Archive for the ‘health care’ Category
I Love this Woman
Posted in feminism, health care, nailing it, politics on April 27, 2009| Leave a Comment »
Posted in health care, politics on March 11, 2009| Leave a Comment »
The Wrong Place to Be Chronically Ill
Posted in health care, sorrow on November 18, 2008| Leave a Comment »
VP Debate, Issues that Matter
Posted in health care, politics on October 3, 2008| 2 Comments »
Well, did you all watch? Do you agree with the “MSM” that she won–not because she won, but because expectations for her were so low, and she managed to fill the air with words while smiling the whole fucking time? No matter that she flat didn’t answer questions, talked about a mysterious General “McClellan,” and couldn’t/wouldn’t come out and say that no, she isn’t for civil rights for gays and lesbians. And for all those hard-working teachers and the like out there: your reward will be in heaven. Just ignore how shitty your life is now.
I watched the debate at the 20th Century Theatre last night, along with a few hundred other Democrats. At least two of the local snooze stations were there, and when I came home to see the coverage, I learned that Republicans were right across the street in Oakley having their own watch party.
How did I not know this at the time? There were only about thirty people there.
Do you think the news mentioned this basic fact–that hundreds turned out on the left, and dozens on the right? Not a word. Oh, they showed pictures that told the story, sure, but there were intermingled, so if you don’t know the interior of either place, you wouldn’t know who had the big turnout. Yeah, it was the Democrats. About 10 times the number of people were there. Good reporting, folks. Heckuva job.
It was nice being around a large group of “like-minded” people last night. I use the scare quotes knowing full well that the like-mindedness is largely a myth–a hopeful one, but a myth nonetheless. My political views are much further left than the Dems, and I even felt sympathy for the Nader supporter standing outside the theatre telling us “Open up the debates! Don’t let Obama steal the progressive vote!” Well, he’s stealing mine, but circumstances are simply too dire for anything but a pragmatic vote.
I voted for Nader in 2000, thinking that (A) someone as stupid as George W. Bush could never actually be elected; and (B) we need to break the two-party hegemony. Naive? Yes. I was 20; I apologize. I have nothing but admiration for Ralph Nader, but I think he’s a more powerful force for change outside of formal politics. Take Al Gore as an example: Since losing the election* his cultural capital has risen dramatically. He can potentially do more for environmentalism outside the White House than he ever could’ve inside. So I couldn’t vote for Nader again, but I still wish my vote was going to a genuinely more progressive ticket.
That said, I like Obama. I like Biden. As individuals, I think they’re a good force for change. I’m monumentally disappointed in the Democratic Party, overall, but the thought of another four years of the same conservative garbage makes me ill. This doesn’t sound like a ringing endorsement, so let me speak to some specifics.
Health care. Since primary season began, my top issue has been health care. I supported Clinton in the primary mainly because her position on universal health care was stronger, and I believed (and still do) that she had the experience and knowledge to really do something about our crumbling health care system. Obama’s position–without mandates for adults–is weaker, but is still so much better than the McCain plan that it’s hardly fair to even compare the two.
McCain wants to do for health care what the conservatives have done for banking. And we see how that’s worked for them.
Taxing health insurance benefits from an employer as income. Giving Americans a $5,000 check–wait, scratch that–giving insurance companies a $5,000 check in your name, forcing you to buy an independent policy if you lose your job or your employer drops health insurance coverage.
Pre-existing conditions?
Do you know that one visit to a psychiatrist to deal with anxiety issues will cause an insurance company to deem you uninsurable? It happened to my boss’s husband. Their 4-year-old daughter is uninsurable because she was born with–and has already has surgery to fix–a cleft palate. They both own their own businesses. They have no health insurance. They can’t afford to offer employer health insurance benefits, and they can’t afford to pay for an individual family policy–which wouldn’t even cover all of them, because of pre-existing conditions.
Yeah, a tax break should help. Let’s open up the health insurance market.
Health insurance and health care are too connected in America to really talk about them independently. You can be denied health care if you don’t have health insurance. That’s legal in America. If you try to get health insurance but have received some kind of health care in the past, you can be denied coverage. That’s legal in America. If you have health insurance but become ill and receive some kind of health care, your health insurance company can significantly raise your premium or entirely drop your coverage. That’s legal in America.
So, what’s the Republican plan, again? Regulate insurance companies, forbid them from discriminating against the seriously and kinda-sorta-maybe ill? Create real competition, by allowing Americans to buy into a government policy if they choose?
Tax your current benefits and give money to the insurance companies?
You choose.
*Is it fair to say that Al Gore lost the election? If the Court hadn’t intervened, he probably would have won. But he didn’t win his home state of Tennessee. He should’ve done that, at the very least. Still, it’s tough to say, with certainty, that he lost.
15 Minutes…
Posted in health care on September 19, 2008| Leave a Comment »
Sound familiar?
Posted in health care, politics on August 13, 2008| Leave a Comment »
From today’s Times. Exactly the problem I’m facing: marrying without good health insurance is impossible. I hope I’ll be financially able to marry in the not-too-distant future.
Health Benefits Inspire Rush to Marry, or Divorce
LAKE CHARLES, La. — It was only last February that Brandy Brady met Ricky Huggins at a Mardi Gras ball here. By April, they had decided to marry.
Ms. Brady says she loves Mr. Huggins, but she worries they are moving too fast. She questions how well they really know each other, and wants to better understand his mood swings.
But Ms. Brady, 38, also finds much to admire in Mr. Huggins, who is three years older. He strikes her as trustworthy and caring. He has a stable job as a plumber and a two-bedroom house. And perhaps above all, said Ms. Brady, who received a kidney transplant last year, “He’s got great insurance.”
More than romance, the couple readily acknowledge, it is Mr. Huggins’s Blue Cross/Blue Shield HMO policy that is driving their rush to the altar.
In a country where insurance is out of reach for many, it is not uncommon for couples to marry, or even to divorce, at least partly so one spouse can obtain or maintain health coverage.
There is no way to know how often it happens, but lawyers and patient advocacy groups say they see cases regularly.
In a poll conducted this spring by the Kaiser Family Foundation, a health policy research group, 7 percent of adults said someone in their household had married in the past year to gain access to insurance. The foundation cautions that the number should not be taken literally, but rather as an intriguing indicator that some Americans “are making major life decisions on the basis of health care concerns.”
Stephen L. J. Hoffman, an officiant at a wedding chapel in Covington, Ky., said he was no longer shocked that one of 10 couples cite health insurance as the reason they stand before him.
“They come in and say, ‘We were going to get married anyway, but right now we really need the insurance,’ ” said Mr. Hoffman. “There may be an unplanned pregnancy, or there is an illness, or they’ve lost their job and can’t get insurance.”
Though money and matrimony have been linked since Genesis, marrying for health coverage is a more modern convention. For today’s couples, “in sickness and in health” may seem less a lover’s troth than an actuarial contract. They marry for better or worse, for richer or poorer, for co-pays and deductibles.
Bo and Dena McLain of Milford, Ohio, eloped in March so he could add her to his group policy because her nursing school required proof of insurance. Corey Marshall and Kim Wetzel, who had dated in San Francisco for four years, moved up their wedding plans by a year so she could switch to his policy after her employer raised premiums
Ms. Brady and Mr. Huggins concede that their discussions about marriage have been freighted with cost-benefit analysis.
Ms. Brady learned three years ago that she had end-stage renal disease and after two years of dialysis received the transplant in May 2007. Her medical costs remain substantial and unpredictable. The demands of dialysis forced her to give up a much-loved job as a store manager for the Body Shop, and she eventually lost her insurance.
She now receives a Social Security disability check of $1,181 a month, and spends $95 of that on premiums for Medicare, the federal health insurance program for the elderly and disabled, which insures kidney transplant patients for up to three years.
With Medicare covering only 80 percent of most charges, however, Ms. Brady still has been left with thousands of dollars in bills.
Until this spring, Ms. Brady filled the gaps with a supplemental policy bought from State Farm. In April, she received notice that the premium was more than doubling, to $2,621 a quarter, from $1,180.
“ ‘I’ve got to cancel it,’ ” Ms. Brady said she told her agent. “I’m running out of family members to pay for it.”
That is when Ms. Brady and Mr. Huggins started talking about marriage. They reasoned that if they wed, Mr. Huggins could add her at modest cost to the group policy he buys through his union. That policy, combined with Medicare, would provide full coverage.
“I told him, ‘Let’s just do it. Can we do it without family?’ ” Ms. Brady recalled. “I felt the only way I could get around this was to marry him.”
As Ms. Brady has weighed her marital doubts against her medical needs, the couple has shifted wedding dates four times, most recently to Oct. 11. Her instincts tell her to delay. But each time the bills mount, she feels pressure to act sooner rather than later.
“I love him a lot, and I want to marry him,” Ms. Brady said. “I just don’t want to be forced to marry him early for insurance purposes.”
Mr. Huggins asks only that he have enough time to invite a few family members to the ceremony.
“I know I love her,” he said, “and I know I want to spend the rest of my life with her. The reasons and how fast we do it, that’s just secondary.”
In some instances, the need for insurance may prolong unhappy marriages.
When a mammogram confirmed in April 2007 that Sherri Parish had a lump in her breast, she panicked not only because of the devastating health news, but also because she was two weeks from a court date to finalize her divorce. Across the ups and downs of a 20-year marriage, her husband, Jonathan, had insured her through his job as a construction foreman in Noblesville, Ind.
“It was a devastating time for me,” Ms. Parish said. “I wasn’t sure what was going to happen with either the prognosis or the financial side of it.”
A nurse and mother of three, Ms. Parish, 47, had had little contact with her husband since they separated a year earlier. Through lawyers, she asked Mr. Parish, 49, if he would consider a delay so she could pursue treatment. He agreed.
“He didn’t want me to be without health care coverage because I’d never had it without him,” Ms. Parish said. “He’d always been the breadwinner, and I always worked two or three days a week and raised the children.”
Other couples, like Michelle and Marion Moulton, are forced to consider divorce so that an ailing spouse can qualify for affordable insurance.
Ms. Moulton, 46, a homemaker who lives near Seattle with her husband and two children, learned three years ago that she had serious liver damage, a side effect, she believes, of drugs she was once prescribed. She is trying to get on a transplant list, but the clock is ticking; her once slender body has ballooned, and her doctors say her liver could give out at any time.
Mr. Moulton, a self-employed painting contractor, maintains a catastrophic coverage plan for his family, but its high deductibles and unpredictable reimbursements have left them $50,000 in debt. Without better coverage, a transplant could add unthinkable sums.
Two years ago, Ms. Moulton looked into buying more comprehensive coverage through the Washington State Health Insurance Pool, a state-financed program for high-risk patients. She found the premiums unaffordable, but noticed that the state offered subsidies to those with low incomes. As their debts and desperation multiplied, it occurred to Ms. Moulton that divorcing her husband of 17 years would make her eligible for the subsidized coverage.
“I felt like I had done this to us,” she said. “We had worked hard our entire lives, and if this was all the insurance we had, we could become homeless. I just said, ‘You know, we really need to sit down and talk about divorce.’ ”
Mr. Moulton would not consider it — at first. “From a male point of view, you want to be able to fix things, you want to be able to provide,” he said.
“Then you start looking at what things cost and what someone with no assets can get in terms of funding, and you have to start thinking about it.”
The conversations ebbed and flowed with the family’s financial pressures. They talked about the effect on their children and where they might live. They weighed the legal and financial risks against the prospects of bankruptcy.
The debate continued until this summer, when Mr. Moulton’s father offered financial help. “I know we don’t take charity from anyone,” Mr. Moulton told his wife, “but I’m not going to divorce you and I’m not going to let you die.”
Though grateful for the lifeline, the couple remains unsettled by how close they came.
“Nobody should have to make a choice like that,” Ms. Moulton said. “What happened to our country? I don’t remember growing up like this.”
It’s Official
Posted in complaints, health care, movies on March 26, 2008| 1 Comment »
Unemployment, that is.
Yup, the institution of “higher” learning that’s been paying my rent since 2003 majorly fucked up and had to let go *all* adjunct comp instructors for the spring. Not having a job is bittersweet, though. I’ve been in the vicious circle of wanting to find something else, finding I have no relevant experience for work outside the academy (and not enough education for any gainful work inside), agreeing to teach for fear of uncertainty, and doing little aside from not enjoying teaching. Maybe I’ll finally find something that I enjoy…
In other good news, the feeling I’d attributed to winter time, possible S.A.D., possible depression, teaching, fatigue, and general malaise turns out to likely be magnesium deficiency. Who knew?! The doc said a level as low as mine could cause heart palpitations and muscle weakness. After a couple of doses of magnesium oxide, I already feel better. In hindsight, I had easily describable symptoms–especially the increased heart-rate–but find it endlessly difficult to trust what my body tells me. I immediately blame myself for my symptoms (not enough sleep, not enough vigorous exercise, etc.). Good to know it isn’t always my fault.
Finally, on an entirely unrelated note, yesterday I watched/fell asleep during the worst movie: The Grifters. I found myself asking, time and again, “Is this supposed to be funny?” Well, is it?
“On Being Partisan”
Posted in books, health care, politics on February 26, 2008| Leave a Comment »
The following is a section from Paul Krugman’s The Conscience of a Liberal. The book is full of excellent insights and provides a brief history of the twentieth century political economy. One of the major claims of the book is that universal health care–one with a mandate for coverage–is the essential step in reducing social/economic inequality.
I like this section–actually the final one in the book–as it expresses the need for a strong candidate who can argue for her (ahem!) policy proposals and fight off the conservative attacks. We don’t need a message of uniting the country–as if Dems and GOPs could agree on the need for universal health care–but we do need our own strong partisan.
On Being Partisan
The progressive agenda is clear and achievable, but it will face fierce opposition. The central fact of modern American political life is the control of the Republican Party by movement conservatives, whose vision of what America should be is completely antithetical to that of the progressive movement. Because of that control, the notion, beloved of political pundits, that we can make progress through bipartisan consensus is simply foolish. On health care reform, which is the first domestic priority for progressives, there’s no way to achieve a bipartisan compromise between Republicans who want to strangle Medicare and Democrats who want guaranteed coverage for all. When a health care reform plan is actually presented to Congress, the leaders of movement conservatism will do what they did in 1993–urge Republicans to oppose the plan in any form, lest successful health reform undermine the movement conservative agenda. And most Republicans will probably go along.
To be progressive, then, means being a partisan–at least for now. The only way a progressive agenda can be enacted is if Democrats have both the presidency and a large enough majority in Congress to overcome Republican opposition. And achieving that kind of political preponderance will require leadership that makes opponents of the progressive agenda pay a political price for their obstructionism–leadership that, like FDR, welcomes the hatred of the interest groups trying to prevent us from making our society better.
If the new progressive movement succeeds, the need for partisanship will eventually diminish. In the 1950s you could support Social Security and unions and yet still vote for Eisenhower in good conscience, because the Republican Party had eventually (and temporarily) accepted the New Deal’s achievements. In the long run we can hope for a return to that kind of politics: two reasonable parties that accept all that is best in our country but compete over their ability to deliver a decent life to all Americans, and keep each other honest.
For now, being an active liberal means being a progressive, and being a progressive means being partisan. But the end goal isn’t one-party rule. It’s the reestablishment of a truly vital, competitive democracy. Because in the end, democracy is what being a liberal is all about.
On mandates, free riders, and “covering everyone”
Posted in health care, politics on February 23, 2008| Leave a Comment »
Today’s Times article, “2 Plans and Many Questions,” takes a serious look at the health care policies put forth by the Dems. From the details currently available, the major difference is on the issue of mandates: whether every American should be required, by law, to carry an insurance policy. If you read my posts, or know anything about me, I’m all for mandates. Without them, I don’t think the necessary policy provisions will be in place for everyone to truly be able to obtain coverage.
Even Obama’s own people deny his claim that his plan would cover everyone:
Mr. Obama, meanwhile, maintains in a television advertisement that his plan will “cover everyone.” That claim is disputed by some of his own advisers, including Mr. Brown, who recently calculated that the Obama plan might leave behind two million free riders.
“That’s the number we would expect to continue to be uninsured unless they’re forced to buy coverage,” Mr. Brown said.
While two million is certainly different from the Clinton camp’s claim that the number of uninsured could reach fifteen million, there’s clearly an established problem with such a plan.
The notion of “free riders” is one of the most interesting elements of the article. Free riders are people who choose not to buy health care coverage, even though they technically could afford to do so. Here’s an example:
Ms. Coons, a 23-year-old waitress who rents a room and rarely eats out, said she could probably afford a high-deductible policy if she gave up her gym membership and spent less on her amateur photography. But she chooses instead to gamble against the odds of confronting a bankrupting catastrophe.
“I’m young and in pretty good shape,” Ms. Coons said one recent afternoon, on her way to the treadmill at the Fitness Factory in Midtown Atlanta. “I looked at Blue Cross Blue Shield. But the only thing I could see myself really needing it for are prescriptions and dental because there are so many free clinics, or a hospital visit really isn’t all that expensive.”
She continued, “The insurance premium was more than what I would pay for my prescriptions, so I just decided not to deal with it.”
Ms. Coons, in this case, talks about free clinics and emergency room visits–health care options that are being subsidized so that the truly poor–the people who can’t afford, or have been rejected for an insurance policy for any number of reasons–can receive care.
Many free riders, including Ms. Coons in Atlanta, never consider that the care they receive in community clinics and emergency rooms is subsidized by taxpayers and private policyholders. “I still pay for everything,” Ms. Coons said, “and I certainly pay taxes.”
Obama denies that people like Ms. Coons exist.
I pay more for car insurance than I do on car repairs, or damage to any person or any property that I’ve ever done (I’ve never even had a ticket), but is that any legitimate excuse for canceling my policy?
Tomorrow I’m going to blog about the fetish of children and health care. Obama wants a mandate for parents to buy insurance for their kids, but there are currently numerous options for children to receive coverage. They’re not the biggest–or most expensive–group of uninsured.
Hillary in Cincinnati
Posted in health care, politics on February 22, 2008| 3 Comments »
Tomorrow–Saturday, February 23–Hillary Clinton will host a Town Hall meeting at Cincinnati State Community College. Doors open at 8:00 a.m., and the program begins at 9:00 a.m. The event is free and open to the public.
In other Hillary news, she rocked the debate last night. Even though I’m a supporter of her, I went in with an open mind–after all, we need a Democrat to win in November. I was surprised at how disappointing Obama was. He seemed to merely echo everything she said, and to ham it up when he didn’t want to honestly answer a question. Plaigiarism isn’t funny; it’s not the end of the world, if you acknowledge the mistake and move on. How am I supposed to convince my composition students that plaigiarism is ethically wrong when the possible Democratic candidate for president says that he’s been giving speeches for two years, so what’s a couple of lifted lines in a couple of speeches? Shameful. And the whole business of health care? Parents need a mandate to buy health care for their children or else the system won’t work, but adults don’t need a mandate to purchase it for themselves? She really trounced him there, and I was thrilled that neither candidate would let the moderators move on from the topic of the election. The moment was a clear example of the media resisting real politics, and the candidates–for just a moment–not allowing the media to control the discourse.
But I had a clear favorite moment in the debate. Hillary promised to end discrimination of the ill. Thank you for calling it what it is. Insurance companies are legally permitted to discriminate against anyone who has a pre-existing health condition. And that means ill people can be refused health care. If you read my blog you’ll know that this is an issue I am personally invested in and affected by. I was very lucky in 2004 to be on a company health care policy; I was under 25 and still a full-time student. The number one requirement to be eligible for a lung transplant was health insurance. If my quick decline in health had happened a year later, there’s a real chance I wouldn’t have been eligible for the surgery, and that means I wouldn’t be here today.
Another moment in which Hillary proved herself to be the stronger debater–and the better candidate–was her closing statement. After Obama bumbled on about himself, displaying an arrogance that veers on disgusting at times, she brought the message right back to us:
Vote with your head on March 4th.
Funny ha-ha
Posted in health care, humor on October 8, 2007| Leave a Comment »
Educate Yourself about Health Care Reform
Posted in health care, politics, unfettered capitalism on September 23, 2007| 1 Comment »
Health care is the most important domestic issue in the U.S.A.–even for the healthy folks. You need to support reform that curtails rising costs, and prevents insurance plans/companies from denying coverage to the chronically ill and those with pre-existing conditions.
In this country you currently cannot obtain private coverage, and are considered “uninsurable” if you have any of the following conditions:
- Addison’s Disease
- AIDS (HIV Positive)
- ALS (Lou Gehrig’s Disease)
- Alzheimers Disease
- Amyotrophis Lateral Sclerosis
- Angioplasty
- Ankylosing Spondylitis
- Aunria
- ARC ( AIDS Related Complex)
- Arteriosclerosis
- ASD (Atrial Septal Defect)
- Banti’s Disease
- Bi-Polar Disorder (Manic Depressive)
- Bypass Surgery
- Cancer
- Chronic Fatigue Syndrone (Usually within 5 years)
- Colitis
- COPD (Chronic Obstructive Pulmonary Disease)
- Conjestive Heart Failure
- Cirrosis of the Liver
- Collagen Diseases
- Crohn’s Disease
- Cystic Fibrosis
- Cushing’s Disease
- Delirium Tremors (DT’s)
- Dementia
- Depression (Major)
- Diabetes
- Eating Disorders
- Emphysema
- Fanconi’s Syndrome
- Heart Attack
- Hemophilia
- Hemochromatosis
- Hepatitis (Type B, C, Chronic)
- Hodgkins Disease
- Heart Murmur
- Heart Valve Disease or Replacement
- Huntington’s Disease
- Hydocephaly
- Infertility Treatment (Recent)
- Ischemia
- Kaposi’s Sarcoma
- Left Bundle Branch Block
- Leukemia
- Lupus
- Lymphedema
- MS (Multiple Sclerosis)
- Muscular Distrophy
- Myasthenia Gravis
- Narcolepsy
- Organ Transplants
- Pacemaker
- Paralysis / Parapelegia
- Parkinson’s Disease
- Peripheral Vascular Disease
- Porhyria
- Portal or Renal Hypertension
- Pregnancy (Exisiting)
- Psoriatic Arthritis
- Psychoses
- Raynaud’s Phenomenon
- Renal Insufficiency
- Schizophrenia
- Scleroderma
- Silicosis (Black Lung Disease)
- Stroke (TIA, Transient Ischemic Attack)
- Substance Abuse / Dependance
- Suicide Attempt
- Ulcerative Colitis
If you do have any of these conditions, your only option is to obtain employment that offers full group coverage to its employees. Usually that means full-time employment, and if you have any of the above listed conditions, it may be detrimental to your health to work full time. A real conundrum that leaves few options for millions of people.
Here’s an editorial from today’s New York Times that discusses the front-runners’ stances on health care reform. No one favors my personal choice–a single-payer system–but some offer a step in the right direction. Others offer no step, or a wrong-headed step. You guess which is which.
September 23, 2007
Editorial
THE BATTLE OVER HEALTH CARE
One of the enduring frustrations of presidential elections is that candidates and their parties sound like Tweedledum and Tweedledee on many issues. In 2008, when it comes to health care, which is emerging as a defining domestic issue, voters will find stark differences in philosophy and commitment between Democrats and Republicans.
The three leading Democratic candidates all want to achieve universal or near universal health insurance coverage. The four leading Republican candidates espouse no such goal and barely mention the uninsured. The Democrats are willing to put substantial federal money into health care reform. The Republicans are not. The Democrats would expand government health insurance programs and give the federal government a greater role in regulating the insurance industry. The Republicans generally want to shrink federal programs and free the insurance industry from what they consider regulatory shackles.
Compared with these sharp differences between the two parties, the distinctions between leading candidates within each party are small, mostly a matter of tactics to achieve comparable goals. We far prefer the Democrats’ approach to health insurance, since at least they want to address an issue that must be resolved for reasons of economics, public health and fairness. Sadly, none of the leading candidates, in either party, has the vision or the political courage to propose radical solutions for the big underlying problem behind America’s health care crisis: the inexorably rising costs.
THE REPUBLICAN CANDIDATES
Two Republican candidates have yet to grapple seriously with health care reform. John McCain, running largely on Iraq and national security, has not said anything substantial about health care, nor has he even included it among issues listed on his campaign Web site. Fred Thompson has only a brief paragraph on his Web site in which he opposes new mandates, higher taxes or a Washington-controlled program, and calls for free-market solutions. He has also called for reduced spending on entitlements and says he would have opposed the new Medicare prescription drug benefit.
Rudolph Giuliani, who leads the Republican field in national polls, has only sketchy plans but has made it clear that he favors free-market approaches and is strongly opposed to what he mislabels as the Democrats’ push for socialized medicine. Borrowing from President Bush, he proposes a tax deduction of up to $15,000 to help families buy private health insurance instead of getting it through their employers. He believes millions of people might choose that option, creating a market in which insurance companies would rush in with affordable policies to cover them, and the nation would begin to move away from the employer-based system that the Democrats are trying to bolster. For the poor, he envisions some combination of vouchers and tax refunds to help buy policies but has given no indication of how much that program would cost or how he would pay for it.
His proposals are not likely to make much of a dent in the ranks of the uninsured. Tax deductions are of little use to low-income people who pay little or no income tax, and insurers are notorious for refusing individual policies to high-risk or chronically ill people. Given Mr. Giuliani’s eagerness to ease regulation of insurance companies it is hard to see how he could make that market work better.
Mitt Romney has the most developed health plan among the Republicans, as one might expect given his prominent role in spurring health care reform in Massachusetts. As governor of that left-leaning state, he helped make Massachusetts a leader in providing universal coverage, mostly by mandating that everyone must buy health insurance or pay a financial penalty. But as a candidate in the Republican primaries he has changed course, disavowing any need for mandates and contending that what was right for Massachusetts would not be right for the country.
Instead of a national reform effort, he wants the 50 states to devise their own plans, but without much financial help from the federal government. He promises federal incentives to help states deregulate their health insurance markets to encourage cheaper policies.
His key proposal at the national level centers on tax deductions to help people pay for health care. He would allow individuals to deduct their out-of-pocket expenditures — and any premiums paid for insurance policies they bought on their own rather than through their employer — from their taxable income. For those who still cannot afford coverage, he would encourage states to redirect money now used for charity care to help low-income people buy private health insurance. There would be no new federal money for this purpose. His advisers estimate the proposals would cost a modest $10 billion a year in reduced revenues to the United States Treasury.
The problem of relying on tax deductions to increase insurance coverage is that they mostly favor the better off. The problem with relying on the states to enact the needed reforms is that the plight of the uninsured would be left to the whims of geography. Few states have the financial resources that allowed Massachusetts to move to universal coverage, and many states lack the expertise to mount a sophisticated program.
THE DEMOCRATIC CANDIDATES
Although Republicans routinely lambaste the Democrats for supporting socialized medicine or government programs in which bureaucrats would dictate your health coverage, the plans put forth by the three leading Democratic candidates — Hillary Clinton, Barack Obama and John Edwards — are all very careful to build on the existing system of employer-based coverage supplemented by government programs like Medicare, Medicaid and the State Children’s Health Insurance Program.
None of them is proposing a “single payer” system run by the government. And all bend over backward to reassure people that they can maintain their current coverage if they like it. Their political goal is to head off opposition from those who fear that their own coverage might suffer in the course of covering some 47 million uninsured people.
The Democratic plans have far more similarities than differences. All three would move toward universal coverage and would rely heavily on mandates to do so. Mrs. Clinton and Mr. Edwards would require everyone to take out health insurance. That would bring young and healthy people into the system to help subsidize coverage for the more sickly, and would eliminate the problem of “free riders,” who show up uninsured at the emergency room and get very expensive care without paying. Mr. Obama would require parents to get insurance for their children but has no mandate for adults.
All three would require big employers to provide health insurance or contribute to the cost of covering their employees outside the workplace. But they differ in the treatment of small businesses, whose opposition helped derail the last big reform effort in 1993. Mr. Edwards is the toughest. He would require small businesses to provide insurance coverage or help pay for coverage elsewhere. Mr. Obama would exempt them from any mandate. Mrs. Clinton, in what looks suspiciously like a bribe to buy small business support, promises them a tax credit for providing coverage.
The Clinton plan would cost an estimated $110 billion a year, the Edwards plan $90 billion to $120 billion, the Obama plan $50 billion to $65 billion. All three would finance their programs partly by rolling back Bush-era tax cuts for those making more than $250,000 a year and partly with debatable savings they would get through cost-cutting.
All three would require insurers to accept everyone without regard to pre-existing conditions, would provide tax subsidies to low-income people, and would establish purchasing pools to help individuals get low group rates.
There would be a menu of options for people dissatisfied with their current policies because of high costs or limited benefits, including both private health plans and a public program that would compete alongside them. That would provide an interesting test of whether government or private plans are more effective and popular, a matchup that critics of “government-run” programs seem determined to avoid.
The Clinton plan has an innovative proposal to limit the premiums that families have to pay to a certain percentage of their income, as yet undefined. That is a welcome protection for consumers but could cause problems if medical costs continue to rise far faster than wages.
WHAT’S MISSING
All of the plans, both Republican and Democratic, fail to provide a plausible solution to the problem that has driven health care reform to the fore as a political issue: the inexorably rising costs that drive up insurance rates and force employers to cut back on coverage or charge higher premiums. All of the plans acknowledge the need to restrain costs, but most of the remedies they offer are not likely to do much.
Electronic medical records to eliminate errors and increase efficiency, more preventive care to head off serious diseases, and better coordination of patients suffering multiple, chronic illnesses are all worthy proposals, but there is scant evidence they will reduce costs. Proposals to import drugs from abroad, allow Medicare to negotiate drug prices, restrain malpractice expenses, increase competition among health plans, and empower consumers to shop more wisely for medical care might help a bit. But many experts doubt that any of this will truly put the brakes on escalating health care costs.
No top candidate in either party has broached more drastic remedies, like limiting the use of expensive new technologies, cutting reimbursements to doctors and hospitals, or forcing people to use health maintenance organizations. And no one has suggested imposing higher taxes on everyone, not just the wealthy, to finance universal coverage. These solutions are not even discussed on the campaign trail lest they alienate voters and interest groups.
At this stage, the various plans should be considered as broad outlines of where the candidates want to go, with details to be worked out later. Voters who put a high priority on covering all or most of the uninsured will prefer the Democrats’ approach, as we do. The chief danger is that the Democrats have a tendency to imply that everyone can be covered with good benefit packages without inconveniencing anyone but the wealthy. Their cost and savings assumptions will need thorough analysis when more detailed plans emerge.
Voters who put a higher priority on reshaping the health care system along free-market lines than on achieving universal coverage will prefer the Republican plans. Those plans’ likely impact on costs will also need to be analyzed when more details emerge. The “magic of the market” may be less than magical.
Given the wide split between Republican and Democratic approaches, the polarized politics in Washington, and the overriding need to find a way out of the morass in Iraq, it will be an uphill battle to achieve consensus on health care any time soon. But at least voters will have a clear choice of which way the candidates are headed.
World’s Best Medical Care?
Posted in health care, politics, unfettered capitalism on August 12, 2007| Leave a Comment »
A must-read editorial from today’s Times…
August 12, 2007
Editorial
New York Times
World’s Best Medical Care?
Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.
Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.
Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.
Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.
Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.
Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.
Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.
Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.
Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.
That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.
Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.
Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.
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With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.
Reasons You Should Be Angry at America
Posted in complaints, health care, politics on May 31, 2007| 2 Comments »
1. The Supreme Court is out of control. Never thought I’d say this, but where the fuck is Sandra Day O’Connor when you need her? Let’s hope Hill’s bill can make it through Congress…
2. The FDA is out of control. Despite widespread information to the contrary, and pleading from the Red Cross, the FDA upheld its 1983 (yes, that’s twenty-four years ago) ban on gay men donating blood.
I don’t even need to get into the other ways the FDA is out of control. Inspections, anyone? Anyone?
3. The Democrats. How can you have the support of the public and still cave to that sitting duck sonofabitch?
Coral M. Bien 