Posted tagged ‘Health Care’

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

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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.

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.

Today’s Republicans: Traitors Or Psychopaths?

March 22, 2015

On the treason side, I give you Steven King, who is, of course, of interest to any GOP presidential aspirant as a major figure (FSM save the Republic!) in first-in-the-nation-caucus-state Iowa:

“…here is what [one] thing that I don’t understand, I don’t understand how Jews in America can be Democrats first and Jewish second and support Israel along the line of just following their president…”

Speaking as a Jewish-American who thinks Netanyahu is a corrupt, power-for-power’s sake bigoted hack whose policies are a clear and present danger to Israel, let me first say to Representative King:

Fuck you.

With that reasoned and considered reply out of the way, let’s parse this.

“I don’t understand”

Considering the speaker, that clause doesn’t narrow it down very much.

“how Jews in America”

Not, notice, “American Jews.”  This line is the tell, the crack that lets you see into what smells to me like a very familiar trope of anti-Semitism.  I don’t want to be paranoid, but King’s plain text tells you he sees within America a group defined by an affiliation, an bond of connection to a country or a cause that is not native to their home.  We are Jews sojourning in America, and it may come to pass (how appropriate for the season!) that there will arise in Washington a King who knows not Moses.  Or so this false prophet suggests.

“Democrats first and Jewish second.”

First,carnally know you again, King.  I for one, am a Democrat at least in part because of my Jewish education.  Specifically, Isaiah 58 v. 1-12.  I may have lost any belief in a sky god — but tikkun olam* and that strand of the Jewish tradition remains a touchstone.

But more seriously, look at what King does here: he assumes a reflexive Jewish duty of allegiance to a political movement in Israel he conflates with Israel as a whole (not as bad an error I as I would wish right now, alas), which cannot be met as a member of the Democratic party.

“along the line of just following their president…”

Well, intercourse you some more, Congressman, sideways, with an oxidized farm implement.  Barack Hussein Obama is America’s president.  Yours too.  Suck on it.

Diving a little deeper, what strikes me is the combination of hostility to Jews — American Jews — and the smell of treachery.  We U.S. born and bound remnants of the Kingdom of Judea are failing Rep. King.  We are unsatisfactory to him in the failure of our allegiance to a foreign power.  He here explicitly advocates Jews in America form a fifth column for Israel.  Failing to do so, we are to him twice the “other” — Democrats and the wrong kind of Jewish.

Budapest_kunst_0043

To which I say:  beware of the demagogue who starts to define you out of commonwealth.  The next steps…we’ve seen them before.

But even more, what do I see in King himself?

Treason is a nasty word.  But there are clear US interests at stake in controlling any Iranian ambition for a bomb. Conspiring with a  foreign leader to undermine US government efforts to that end?….

Next up: psychopathy, in the form of erstwhile blog favorite Paul Ryan.  Here is his view on the appropriate state response if the Supreme Court were to gut subsidies on Healthcare.gov:

“If people blink and if people say this political pressure is too great, I’m just going to sign up for a state-based exchange and put my constituents in Obamacare, then this opportunity will slip through your fingers,” Ryan said, per the Journal.

That would be the opportunity to wait for Congress to enact a “reform” that would (on the evidence of the latest GOP budget fraud) gut Medicaid, erode Medicare, and leave millions of Americans (twenty million or more, as of this writing) without the health insurance they so recently gained.

In other words, the opportunity Ryan wants state governments to seize is to allow their citizens in great numbers to face the inevitable reality of illness and accident without a net.

Pure psychopathy.  I’d use the word “evil” but I wouldn’t want to be accused of being shrill.

Beyond labels (see what I did there?) this is the message I take from the juxtaposition of Messrs. King and Ryan.  This is the Republican party. These aren’t fringe players. They’re leaders, major shapers of policy, rhetoric and belief for just about half of the country, and much more than half of those with money enough to move power.  And they are freaking crazy.

We have nothing but work to do between now and 2016.  Not just the United States but the world can’t take the punishment of these guys holding all three branches of the government in Washington.

One last thing:  to the question at the head of this post.  To channel the wisdom of Reb Chevy Chase, they’re both.

*F**k you WordPress autocorrects olam to loam, just so you know.

Image:  Rembrandt van Rijn, The Old Rabbi1642.

Flop Sweat, GOP edition

March 30, 2014

At least some Republicans have grasped what it means — maybe for 2014, certainly later — if/when Obamacare is and is seen to be a success:

“I don’t think it means anything,” [Sen. John]Barrasso said on “Fox News Sunday” about the news that 6 million people had signed up for health care plans. “I think they’re cooking the books on this.”

Barrasso, (R-Not-Liz-Cheney’s-real-home-state) is not your garden variety Republican talking horse. He is, in fact, the chairman of the Senate Republican Policy Committee — which is a post that puts you on the GOP leadership team in the upper house. This is, in other words, someone taken seriously by people who have plenty of evidence to suggest they shouldn’t. And this Very Serious Person is telling the Most Misled Viewership™ in America that any reports that might have troubled their spotless minds about the possibility that Obamacare may succeed are skewed, false, nothing-to-see-here-move-along lies of the sort they’ve come to expect from the Kenyan Mooslim Usurper.

Frans_Hals_-_Regents_of_the_St_Elizabeth_Hospital_of_Haarlem_-_WGA11139

Given that the argument for the last several months has been that the new health care law is an obvious and abject failure, just waiting for that one last shove to send it crashing on to the ash-heap of history, evidence of the law actually functioning pretty much as designed is a disaster.

I suspect Barrasso grasps the difficulty he faces. Facts have a habit of willing out — and the many millions covered by the new health marketplaces, by Medicaid, by extended access to their parents’ policies — are going to be acutely aware if their health insurance falls under renewed threat. So (in a rhetorical move that might confuse the uninitiated) Barrosso adds the inevitable “numbers are irrelevant” dodge:

Barrasso said people care more about what kind of plans people are purchasing and whether they can keep their doctors, not how many people have signed up for new plans.

Maybe so. Fox News viewers (and anchors) may continue to believe this kind of nonsense. But those who have the good fortune to live in places where denialism isn’t what’s for breakfast know better. And they vote. As do their kids, their friends, the whole shooting match.

I just hope they do so this November.

Image: Frans Hals, Regents of the St. Elizabeth Hospital of Haarlem, 1641.

 

 

 

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.