Posted tagged ‘Obamacare’

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.

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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

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)

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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

The House Republican Caucus: Conspiring to Murder American Citizens

September 28, 2013

The breathlessly awaited Saturday meeting of House GOP caucus is over, and we now know what these feral children want in exchange for not blowing up the American economy:

 The federal government on Saturday barreled toward its first shutdown in 17 years after House Republicans, choosing a hard line, demanded a one-year delay of President Obama’s health care law and the repeal of a tax to pay for the law before approving any funds to keep the government running.

In all the talk about defunding or delaying Obamacare, there’s one thing that hasn’t been discussed  much, certainly not by the Village.  That would be what  delaying Obamacare would actually mean in the real world.

There, we’re looking at dead Americans, needlessly and avoidably cut down before their time.

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Here’s the train of thought behind that claim:

The primary goal of the health care reform is to cover as many Americans who lack insurance as possible. As of this year, that is in the neighborhood of 48 million people — roughly 15% of the total US population.  Under the terms of the ACA, that number will be cut by 14 million next year, with more to come as the law persists.  That’s still well short of the goal for a civilized society, in my view, but 14 million people with access to health care is a real and important social and ethical good (not to mention an economic plus, in many analyses).

Those 14 million people — 14 million individual human beings with hopes and aspirations and real desires to avoid pain, misery and worse — are the primary victims of the morally bankrupt cabal that calls itself the House Republican caucus.  If they were to get their way and either fund the government or commit to allow the Treasury to continue to meet obligations already undertaken only on condition that those 14 million must once again go without health care coverage then the suffering that follows is on their heads.

In that context, it’s important to note that this means that the House GOP caucus will thus almost certainly be guilty of causing some significant number of unecessary, premature deaths.  The study of the connection between mortality and health insurance status is somewhat complicated, and a couple of very well publicized studies recently [PDF] have suggested that there isn’t any correlation and/or that Medicaid coverage in particular makes things worse.  Those studies and even more, the trumpeting by such deep thinkers as our old friend, Megan McArdle, have in their turn been strongly criticized, to put it mildly, and they are outliers against a background of some decades of work that show real and deadly links between whether or not you are covered and whether or not you die.

To put this all in a nutshell, take a look at the good recent-ish summary of the state of play of the uninsurance-death argument  comes from Dr. David Gorski writing in the Science Based Medicine blog.  The key point:

analysis of survey data from patients who were uninsured but then became old enough to be enrolled in Medicare suggests that “acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.” In summary, there is a large and robust body of evidence suggesting that people do, in fact, die because of lack of health insurance.

J. Michael McWilliams, MD, PhD, Assistant Professor of Health Care Policy and Medicine at Harvard Medical School and an associate physician in the Division of General Medicine at Brigham and Women’s Hospital … speculates:

How many lives would universal coverage save each year? A rigorous body of research tells us the answer is many, probably thousands if not tens of thousands. Short of the perfect study, however, we will never know the exact number.

In other words, it’s hard given our current state of knowledge to point to John Doe over there, and say that lack of coverage killed him.  The Republican House doesn’t have to worry about answering a bill of indictment charging them in Mr. Doe’s murder.  But next year, were the House Republican branch of the Bolshevik party to succeed in delaying (or killing) health care reform, the some significant number of uninsured Does and Roes will die.  My truly primitive back of envelope calculation yields an estimate  of the number to be sacrificed to meet Republican Congressional priorities in the single digit thousands.  Let’s just say the death toll would be on the scale of  a couple of 9-11s.

The men who flew planes into the towers were terrorists.

What, then, should we call the House Republican Caucus, and their Ted Cruz-led Senate colleagues?

As our Roman friends would have said:  “res ipsa loquitur.

One more thing:  Factio Grandaeva Delenda Est.

Image: Josse Liefernixe, St. Sebastian interceding for the plague-stricken,  1497-1499.

American Exceptionalism, Healthcare Division

September 18, 2013

With a h/t to my spouse, this piece from a couple of days ago offers a beautiful (not really the mot juste) window onto the multiple levels of fail of US medical business and (or rather, hence) practice.  The action gets going as a young physicians assistant named Andrew T. Gray describes waking up an upset stomach, which over the course of the day blossoms into really nasty pain.  Then comes the twist:

Crawling into bed, however, I realized that my pain had coalesced in the right lower quadrant of my abdomen. Could it be appendicitis?

Panic flooded me. After six weeks at my new job, I now qualified for health insurance, but I’d neglected to fill out the necessary paperwork.

Only an hour after leaving the clinic, I returned. Almost hysterically, I completed and faxed in the insurance forms.

“Go to the emergency room right now,” urged one of my supervising physicians.

Instead, Gray waited overnight so as to reduce the odds of insurance company shenanigans.  The next morning, though he can’t wait anymore:

Waiting for the ER doctor, I recalled that, at some point in my schooling, I’d read a Swedish study about treating appendicitis with antibiotics. Googling the study on my smartphone, I found it.

By the time the ER resident approached, I was ready.

“I don’t have health insurance,” I said calmly. “Can I be treated with antibiotics instead of surgery?”

“I doubt they’re going to let you do that here,” he said. “But keep expressing interest.”

When the ER attending physician came in, I repeated the question.

“Absolutely not,” he replied flatly. “This is America, not Sweden. If you have appendicitis, we operate.”

The story gets better — which is to say from a policy and medical care point of view, worse.  Go read the whole thing.

As to it’s relevance beyond itself. Well, Gray’s telling an anecdote, of course, a single encounter in a system that touches millions every day.  Even so, there are at least two key points I draw from it:  (a)  there are structural problems with the culture of medical practice in the US that both drive up costs and affect (not for the better) patient outcomes.  “This is America…we operate.”

Hans_Holbein_d._J._-_Henry_VIII_and_the_Barber_Surgeons_-_WGA11566

And (b):  there are lots of reasons medical costs in the US seem both arbitrary and excessive. But (a) they are and (b) it actually matters to know what happens elsewhere, because from such knowledge it finally becomes much easier to see that US health care is exceptional alright — but not how the foaming hordes raving against tyranny in the form of Obamacare would have it.  We sure do lead the world in what we pay. Just not in getting what (we think) we’re paying for.*

*This is not to say that for particular conditions in particular cities there is no better place in the world to receive care than, say, my current dwelling place, Boston.  But brilliant tertiary care available  to those clued in and covered in just the right ways doth not a system make.

Image:  Hans Holbein, Henry VIII and the Barber Surgeons, 1543.

Hurts Too Much To Laugh; I’m Too Old To Cry

April 6, 2012

This is how one sad story begins:

May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.

This is what follows that terrible moment:

My brother’s small employer — he is the manager of a metal-fabrication shop — does not offer health insurance, which was too expensive for them to buy on their own. Fortunately, my sister-in-law had enrolled in the Access for Infants and Mothers program, California’s insurance plan for middle-income pregnant women. AIM coverage extends 60 days postpartum and paid for her stay in intensive care and early rehabilitation. But when the 60 days is up next week, the family will fall through the welfare medicine rabbit hole.

And here is what those people will have to deal with for the rest of their lives:

When the AIM coverage expires, my sister-in-law will be covered by Medi-Cal, California’s version of Medicaid, because she is disabled and has limited income. But because my brother works, they are subject to cost-sharing: they pay the first $1,100 of her health costs each month. Paying $1,100 leaves them with a monthly income of just 133 percent of the federal poverty level. If my brother makes more money, their share of the cost increases.

They must also meet the Medi-Cal asset test: beyond their house and one vehicle, they can hold $3,150 in total assets, a limit last adjusted in 1989. They cannot save for retirement (retirement plans are not exempt from the asset test in California, as they are in some states). They cannot save for college (California is not among the states that have exempted 529 college savings plans from their asset tests). They cannot establish an emergency fund. Family members like me cannot give them financial help, at least not officially. If either of them receives an inheritance, it will go to Medi-Cal. Medi-Cal services that my sister-in-law uses after age 55 will be added to a tab that she will rack up over the rest of her life. When she and my brother die, the state will put a lien on their estate; their child may inherit nothing. Even my brother’s hobby runs afoul of the asset test: he enjoys working on old cars, which he can no longer keep.

This is what this story reminds us:  for too many of our fellow citizens, our health care system, when it delivers care at all, turns families permanently poor.

This is what “Repeal” means.  Welcome to the Republican vision for health care.*

Oh — and, yes, of course, this is what the case before the Supreme Court is alll about.  Which is why the willed and faux-naive ignorance of  Scalia, Alito and others earns the name of evil.

Go read the whole piece.  Get angry, then angrier.  If you live with GOP representatives, send this column to them.  If you have friends or family or acquaintances who might be able to make the same leap John managed, pass it on to them too.  Pressure is a daily accumulation of little taps and nudges, and there is no time the present.

*I won’t insult you by adding the reflexive “and Replace,” as there is no replacement on offer; vouchers are not a health care system, and would, as now proposed, do that quantity of good that asymptotically approaches zero for this family.

Image: Gustave Doré, A Couple and Two Children Sleeping Under the London Bridge 1871.