beneker Telephone Operator (A Weaver of Public Thought), 1921.

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.