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Tag: "health care"

Who Knew?

[ 210 ] February 27, 2017 |

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The last person to understand a basic fact is of course our president.

President Donald Trump told a bipartisan group of governors at a White House reception Monday morning that GOP tax reform would have to wait for lawmakers to move on repealing Obamacare, cautioning that, “Nobody knew that health care could be so complicated.”

“I have to tell you, it’s an unbelievably complex subject,” Trump said.

OK.

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Who Uses the ACA? Trump Voters.

[ 216 ] February 6, 2017 |

1in4WA

As this story on Washington demonstrates, one of the many sad ironies of the election is that the counties most reliant upon the ACA for health care are also the counties most likely to vote for the fascist Trump.

The ACA and the Republican War on the Arts

[ 145 ] January 19, 2017 |

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Repealing the ACA would decimate the lives of musicians who rely on it to stay healthy. This is of course part of the point for Republican “governance” that is launching a head-on attack on the arts.

For much of his life, Andrew Savage, the 30-year-old singer-guitarist for New York indie-rock band Parquet Courts, went without health insurance. The musician suffers from epilepsy and suffers two or three seizures a year, the most severe of which have resulted in head trauma. He quit his day job six years ago to tour with the band, which was just starting to take off, but that meant no insurance to pay for his daily medication. He spent years shuffling payments on credit cards; once, he openly wept when a pharmacist told him a generic drug was available for $40 instead of $400.

The ACA would have helped, but by the time it took effect in 2013, the members of Parquet Courts were big enough, like most successful bands, to form a Limited Liability Company and purchase group insurance. “We were worried that if we got Obamacare, there would be a lot of limitations — the bill, when it was first conceived, was very different from the one that made it through because so many things got taken away from Obama and his original vision of the plan,” Savage says from his Brooklyn home. “Of all the cynical things promised by Donald Trump, this has got to be one of the most scoundrel-ish — this is taking things away from people who definitely need it.”

Even musicians who haven’t purchased insurance through the exchanges have benefited from Obamacare. Insurance companies can no longer raise rates for customers who have pre-existing conditions. That means sick people have an easier time than ever getting coverage.

Members of Drive-By Truckers, the veteran southern-rock band, run an LLC and share a group health-insurance plan. But 52-year-old Patterson Hood, one of the band’s lead singers, says the central Obamacare provision that prevents insurance companies from raising rates due to members’ pre-existing conditions has helped his family immeasurably. His wife and 12-year-old daughter have scoliosis, or curvature of the spine, and his 7-year-old son has growth hormone deficiency that requires an expensive shot every day for the next decade.

“My son’s shots are in the thousands per month. I mean, it’s a lot of money. And we do not have it,” he tells Rolling Stone just before a Conan appearance in Los Angeles. “We’re paying $2,000 a month as it is just for the insurance. I’m lucky I’m gainfully employed — my band, we’re not stars, but we’re successful enough to where I can make ends met. But it terrifies me. It literally woke me up in the middle of the night last night.”

You ain’t the only one Patterson. You ain’t the only one.

But hey, I bet Pat Boone has the best health insurance. And that’s all the music we need in the new White Christian America.

Repeal and Replace…With Manly Suffering and Life Lessons

[ 136 ] December 19, 2016 |

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GOP health care in a nutshell:

A Republican congressman outlined the way he would like to see the health care system operate if Obamacare is repealed, as GOP lawmakers are promising. It is a brave new world in which parents would wait and think about it before bringing in their sick or injured kids for costly treatments.

The example Rep. Bill Huizenga (R-MI) gave in an interview with MLive.com was from his own experience when he waited until the morning after to take his youngest son to the doctor with an injured arm, because he did not want to waste money on an expensive emergency room visit. The arm, it turned out, was broken.

“We weren’t sure what was going on. It was in the evening, so I splinted it up and we wrapped it up, and the decision was, okay, do we go to the ER? We thought it was a sprain, but weren’t sure,” Huizenga said, adding that he and his wife “took every precaution and decided to go in the next morning.”

“When it [comes to] those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don’t have a cost difference, you’ll make different decisions,” he said.

Explaining to your kid that you could relieve his pain immediately, but then poor people would have health coverage and become horrible welfare slackers driving around in their Cadillac after ordering their t-bone steaks is simply good parenting. Preventive care? Well, that’s preventing our kids from being losers as adults by simply not treating their illnesses.

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.

Building on Obamacare

[ 116 ] August 23, 2016 |

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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?

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