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Tag: "health care"

Sick Leave

[ 36 ] November 5, 2016 |

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The national conversation about the social safety net is in terrible shape, far behind where it was in the 1970s. There are of course sharp structural reasons for this, as the rise of the conservative movement and the reestablishment of corporate control over politics makes the passage of even basic legislation like keeping the government running is extremely contentious. That’s sad because in the 1970s, it seemed like we were about to make whole new leaps into a social safety net something like in western Europe. Today, we are just hoping to gain enough momentum to provide some fixes to the ACA, which while an improvement on the terrible state of health care in the United States, is a very flawed and limited program. A national child care program, the forgiveness of trillions in student debt, free public higher education, and other obviously beneficial programs are either not on the table today at all, only in the dreams of the liberal left, or just getting off the ground. Another of these is a vigorous national sick leave program. The Family and Medical Leave Act was a slight step forward, but any program that only provides unpaid leave is obviously quite flawed. Yet the costs of not having a real sick leave program are quite real.

Low-income mothers are particularly likely to work while sick. Another study, by LeaAnne DeRigne of Florida Atlantic University and colleagues, explains why. It found that families with less ability to afford unpaid time off are more likely to lack paid sick leave. According to the study, published in Health Affairs, 65 percent of families with incomes below $35,000 had no paid sick leave, while the same was true of only 25 percent of families with annual incomes above $100,000.

Paid sick leave slows the spread of disease. Cities and states that require employers to offer paid sick leave — Washington, D.C.; Seattle; New York City; and Philadelphia, as well as Connecticut, California, Massachusetts and Oregon — have fewer cases of seasonal flu than other comparable cities and states. Flu rates would fall 5 percent if paid sick leave were universal. According to one estimate, an additional seven million people contracted the H1N1 flu virus in 2009 because employees came to work while infected. The illnesses led to 1,500 additional deaths.

Paid sick leave has other benefits besides reducing flu deaths. For example, workers may use it for preventive care, forestalling subsequent, more disruptive health problems. Workers lacking paid sick leave are more likely to delay needed medical care, a finding that holds for both insured and uninsured workers. In other words, though health insurance helps people pay for health care, it does nothing to help them afford to take time off to get it.

Sicker workers may be more prone to job-related injuries. One study found that even within industries in which accidents and injuries are relatively more likely — like forestry, mining and construction — workers with paid sick leave experienced fewer of them than workers without it. Another study found that employees who work while sick are more likely to have heart attacks than those who take time off.

Unfortunately, like so much in the United States, the unwillingness of the government to provide social services means that risk gets placed on the individual, in this case disease spreading through society unnecessarily and at great cost.

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Building on Obamacare

[ 116 ] August 23, 2016 |

Obama_signs_health_care-20100323

The Affordable Care Act is arguably the biggest progressive legislative victory since the Johnson administration. It’s also deeply flawed and in need of update in many areas. These two statements are not contradictory. The question, as Jim Newell asks, is whether Democrats are ready to build upon that great victory and improve the law.

First, some of the issues, which have been more in the news lately because of Aetna deciding to play the villain.

But it’s becoming clearer that the Affordable Care Act, for all its advances, is due for the sort of legislative maintenance that most major laws require after implementation. Two temporary federal programs, reinsurance and risk corridors, designed to cushion losses for insurers as they determined sustainable premium price points in new markets, expire in 2017 as the exchanges enter their fourth year of operation. Carriers serving sicker-than-expected pools or rural areas find that their options are either to sharply increase premiums or to leave the exchanges altogether. Average premium increase requests from insurers on the individual exchanges are well into the double digits across much of the country. And a Kaiser estimate in May projected the number of counties that could have a single exchange insurer in 2017 to be 664—70 percent of which are mostly rural—up from 225 in 2016. That number will increase following Aetna’s withdrawal and could reach roughly a quarter of all counties in the country. Alabama, Alaska, South Carolina, and Wyoming are set to have just one insurer offering coverage on their exchanges in 2017. Most of North Carolina, except for the Raleigh metropolitan region, will be down to one insurer as well.

One problem with legislative redress for Obamacare is that the legislators who are supposed to do the redressing seem less than eager to return to the front where not long ago they’d declared victory. The second problem is that, once again, the fight will almost certainly involve the public option.

So what about the public option and what, if anything, are Democrats ready to do if they have a big win in November? Newell correctly notes that most Democratic politicians see the fight as protecting the ACA from Republicans and therefore really not articulating any changes. He does have a slight bit of hope that Hillary Clinton will push toward something like the public option.

There is one Democratic figure who might be in office in 2017 who has treated the law’s shortcomings seriously and put together a bevy of health care proposals—and she happens to be the party’s presidential nominee.

In the beginning of the campaign, Hillary Clinton, too, suffered from the “everything is fine!” bug, going so far as to red-bait Sen. Bernie Sanders over his Medicare-for-all plan. Sanders’ specific proposal suffered from some fuzzy math. But he understood that though the ACA was a vast improvement on an untenable status quo, its flaws really were flaws, and it made little sense to avoid confronting them just because doing so would be a pain. One staple of Sanders’ events during the campaign was to ask members of his crowds to raise their hands if they were facing sharp premium increases, and then to say how large the increase was. There was never a shortage of volunteers.

Eventually Clinton put together a series of health care proposals. It wasn’t the overhaul Sanders wanted, but he gave his enthusiastic endorsement anyway. Clinton would add a Medicare “buy-in” option for those 55 and older, and she also committed to doubling the money for community health centers from the funding mark set in the original ACA, an important provision won by Sanders in 2009. She offered further inducement for states that haven’t already accepted the Medicaid expansion to do so and would grant the HHS secretary additional “authority to block or modify unreasonable health insurance premium rate increases,” increase resources for enrollment outreach, and expand existing exchange subsidies.

And yes, she’s also pledged to “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan.”

It’s unclear how high a public option, and the political fight that will come with it, ranks atop Clinton’s list of priorities. But if 2017 open enrollment goes poorly and more insurers flee the exchanges, the public option—which has always polled well—would be an obvious go-to solution for restoring competition. The idea doesn’t rely on hand-holding private insurers until they feel properly incentivized to perform their societal function. It is a direct delivery of health insurance plans to health insurances exchanges. “Health care markets will inevitably differ from region to region,” Jacob Hacker, the Yale professor and so-called “father of the public option,” wrote in Vox on Thursday, “but there’s no reason every one of the existing marketplaces couldn’t offer a Medicare-like plan—a plan that’s stable; a plan with predictable costs; a plan that gives patients a broad choice of providers just as Medicare does.” It would also save money—$158 billion over 10 years, according to a 2013 Congressional Budget Office estimate.

There’s another problem that Newell does not discuss, but that I feel. The ACA was a big win but the Tea Party’s rise and McConnell destroying the historical norms of the Senate has meant that it’s now been 7 years since we have seen a major progressive bill become law. The victories of the last 7 years have been in the courts (especially in the last few months) and through the executive branch. There are a lot of other priorities that have been ignored or put aside. If Clinton wins and has the ability to pass any legislation (just play along here), I think her top two priorities should be an immigration bill with a path to citizenship for undocumented Americans and a sizable minimum wage increase. Both of these have significant political support and are fairly simply to articulate. After that, maybe health care comes back on the table, but so does a climate bill, college tuition and debt issues, a revived Employee Free Choice Act, and a whole lot of other things. Given all of this, to what extent should Democrats fight to improve Obamacare?

Which, in other words, means that this could serve as a thread on what you think Clinton’s top legislative priorities should be, in particular keeping in mind what is actually possible, even if she does have 55 senators and a narrow House majority for the precisely 2 years that will probably last.

He. Didn’t. Even. Try.

[ 128 ] October 28, 2014 |

If only Obama had given one more speech, the Democratic caucus in the Senate would have totally supported a Swedish-style single payer health care system:

One of the most interesting examples of the reform effort are the “copper plans” being proposed in the Expanded Consumer Choice Act, which is being pushed by seven moderate Senate Democrats: Mark Begich, Mark Warner, Heidi Heitkamp, Tim Kaine, Mary Landrieu, Angus King, and Joe Manchin.

The bill has been around for a few months, but it’s gained more attention in recent weeks because Begich — one of the most vulnerable Democrats in the 2014 election — is using it as proof that he really does want to fix Obamacare, rather than just protect it. If he wins his election, it could become a model for Democrats trying to run on Obamacare going forward. It might even end up being part of a Republican reform package.

Copper plans cover 50 percent of expected health costs (or, as the health wonks put it, they have an “actuarial value” of 50 percent). That means premiums are cheaper than the platinum, gold, bronze or silver plans — the consulting group Avalere Health estimates that copper plan premiums would be 18 percent lower than bronze plan premiums.

But if you get sick, the deductibles and co-pays are much higher. Larry Levitt, a vice president at the Kaiser Family Foundation, says that the deductibles would have to be in the range of $9,000 — which would make them higher than the $6,350 out-of-pocket maximum that the law currently allows.

In other words, a significant percentage of the Democratic caucus is looking to fix the ACA by making it a lot worse for poor people.

When someone tells me how Obama was supposed to get votes 53-60 for a better health care bill–in a Democratic caucus that was worse in 2009 than in 2014, let me know.

Cubs Failure

[ 66 ] August 22, 2014 |

Typical that the Chicago Cubs, with their century of pathetic failure and fans who revel in it combined with their Koch Brothers-esque owners, would provide one of the great, if minor failures in baseball history so the billionaires wouldn’t have employees become eligible under Obamacare.

Earlier this week, the Chicago Cubs grounds crew experienced a disaster. As rain poured onto Wrigley Field, they were unable to cover the playing surface with a tarp in time. They were booed. The game was called. Because of the mismanagement, their opponents, the San Francisco Giants, protested the game after it had been called as a win for the Cubs. They succeeded. It was the first successful protest in Major League Baseball in 28 years, according to Deadspin.

But the whole bizarre episode was cast in a new light Thursday when the Chicago Sun-Times reported that the Cubs had slashed worker hours to keep them under 30 hours a week to avoid paying health benefits under Obamacare.

Citing “numerous sources with direct knowledge,” the Sun-Times reported that the Cubs had sent home 10 grounds crew workers early the night of the Tuesday game that ended in disaster. And at least part of the reason, per the newspaper’s sources, is that the team has been trying to keep seasonal workers under 30 hours per week as the Affordable Care Act takes effect.

The law requires large employers to offer health insurance to full-time employees (defined as those who work more than 30 hours a week) or pay a fine. The rule goes into effect in 2015.

A spokesman for the Cubs, which are reportedly worth $1 billion and were the most profitable team in baseball in 2013, didn’t refute the claims when asked by the Sun-Times, but he denied personnel changes were responsible for the field tarp incident.

The only problem with the Cubs enduring another 100+ years of failure is that it gives their fans a meme to organize around. Would another deserved 100 years help or make the franchise and its fans even more annoying, if that’s possible?

Structural Inequality and Infant Mortality

[ 114 ] April 2, 2014 |

I can’t recommend this Stephen Bezruchka essay on structural inequality and infant mortality strongly enough. Just a quick excerpt:

Everyone in a society gains when children grow up to be healthy adults. The rest of the world seems to understand this simple fact, and only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States. What does that say about our understanding, or concern, about the health of our youth?

Infant death rates, those occurring in the first year of life, are a particularly sensitive measure of health in a population. According to a U.S. Centers for Disease Control and Prevention report released in 2013, our infant mortality rate is about 6.1 deaths for every thousand live births. Sweden has an infant mortality rate less than half of ours, 2.1 deaths per thousand births. If we had Sweden’s rate of infant deaths, the United States would have around forty-seven fewer infants dying every day in the United States. That is what is achievable: every day forty-seven babies wouldn’t die if we had Sweden’s rate of infant deaths.

Differences in mortality rates are not just a statistical concern— they reflect suffering and pain for very real individuals and families. The higher mortality in the United States is an example of what Paul Farmer, the noted physician and anthropologist, calls structural violence. The forty-seven infant deaths occur every day because of the way society in the United States is structured, resulting in our health status being that of a middle-income country, not a rich country.

There is growing evidence that the factor most responsible for the relatively poor health in the United States is the vast and rising inequality in wealth and income that we not only tolerate, but resist changing. Inequality is the central element, the upstream cause of the social disadvantage described in the IOM report. A political system that fosters inequality limits the attainment of health.

Resist changing? For Republicans, rising inequality is the stated goal, with an underlying racial tone that gets poor whites to buy in against their own economic interests.

The only thing I’d add that Bezruchka leaves out is how the decline of labor unions has played into this problem. He suggests worker-owned businesses as part of the strategy to overcome this structural inequality, but that he mentions this and not unionized workplaces says a lot about just how desperate organized labor’s situation has become. In all of American history, only labor unions have allowed workers to have a real voice on the job and provided a powerful and long-term voice for the American working class. Without that voice and the potential of delivering (or withholding) votes and money, politicians have little reason to care very much about structural inequality.

But otherwise, an outstanding essay.

Uncle Sam the Rapist

[ 52 ] September 19, 2013 |

Not sure what the Koch Brothers are getting at in this anti-Obamacare ad portraying Uncle Sam as a rapist. Given that he seems be to using the same transvaginal ultrasounds that conservatives like the Koch Brothers support when a woman wants an abortion, is Uncle Sam just practicing on all women?

In any case, it’s hard to imagine the Germans or Japanese during World War II using Uncle Sam in a more offensive and anti-American way than this ad.

….If you want to make Uncle Sam creepy, at least go old school Committee on Public Information style.

Stand Beside Her And Guide Her

[ 69 ] August 9, 2013 |

As you probably heard, Karen Black died. A key actress to so many major films of the 70s, she succumbed to cancer. She could have had a dignified end of life. Or maybe even defeated her cancer. Instead, she lived in the United States, where our disastrous health care system (even after the significant improvements of Obamacare) forced Black and her husband to crowdsource her cancer treatments after they used up all their savings.

At least Black had the name to do this. How many thousands of people just die because they don’t have the ability to put up even a basic fight against illness?

The Greatest Country in the World

[ 34 ] July 1, 2013 |

Oh beautiful for spacious skies, for amber waves of grain:

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey by Childbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

How long until American families start going to Canada to give birth? For all that conservatives complain of so-called “anchor babies,” by foreigners supposedly coming to the U.S. to give birth, doesn’t it make sense for everyone who can to flee to a country where you can give birth for free? Does it cost more to give birth in Canada or pay for things that should be but aren’t provided by the government in the United States?

Obama’s War on the NFL. And America Of Course. Let’s Not Forget His War on America

[ 39 ] June 27, 2013 |

This is even stupider than the usual Republican paranoia. Evidently, Obama is trying to destroy the NFL–by planning to run ads during NFL games this fall explaining the details of the health care bill as it goes into effect.

It’s just one scandal after another with this administration. Did you see that it is now trying to destroy the NFL? This is what’s happening, according to certain quarters of the Internet. Here’s the skinny: the Health and Human Services department is ”in talks with the National Football League to promote [Obamacare]’s insurance marketplaces that begin enrolling people Oct 1.” Who knows how deep this corruption goes — HHS secretary Kathleen Sebelius also ”said the administration is also talking to other major sports franchises about improving public awareness of the Obamacare online insurance exchanges.”

Kaiser Health’s story also notes that during the media push for Massachusetts’ similar health care law, “the campaign was advertised during Red Sox games at Fenway Park. That marketing is widely credited with helping build public acceptance.” Once again in the health care field, the federal government is just following Mitt Romney’s lead.

Conservative media outlets are getting upset at this co-opting of America’s favorite sports franchises, coerced to do the dirty work of promoting the most evil law in the history of the universe. Perhaps this top comment, on The Hill’s story, left by one “MR FOOTBALL,” epitomizes the attitude: “Goodbye NFL!” MR FOOTBALL’s presumably got all sorts of things goin’ on and with football, he can take it or leave it.

We’ll see if this deal comes to fruition. It may turn out that the NFL’s rates are too high to justify the expenditure. And not everywhere in the country is like Massachusetts, where Red Sox players can order any person in the state to do anything – fix up a pre-game cheese plate for them, enroll in subsidized health insurance plans, whatever – at any time.

Poor football fans.

Chronicles of Mayo

[ 46 ] June 6, 2013 |

A year and a half ago, a friend and former student had a sudden, unexpected medical emergency. She’s telling her story here, and it’s fantastic stuff. Start at the beginning:

I peered over my doctor’s shoulder to have a look for myself at the CT scan on the computer screen. He was pointing to what looked like an Easter egg shaped blob which was situated in my sinus cavity. I nodded my head at him waiting for him to tell me that it was something easy to fix. To my frustration all he did was look at me.

“So what is it?” I asked after a few seconds of silence. Up until now, I had thought he would tell me I had a sinus infection. My head had felt stopped up for weeks and my right eye hurt whenever it moved. My GP had been giving me antibiotics and prednisone for the past month until he threw up his hands and referred me to an ENT specialist. I just figured this guy would have stronger meds and we could be done with it already.

Spare the Brush and Spoil the Teeth

[ 18 ] May 26, 2013 |

Good advice.

Date unknown, but early 20th century.

Today at the Supreme Court

[ 10 ] June 28, 2012 |

I’ll have a piece up shortly at Salon about why it’s basically nuts that John Roberts gets to decide what sort of health care system America has. It quotes a good point made by Richard Posner earlier this week in the context of the life without parole for teenagers case:

I don’t object to a loose construction of the Constitution; there isn’t any sensible alternative, given how old and out of touch the document is, how unrecoverable the actual thinking of its authors and ratifiers, and how vaguely worded so much of it is.

Posner’s point is that, under the circumstances, “constitutional interpretation” must give justices — or, in the case of 5-4 decisions, one justice — the power to do pretty much whatever they want in regard to the sorts of issues that end up before the Supreme Court.

Whether this is a desirable state of affairs is another question entirely.

Here’s the Salon piece.

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