A friend who is a doctor in a New York City hospital sends this:
Things here are changing daily. The number of virus patients has increased rapidly, tripling in a day. We have twice as many doctors and nurses infected as patients. This is because we are at the beginning, and doctors and nurses have more social contacts than our generally more isolated patients, and possibly because of reinfection, which is still controversial but seems more likely as a possibility now than it did last week. But also it is because we do not have enough masks and equipment.
The number of people who go into a room has been strictly limited but still people must go in. The hospital has now issued guidelines for reusing masks. This is more or less like being told that we should reuse needles, shocking for anyone trained in the modern era, contrary to the basic rules we are drilled on every year as part of the hospital licensing requirement. We think this is “better than nothing,” but we do not know. What we are doing now would never be the answer on any licensing examination. People are doing the best they can.
The pneumonia caused by this virus is especially severe. While even most cancer patients will survive, those who are severely ill have to be kept on a ventilator for a long period of time -- it seems to be about ten days usually -- before either improving or entering a brief final deterioration. They often must be kept in the prone position during this time, which is much more physiologically taxing and of course psychologically distressing.
The virus seems to be associated with a particularly severe form of agitated delirium, worse than what we might see occasionally with other pneumonias. Some of the most important treatments for agitated delirium have potentially dangerous interactions with medications for the virus, which makes management more challenging. Delirium is often but not always managed by psychiatric consultants so this may put a strain on our department though it has not yet. Across the street at New York Hospital the psychiatric residents have been redeployed to the ICU not as consultants but as regular ICU doctors because of the growing need and the number of doctors and nurses who are out owing to infection.
This type of redeployment is not as likely to happen in our hospital because we have been designated as the hospital to receive cancer patients who must be moved from other hospitals to make room for virus patients. We are likely to continue with a smaller overall percentage and number of virus patients. It is a hard thing though to be hospitalized with cancer and to be moved to an unfamiliar hospital away from your oncologist. It is especially tough because visitors are no longer allowed in the hospital with the exception of those visiting pediatric patients and patients actively dying. One virus patient committed suicide yesterday at another hospital, though I do not think this is public. We do not know the circumstances but certainly one way or another the prolonged isolation and limited staff contact are likely to have played a role.
Still, though, as I said to one of my Catholic patients, until we see four horsemen out the window, it is not Armageddon. Grocery stores and restaurants are delivering. The mail is getting through. Apart from some consolidation of nearby branches and reduction in some hours, pharmacies are open. The power and the Internet have been reliable. (If I had money to invest I would look into Zoom, which has proven much more stable than other teleconferencing apps.)
Theoretically you need an ID with a special sticker and a letter from your “essential” organization in order to walk on the street (yes, we actually have to carry papers!), but in fact there are people outside walking and clearly not just going from home to their critical work. I do not know how to feel about this: on the one hand it is a violation and possibly demonstrates some lack of awareness; on the other, it is easy to maintain more than six feet of distance outside, and except in crowds, which have now vanished from the city, transmission out of doors should be very unlikely. Certainly we have seen the physical and emotional dangers of isolation. So people are doing their best, and eventually we will come out on the other side.
…from Anthony Piel, former General Legal Counsel of the World Health Organization.Dear Senator Elizabeth Warren,
You and your campaign are doing a great job fighting for all Americans and correcting a decidedly “rigged” political, economic and taxation system. We admire and support you in this fight.
However, you are taking two counter-productive and unnecessary risks that you can readily avoid, while still getting the job done :
(1) Fair Taxation of the Uber-Wealthy. You have proposed a yearly wealth tax of 2 % on net worth above $ 50 million, and 3 % on over $ 1 billion. A majority of Americans, however, consider it “un-American” to tax pre-existing wealth. Nevertheless, they could accept taxing annual increases in wealth as a form of tax on annual income. This would be compatible with the language of the US Constitution’s Sixteenth Amendment which asserts that: “The Congress shall have power to lay and collect taxes on incomes, from whatever source derived.” Proposal: You should consider adjusting your wealth tax rate upwards, but apply it to annual wealth gain only.
(2) Single Payer Health Care System. You have joined others in supporting a “Single Payer” National Health Care System, but you have perhaps moved too quickly to adopt Bernie Sanders’ proposal for “public ownership” of the drug and insurance companies. A majority of Americans will not accept this extreme version of what Bernie calls “socialized medicine.” But it is unnecessary. Because, for all intents and purposes (of patients, hospitals, insurers and other providers), you can have the convenience, effectiveness and cost saving of a standardized “single payer” system by “partnering” with private insurers. There is no need for governmental public takeover of private health insurance.
How can this be done ? Here are two actual examples that deserve study :
(1) Under the National Health System of Germany, which appears to patients, providers and insurers alike as a pure “single payer” system, the national system claims and payments are “mediated” by over 100 private health insurance companies and funds. (2) The World Health Organization (WHO) Staff Health Insurance Plan (SHI), which is operating effectively (and “in the black”) in over 200 countries, is for all intents and purposes a “single payer” system, and here in the USA is “partnered” with AETNA International, a private US insurance company. Results ? Better health outcomes at lower cost.
In any event, these policy and strategy details can be worked out after Democrats and other responsible Americans have taken back the Presidency and both Houses of the US Congress --- but NOT before. We have to win in the voting booth first.
It's basically the same thing, as my son Ted explains in this article from The Hill
Here’s a yes or no question that most Americans, including those running for president get wrong: Is Medicare run by the government? Before I started working at Medicare after a decade in health care, I would have said so. But after several years at the agency, I came to realize that the better one-word answer is actually no — Medicare in truth is run by private industry.
Sure, the relatively tiny number of employees at the federal Centers for Medicare & Medicaid Services (CMS) play a key oversight role, but they don’t in any real sense deliver Medicare to the American people. The principal job of CMS’s 6,200 employees is to manage contracts with hundreds of private companies, both small and large, that together provide Medicare to us all.
I am not only talking about the relatively well-known Medicare Advantage plans, whereby about one-third of Medicare recipients choose to get their benefit directly from a health insurance company like Cigna or Aetna.
Medicare Advantage just happens to be one area of CMS’s operation where the agency allows the companies that are delivering Medicare to use their own names, logos and limited provider networks.
No, what I mean is that even traditional Medicare is delivered by private industry. Sure, when you get the old standby red, white and blue card in the mail, it appears to come directly from the feds. And, the website has a reassuring “medicare.gov” address. Likewise, when you need help and dial 800-MEDICARE, you’ll hear an authoritative, soothing “Welcome to Medicare” greeting, and that branding will continue seamlessly until the end of the call — and indeed will continue throughout your decade or more on
Medicare, even though virtually all of the friendly, efficient folks you deal with will in fact work for private companies, not the federal government.
But don’t take my word for it. Look at the numbers. CMS has 6,200 employees and in 2018 spent $995 billion, meaning each employee oversees spending of $160 million. Sounds like a lot, even for an insurance company, right? It is, and how.
This level of money managed per employee is about 100 times what we see with other health insurers. For instance, Aetna with fewer than 50,000 employees had 2017 revenues of over $60 billion, or about $1.2 million per employee.
In 2017, Cigna’s 46,000 employees managed $41.6 billion, or under $1 million per capita. And, Anthem’s 63,900 employees oversaw $91 billion in revenue, or $1.4 million each.
I can say that CMS employees, overall, are at least as good as their private-sector counterparts. And, certainly federal employees, instead of private industry, could run Medicare. In fact, Social Security, with 60,000 employees managing a successful and popular benefits program that is not nearly as complicated as Medicare, looks a lot more like a true government-run program.
But primarily government employees have not run Medicare since its creation in 1965. Medicare is designed to be a federally funded program delivered almost exclusively through contracts with private, for-profit companies.
Today, these contractors include every one of the major health carriers, and this also has been true from the start: the first-ever Medicare claim was paid by Aetna in 1966 – a check to Hartford Hospital for $517.57.
The reality is that for more than 50 years Medicare has been perhaps the most successful public-private partnership in American history.
What does this mean for the current debate over the many proposed flavors of Medicare expansion? First, the argument that expanding Medicare would amount to creeping socialism is exposed as uninformed and overblown.
Medicare’s historic approach is to rely heavily on the private sector, and none of the expansion proposals on the table require an overhaul of the program’s underlying private-industry based business model.
Second, the emerging litmus test in the presidential race over whether or not private insurance should continue to exist after the next stage of health-care reform becomes a bit beside the point.
Every one of the nation’s largest health carriers already works for Medicare, and these companies’ government segments are typically among their fastest-growing and most profitable. Any imaginable Medicare expansion will mean more, not fewer, private sector jobs, and the carriers will get a good share, as they always have.
Under even the most ambitious reform proposals, the worst-case upshot for the carriers will be a re-balancing — a marked expansion and reconfiguration of their already vibrant government segments over a period of several years, with a parallel pullback on the commercial sides. Not to sugarcoat it, the transition will be a difficult scramble; but for the insurance companies, even “Medicare for all” would mean disruption, not destruction.
Ted Doolittle, currently the health-care advocate for the State of Connecticut, is a former senior official at the federal Centers for Medicare & Medicaid Services.
You will have noticed, of course, that Trump’s ex-bodyguard walked off with the so-called “president’s” medical records two days after his doctor for 35 years made a terrible mistake. Dr. Harold Bornstein had told the New York Times that Trump took Propecia, a hair-loss drug. This was a firing offense of course, and a White House clean-up squad was sent to disappear the doctor’s medical records.
Bornstein said the original and only copy of Trump’s charts, including lab reports under Trump’s name as well as under the pseudonyms his office used for Trump, were taken.Something queer here. Why not all pseudonyms or no pseudonyms? The doctor knew who was taking which drugs for what problems — so who was the secret being kept from?
A weird exchange from the transcript of CNN’s interview with our so-called “president” and Klaus Iohannis, the President of Romania…
Mr. President, was there any discussion about the visa waiver program for Romania? Is there a time frame for including our country in this program?
TRUMP: We didn’t discuss it. We didn’t discuss it, but there would be certainly — it would be something we will discuss.
IOHANNIS: I mentioned this issue. And I also mentioned it during other meetings I had, because this is important for us, it’s important for Romanians, one, to come to the United States.
I haven’t read Politico regularly enough over the past few years to be entirely certain, but it seems to me those “gotta win the morning” folks have become since the last election a bit less the stenographers of power and somewhat more often the critical observers; does that fit your experience?
Witness Harold Pollack’s politely titled piece today, “Paul Ryan Failed Because His Bill Was a Dumpster Fire”. Pollack doesn’t fail to point out all the ways Paul Ryan and his allies might have tried to improve their bill’s chances, both process issues such as working with moderates to lure a few Democrats rather than expecting the Freedom Caucus to come round, and policy issues like the explicit transfer of hundreds of billions of dollars from the poor and sick to the top 1%. Consider that under the Ryan bill the richest 400 households in the US would have seen a tax cut greater than the total expenditures for premium tax credits under Obamacare for the twenty smallest states plus the District of Columbia.
A shrewd legislator would have found a way to make this less obvious. Ryan’s reputation for intelligence seems in this case to have overshot his actual capacities.
But it’s not simple legislative tactics or even longer-term strategy that’s at issue here, as Pollack notes.
So why did Republicans fail? In a word: insincerity. Republicans had seven years to do their own hard work, to coalesce around a credible conservative alternative to the ACA. They might have used this time to work with Republican governors, to explore which conservative policy ideas seem to stick, which aspects of ACA needed to be retained. They might have crafted a more moderate bill along the lines of the Cassidy-Collins bill, which would have given liberal states and Republican governors who adopted Medicaid expansion much greater leeway. Or they might have refined another conservative model, such as Avik Roy’s modifications to ACA exchanges, to turn ACA’s exchanges in a more conservative direction. They might have prepared the American public for whatever plan they chose.
They didn’t do any of this, perhaps because they believed they would never have to. Secure in the knowledge that they would face President Obama’s veto, Republicans rammed through a succession of extreme repeal-and-replace bills that resembled AHCA’s original draft. These bills excited the Republican base, but would have horrified most other Americans if they ever found sufficient reason to look. Then Congressional Republicans suffered what George W. Bush might call a “catastrophic success” with Donald Trump’s unexpected victory. They had nothing real to deliver.
Much has been made of Republicans’ hypocrisy in trying to ram the AHCA through Congress after complaining so vociferously about the legislative process that produced Obamacare. This hurt House Republicans less than the shoddy content of their actual bill, and the glaring mismatch between their political rhetoric and what their actual policy proposals were designed to do.
Day before yesterday the hospital cut me loose (having twice cut me up) following the last of three stays since mid-December. Bowel obstructions, which now seem to be removed. This, plus a certain natural laziness, accounts for the nearly nonexistent blogging of these last few months. My plan is to ease back into things slowly, starting tomorrow.
See you then.
I’ve been pretty much out of service since before Christmas, when I had emergency surgery to unblock my obstructed bowels. The operation went well and so did the recovery, which was as pain-free as anesthetics could make it. Which was, apart from the first day after the operation, just flat pain-free. I was amazed and thankful.
Anyway here I am, and a Happy New Year to you, too.
This from The Washington Post:
As advanced CT scans and other analytical techniques become cheaper and more widely available, scientists are able to noninvasively tease out secrets locked within ancient sarcophagi. After examining what was long thought a jar of organs, Cambridge archaeologists discovered a tiny Egyptian mummy in May. The embalmed fetus, as young as 16 weeks, is the smallest yet found.And this from our next vice president:
A few months later, Dutch museum curators were shocked to see the bodies of 47 mummified infant crocodiles lining the walls of a sarcophagus. The curators were expecting to find just two adolescent reptiles.
The sweeping abortion bill that Indiana Gov. Mike Pence signed into law in March gained national attention for prohibiting women from electing to have an abortion due to the race, gender, or disability of the fetus. But the bill contained another unusual provision: It required that aborted fetuses receive what amounts to a funeral…
This sort of fetus funeral provision has recently gained traction in legislatures around the country: Arkansas and Georgia have similar laws on the books, while Ohio, South Carolina, and Mississippi have all considered similar measures in the last year.
Hot off the AP wire:
Donald Trump is accusing rival Hillary Clinton of being on some kind of drug during the last debate, and says that both candidates should be tested for substances ahead of the next one.
The Republican presidential nominee offered no evidence to support the bizarre claim, which he appeared to base on his belief that Clinton was energetic at the start of their second debate and downbeat at its conclusion.
He says, “I think she’s actually getting pumped up” while she’s off the trail. He also mocked Clinton for what he suggested was wasting time by preparing for their debates.
Trump called on both candidates to take a drug test prior to the final debate on Wednesday.
The GOP nominee made the extraordinary, baseless assertion when speaking at an outdoor rally on Saturday in Portsmouth, New Hampshire.
Ain’t nobody here but just us folks:
Andrew Ogles, the young director of AFP-Tenn, laughed off intimations of Koch-conspiracy, saying “Obviously David Koch is our chairman and we appreciate everything he does for us, but we’re grassroots.” Ogles says that the group’s opposition to Insure Tennessee is rooted in the ACA. “From the onset we’ve opposed Obamacare. Insure Tennessee is funded by the Affordable Care Act and it’s an extension of Obamacare.” Toppling the ACA is a priority and their opposition to insuring low-income Tennesseans is part of that plan.
This is the beginning and the end of a long memorial in today’s New York Times. It’s a paid notice, and thus not available on the paper’s website, but Wikipedia can fill in the details of Dr. Bem’s admirable life. The circumstances of her death were equally admirable:
Emerita Professor of Psychology at Cornell, past director of Cornell’s Women’s Study Program, and a psychotherapist, peacefully ended her own life at her home in Ithaca on May 20, 2014, one month before her 70th birthday. She had been diagnosed with Alzheimer’s Disease in 2010, and made known at that time her intention to end her life while she could still do so without assistance if and when the disease became too debilitating for a meaningful quality of life…
Her final months were considerably brightened by her delight with her new grandson, Felix. In lieu of a funeral or memorial service, the family met as a group with Sandra two days prior to her death to share their thoughts, feelings and reminiscences with her and each other.
If after-death rotation exists for atheists, Ayn Rand must be spinning in her grave. From today’s New York Times:
BOSTON — The death rate in Massachusetts dropped significantly after it adopted mandatory health care coverage in 2006, a study released Monday found, offering evidence that the country’s first experiment with universal coverage — and the model for crucial parts of President Obama’s health care law — has saved lives, health economists say.
The study tallied deaths in Massachusetts from 2001 to 2010 and found that the mortality rate — the number of deaths per 100,000 people — fell by about 3 percent in the four years after the law went into effect. The decline was steepest in counties with the highest proportions of poor and previously uninsured people. In contrast, the mortality rate in a control group of counties similar to Massachusetts in other states was largely unchanged…
Big deal. As the second paragraph clearly shows, Romneycare’s so-called “success” consists mainly of keeping a bunch of moochers and slackers on big government’s teat for a few more years.
As The Washington Post reported in December:
The story of Avastin and Lucentis, two nearly identical drugs for blindness, offer a glimpse into the problematic world of Medicare pricing.
A dose of Avastin costs only $50. A dose of Lucentis costs $2,000. Both Avastin and Lucentis are made by the same company, and they're remarkably effective in treating a form of macular degeneration that was long the leading cause of blindness among the elderly, The Post reported. They are very similar on a molecular level and probably cost about the same amount to manufacture.
Nonetheless, doctors prescribe Lucentis almost as often as Avastin. They also make more money doing so. Medicare is legally obliged to pay for any drug a doctor prescribes, and doctors also receive commissions of 6 percent to cover their own expenses. The commission a doctor collects on each dose of Avastin would be only about $3, as opposed to $120 on each dose of Lucentis. Congress and the courts have refused to allow Medicare to save money by scrutinizing doctors' decisions.
As a result, taxpayers spent about $1 billion in 2012 more than they would have if doctors had been prescribing Avastin. Avastin, for all intents and purposes, has been shown to be equivalent to Lucentis in six studies and one massive review of Medicare records.
Ezra Klein pinpoints the real villains in our atrociously overpriced health care system, and claims it’s not so much those greedy insurance companies:
A health-care system that followed international best practices would direct the government to set rates. Or it would let insurers band together and negotiate rates collectively — a practice called “all-payer rate setting.” But it wouldn’t need to eliminate private insurers. It’s good for consumers to have a choice of insurers, who have real incentives to innovate and devise better ways to keep customers healthy and costs down.
It’s health-care providers — not insurers — who have too much power in the U.S. system. As a result, they have the most to lose if health-care prices fall. But, as is often the case, political power flows in part from popularity. So politicians who routinely rail against for-profit insurers are scared to criticize — much less legislate against — for-profit hospitals, doctors or device manufacturers (though drug companies come in for a drubbing now and then). These are the people who work every day to save our lives, even if they make us pay dearly for the privilege. No one cheers when you take them on…
Rubber Hose spells out what should be obvious to anybody who doesn’t mainline Fox News. Apparently it isn’t, though, to judge by the polls. You’d think that nobody on God’s little green footstool ever had an insurance policy cancelled until Obama came along.
One annoying thing about the ACA is anything bad related to health insurance is deemed to be an Obamacare problem even if it is a problem that long predated the health reform law.
For as long as I have been aware of this stuff, companies have cut employee hours to avoid giving them benefits. Just after I graduated high school, a friend of mine worked 29 hours per week at a book store. Why such an odd number? The company gave benefits to “full time employees” and defined people as full time if they worked 30 hours or more. This was in 1988. But when it happens today, it is all Obamacare’s fault. Labor stats don’t back up the notion that the ACA is causing any cutback in hours. But any company that cuts its hours has an incentive to say that it is doing the cuts because of Obamacare because then the law, and not the company, becomes the bad guy.
Likewise, business have been reducing the number of employees who get health insurance for decades. That phenomenon is what people were calling the “health care crisis” back in the early 1990s and the reason that Obama campaigned on health care reform as an issue which led to the ACA’s passage. But whenever any employer drops health insurance after the ACA’s passage, it must be Obamacare’s fault. And private insurance carriers have long been restricting the doctors and medical facilities you can visit (in-network vs. out-of-network), changes in policies, etc. This stuff was not invented by the 2010 law.
A retired insurance executive sends along this discouraging analysis of Obama’s latest cave-in to the insurance companies and the Republicans or — as the president no doubt considers it — to reality.
I am appalled that Obama’s advisers, in trying to get him out of the jam created by promising that the insurance companies would not kick anyone off a plan they liked, allowed him to go out there and promise to fix the problem by allowing the insurance companies to continue offering the old plans for another year.
It’s repeating the exact flaw from the first pledge: in order for the promises to work, both rely on totally voluntary actions by the insurance companies! No government official can force an insurer to offer any policy, ever. There are some options governmental players can use to force insurers to comply with certain requirements once they do decide to issue a policy or a plan — but that presumes that the carriers have decided to offer a plan. No one — President, governor or insurance commissioner — can force an insurer to offer a plan in the first instance.
So Obama’s political advisers are telling him to fix a problem caused by implicitly promising that insurers will continue to offer certain plans by ... promising that insurers will resume offering certain plans.
It is not unlikely that the insurers will behave that way — it is impossible. Even if they wanted to do this, which they don’t (who wants the headache and expense of offering a bunch of small little plans for a dwindling number of policyholders when the business is shifting to a new and much larger arena with much better economies of scale) they actually physically, logistically and legally can’t do it.
Issuing a health care plan is incredibly difficult, cumbersome and complex. Launching a new plan requires at least a year of hard work and prep — designing the benefit, underwriting it, getting the actuarial work done, getting the state rate filing process accomplished including time for a rate appeal, making sure the right network of providers are in place ... on and on it goes.
Bottom line is that the fix the president just promised can’t happen until January 2015, even if it was a good idea, which it is not. And even if the issuers wanted to keep offering the old plans, which they don’t — something we know to a 100% certainty because they dropped these grandfathered plans even though they already are currently free to continue to offer these plans.
Obamacare allowed the issuers to continue the grandfathered plans — and the plans chose to drop them instead. So now the president announces that the plans can re-offer the grandfathered plans they were already allowed to offer, but chose to drop. Which the plans not just won’t, but can’t do, making the president again look like a liar.
This is political malpractice — the president has just made another healthcare promise on which he cannot deliver. And just like the first time, he appears to have no clue that he is doing so. This is going to be like chickenpox — the first time, it is bad enough. But when the same virus comes back the second time you get shingles, a much worse and more painful condition.
It’s almost as if no Democrat has ever worked in the health insurance industry or at least the White House isn’t checking with them. You’d think the political and communications advisers would want to get the policy part right to make sure the reality would match the message, but they appear oblivious.
So weird. Potentially devastating and entirely self-inflicted.
Bertrand Russell tells it like it too often is:
Curiosity so called, on the other hand, is inspired by a genuine lover of knowledge. You may see this impulse, in a moderately pure form, at work in a cat which has been brought to a strange room, and proceeds to smell every corner and every piece of furniture. You will see it also in children, who are passionately interested when a drawer or cupboard, usually closed, is open for their inspection. Animals, machines, thunderstorms, and all forms of manual work, arouse the curiosity of children, whose thirst for knowledge puts the most intelligent adult to shame. This impulse grows weaker with advancing years, until at last what is unfamiliar inspires only disgust, with no desire for a closer acquaintance. This is the stage at which people announce that the country is going to the dogs, and that “things are not what they were in my young days.” The thing which is not the same as it was in that far-off time is the speaker’s curiosity. And with the death of curiosity we may reckon that active intelligence, also, has died.
“Whatever the chain of events is, the chain begins before birth,” said James M. Cantor, a University of Toronto professor of psychiatry whose research team has made a series of startling correlations finding that pedophiles are likely to share physical attributes, such as slightly lower IQs, shorter body height, left-handedness and less brain tissue.
Hey, wait a minute, I resemble that. Only I thought it was just old age.
How can I not pass along the news that Sarah Palin ran a faster marathon than Paul Ryan?
One key element in clinical psychology training is learning to pay attention at a finer granularity. Subtle shifts in wording, posture, and expression can convey much to the attentive observer. Even the inattentive are affected unconsciously. A corollary is that my own subtle shifts communicate a great deal to those I’m working with, and I need to be unusually aware of their detailed presentation.
As with most intrapsychic occurrences, this dynamic also plays out on the social plane. What feels like a subtle shift in mood and approach can speak volumes to those on the other end of the power equation. As a result what seems on one end to be a legitimate ruse to locate a dangerous enemy can be experienced on the other end as an invalidation of everything associated with the deception.
Such, unfortunately, is the case with the US employment of a fake campaign promoting and dispensing hepatitis vaccine in Pakistan as a means of locating Osama bin Laden and kin. Given the way vaccination campaigns were recently used, much of Pakistan no longer trusts them, and immunizers have been banned from Taliban territory, an area that includes over 300,000 children. What makes this particularly troubling is that the Afghanistan/Pakistan border area includes one of the world’s two “persistent pockets of polio transmission” according to the WHO.
The prospect of polio transmission draws the attention of national governments, and India has declared its children at risk of cross-border infection as long as Pakistan cannot carry out vaccination programs. And it cannot: recently immunization workers were publicly beaten in Islamabad.
As Laurie Garrett says at CFR:
Some people said a small amount of suspicion of vaccines from the CIA activities a year ago was merely collateral damage in the “war on terrorism.” Al-Qaeda attacks on the United States and its allies have over the last fifteen years killed about five thousand people. Today that collateral damage could mean that many children in Pakistan are at risk of dying or being permanently paralyzed by polio, and the reversal of eradication efforts that could swiftly spawn outbreaks across the entire region.
Ohio state legislator Nina Turner has decided to dramatize the War On Women: Contraceptive Theater of Operations by attempting to place an equivalent burden on men:
...the Democrat has become the latest in a series of female state legislators to give her male colleagues a taste of their own medicine by introducing a bill that limits men’s ability to get a Viagra prescription without meeting certain government conditions.
Not bad. But I suggest we think in different terms. This is a calculated burden on a settled issue of the rights of American citizens. I modestly propose we burden another settled right, to dramatize that fact. Therefore, no one should be allowed to purchase a firearm in this country without being required to watch a 30-minute montage of coroner’s photos of children who have been killed by firearms in this country. The montage’s soundtrack should include “Tears in Heaven” by Eric Clapton and “My Heart Will Go On” by Celine Dion. Remaining music should be left up to the states, in acknowledgment of the Tenth Amendment.
Undoubtedly we will hear that this violates the Second Amendment. But since it doesn’t actually prevent anyone from acquiring the means to slaughter additional children, that argument should be easily countered.
This went into effect Monday. I’ve waited a while to see whether the MSM would jump on the good news with its customary enthusiasm. Oddly, no.
On Friday, the federal government launched an element of the Affordable Care Act that is likely to have far-reaching consequences on the cost of health care in the United States in the form of new regulatory controls on how private health insurance companies spend the money they collect in premiums. Rick Ungar, a left-leaning specialist on health care policy who writes for the corporatist site, Forbes.com, explains:
That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80 percent of the consumers’ premium dollars they collect — 85 percent for large group insurers — on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.
This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare — but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.
Recently I found myself lying on an oversized tongue depressor, being transported feet first through a giant, humming doughnut called a PET scan machine. Which fortunately found no malignancy, to get that out of the way right at the start.
The process requires 45 minutes of lying perfectly still on the back, arms at the sides and hands in pockets. This allows plenty of time to reflect not just on the transitory nature of man, but also on the design of PET scan machines.
For one thing, the tiny label that warns you not to blind yourself by looking at the laser is printed upside down. For another, the hole through which you are being drawn with such excruciating slowness is pretty damn small. I am six feet long but not, at 160 pounds, very wide. The smooth sides of the doughnut grabbed my shirtsleeves and pulled them up.
One out of five adult Walmart customers — I’m guessing here, but I doubt if I’m far off — could no more have gotten through that opening than an orange could squeeze through the neck of a milk bottle. Life-threatening compression or major surgery would be required.
I asked mysonthedoctor about this afterwards and he said it was indeed a problem. “Sometimes they have to send patients to the zoo where they have larger machines,” he said. “It can be psychologically devastating.”
The zoo? Off to the internets, where that part turned out to be something of an urban legend:
“We found that only 1 percent of zoos had CT scanners at all,” [Dr. Ginde] said. “And neither of them said they would image human patients.” About 15 percent of the veterinarian schools had scanners, “but almost all of them said they had policies prohibiting human patients because there were medical and legal issues about them not being licensed.” So, except for one or two isolated cases, no human has ever been scanned by a machine meant for animals.
For instance, it is difficult for some obese patients to fit in the openings of standard MRI scanners so they can be examined. These patients are often referred to an open MRI scanner that presents physicians with a Catch-22 situation: While the open MRI scanner can physically accommodate larger patients, these scanners typically have much less power and images of obese patients tend to be of diminished quality.
The technical description for such images is LBBH (Limited By Body Habitus). Just so you know.
Further information may be had here. Meanwhile:
…Bettybeauty Inc., which makes pubic hair dye, was started by Nancy Jarecki in 2006 and sells its products at salons and beauty stores. The $14.99 product works like normal hair dye but is formulated to be safe for the pubic area. The colors run from basics like black, brown and blonde to hot pink, turquoise and purple.
Jarecki said sales have tripled since the line was introduced, although she declined to give figures. Some women are looking to cover gray hair, while others just want a fun color, she says. “When I came out with it, there was this kind of burst of ‘Oh my god, you solved our problem. I didn’t realize how much gray hair was down there,’” she said…
Rick Santorum offers up this frothy bit of wisdom:
“Does anybody in this room believe that somebody that’s 62 years old is too old to work in America today?” Santorum asked. “Social Security was established for people who were too old to work and therefore they needed the support of the federal government.”
For the moment, let’s leave aside that this is not historically correct. (Thom Hartmann neatly pointed out on his show today that both Roosevelts believed people should be able to retire after a lifetime of work. But since they were both commies, that probably doesn’t count.) Instead, let’s take Santorum’s statement on its own terms. Just for a few moments.
I don’t know specifically who was in the room when the statement was made. But the reality is that there are a lot of people who believe that someone who is 62 years old is too old to work in America today. Most CEOs. Most HR managers. Most of the so-called “job creators.” Pretty much everybody, in other words, in a position to actually hire someone who is 62 years old.
But don’t worry — they feel the same way about someone who is 52 years old. This is the reality in America today: the de facto retirement age is somewhere in the neighborhood of 49. That’s the age at which business is done with you — unless it’s your own business, of course. But if that’s the case, you’re most likely not hiring people older than 49 either. And if you’re a Republican you are most likely berating everyone you think is too old to hire for being lazy when everyone else with a job to offer makes the same unfair assessment of older workers that you did.
So, Rickster, here’s a modest proposal: Ask your campaign contributors if they think 62 is too old to work.
And then get ready to offer “the support of the federal government” to a whole lot of middle-aged, able-bodied people.
Senior moments and aching joints are the least of aging’s problems. When you reach the point where there is no jacket in your closet, no tie, no pair of pants, no sweater, no shirt, no pair of shoes, that does not bear the telltale of declining mealtime motor skills, only then can you speak with authority about the trials and humiliations of growing older.
I don’t know when it started, but somewhere back along the zigzag path a tiny tremor announced the dinner hour, the slightest quaver of uncertainty, unnoticeable except as the cause of an occasional pea rolling across the floor or a small salad leaf landing soft and oily on my lapel. This was the start and it was a good while ago. In the intervening years the slight quivering of the hand became a dread quaking, a nightmare of flying food and a flood of juices and sauces rushing though the sluiceway of my shirt.
Yet I can still remember an earlier time of confronting a bowl of spaghetti with the calm confidence of the sure-handed and the skillful. A bowl of spaghetti was a piece of cake. So was a piece of cake.
Not any more. No tie would now survive even the smallest taster’s sampling of a simple pasta. And, with no tie as catchall in these open-necked days, your fondest white shirt will soon be headed to Goodwill. And then only if Goodwill is feeling full of good will. And the cake, the cake that once went directly from plate to mouth with zero wastage will now leave a heavy snowfall of crumbs on your lap and on your shoes and on the rug. Indeed most of the cake will fail to reach its destination.
Not that you can do much about any of this. Wearing a bib seems extreme and is not much of a style statement. Besides, it doesn’t protect your pants or most of your jacket, your shoes, or any of the floor. Of course you can eschew spaghetti and peas and cake, but eventually you must come to the unhappy conclusion that the only food you can handle without embarrassment is the intravenous kind.
Those who still think spaghetti and lobster are among the most threatening foods have not yet entered the twilight zone of palsied late-late-middle age. Watch out, they say to themselves, those slippery little strands of tomatoey pasta could cause trouble. No one who has crossed the line would have such a thought, for no one who has crossed the line would seriously consider eating spaghetti, and then only in a wet suit.
As the infirmity asserts itself, mealtime will become a trial of anxiety. Almost all foods begin to carry peril, some, of course, much more than others. Here are a few of the most perilous: corn on the cob; anything served in a sauce; stews; compotes; berries; salad of any kind, but especially those with beans or chickpeas, or any oily round thing that will escape from your fork and leap on to your lap; peaches; nectarines; plums; vanilla ice cream with chocolate syrup; olives and their oil, particularly their oil.
There are no garments in my closet that haven’t been seasoned with a few drops from the groves of Tuscany. There is no tie on my rack that doesn’t bear the evidence of a savory sauce or a sybaritic syrup, no shirt without at least the ghost of a bygone meal, no lapel or pant leg or shoe top that wouldn’t like to start fresh, free and cleansed of the mark of the klutz.
In my case, chocolate is the stain of choice. For all the rich and colorful variety of dried globs on my clothes, none is so dear to me as the chocolate splotch. This indelible memento of all those profiteroles and chocolate sundaes and tarts, candies, cakes, and fudges makes it all seem worthwhile.
Sooner or later you will be known by the stains on your shirt. Wear them with the pride of a man who has been to the cleaners and back, and who knows where the chocolate is buried.
…I was working my way contentedly through this report from Miller-McCune, prejudices being reinforced one by one, until I got to the last paragraph and realized that the whole thesis was utter nonsense:
The research team, led by Amy Owen of Duke University, notes that the human brain shrinks with age, and the region known as the hippocampus, which has been linked to learning and memory, typically atrophies at an accelerated rate late in life. This shrinkage has been linked to depression, dementia and Alzheimer’s disease.
Intrigued by previous research that linked smaller hippocampus volume with hyper-religiosity in some epileptics — as well as research on the effect of meditation on the hippocampus — the researchers decided to conduct a wider study of religious belief and brain shrinkage. The participants were 268 residents of the American Southeast, all of whom were at least 58 years old when the project got underway. All were involved on an ongoing basis for two to eight years.
MRI scans of their brains were performed every two years; data on their spiritual life and psychological state (including levels of stress and depression) was collected annually. Religion-oriented questions included their specific affiliation (or lack thereof); how often they worship publicly and pray privately; and whether they consider themselves “born again,” or have had any other religious experience that changed their life.
“Significantly greater hippocampal atrophy was observed from baseline to final assessment among born-again Protestants, Catholics, and those with no religious affiliation, compared with Protestants not identifying as born-again,” the researchers report.
From Aging Well, by George Vaillant. The Inner City study followed a group of Boston area men throughout their lives. The men, mostly from working class backgrounds, were born between 1925 and 1932.
When reinterviewed at age 67, one Inner City man was asked about how his parents had supervised him. He earnestly replied, “Oh, they really made us go to school, and back in that era, you know, elementary school, you would go home for lunch. My mom would have a hot meal waiting for me. And I would spend an hour or so with her, then I would go back to school. No foolish stupid buses or these cold, dumb lunches that they give you today. My mommy took care of these things. Didn’t let the State worry about it.
“Maybe that’s probably one of the reasons I have a lot of resentment toward liberals; I don’t want to get into no political thing with you, but I don’t like liberals. The left liberals especially.” The interviewer asked, “Was your family poor?” “Ah, no,” came the answer. “I would say we were probably lower middle class back then.”
The original record revealed that when this man was one year old the Society for the Prevention of Cruelty to Children (SPCC) had been called in. They noted that the subject had rickets (a disorder of malnutrition) and “the house was dirty and in disorder.” When he was 16 the interviewer noted that his parents “harped on how little aid they were getting from Welfare.” Selective amnesia at 67 allowed him to feel in control. He needed no help from liberals; he had never needed help from liberals.
Another holy shit moment, this one from my secret love, Gail Collins:
The new findings, which come with many qualifications, apply only to women who’ve had a hysterectomy. But that’s quite a population; about one-third of all American women have their uterus removed at some point in their lives.
You cannot contemplate this information for too long without asking whether the medical profession has a tendency to get carried away.
A deadly Egyptian cobra, which drew thousands of Twitter fans, has been found alive after it went missing for days from a New York City Zoo…
The species’ more common home, however, is North Africa. Its venom is so deadly that it can kill a full-grown elephant in three hours — or a person in about 15 minutes, according to wildlife experts.
Oh, all right. I guess it’s finally time to tell my Egyptian cobra story.
In 1964 our embassy in Morocco assigned me to accompany an American film crew making a documentary in the Saharan desert. With some difficulty our Moroccan army liaison officer had convinced a Tuareg band to let us film their camp, as long as the women remained out of view.
As the crew was setting up in front of one of the tents, a camera man noticed something odd about the collection of shoes and sandals that the occupants, as good manners dictated, had left outside. There were fifteen. Why an odd number?
The officer called inside and an old man with a cane and a missing foot hobbled out. How did he lose his foot?, the officer asked and then translated the answer for us.
As a young shepherd, the old man had been bitten by a cobra while tending his flock. Miles from any help, which would have been useless in any case, he sat down, drew his dagger, and cut off his own foot. That’s how he got to be an old man.
Former Mississippi governor Haley Barbour, whose heart brimmeth over with compassion for the littlest people of all, spake thus to the Conservative Political Action Conference:
“My first year as governor my pro-life agenda was adopted by our Democrat-majority legislature, and Americans United for Life, I am proud to say, named Mississippi the safest state in America for an unborn child,” Barbour said.
He made no mention of born children, perhaps because life expectancy in Mississippi, 73.6 years, is fiftieth among the states. Topping the list at 80.0 years is Hawaii, where President Obama may have been born in the summer of 1961. If so, he can be expected to live until August 4, 2041, a Sunday.
WASHINGTON (Reuters) – A third of Americans say they have gone without medical care or skipped filling a prescription because of cost, compared to 5 percent in the Netherlands, according to study released on Thursday…
Healthcare reform was U.S. President Barack Obama's signature policy effort, but not a single Republican voted for the bill that Obama signed into law this year and conservatives in Congress have promised to try to dismantle it…
And this from Columbia University’s Mailman School of Public Health:
Fifteen-year survival rates for men and women ages 45 and 65 in the U.S. have fallen relative to the other 12 countries over the past 30 years. Forty-five year old U.S. white women fared the worst — by 2005 their 15-year survival rates were lower than that of all the other countries. Moreover, the survival rates of this group in 2005 had not even surpassed the 1975 15-year survival rates for Swiss, Swedish, Dutch or Japanese women. The U.S. ranking for 15-year life expectancy for 45-year-old men also declined, falling from 3rd in 1975 to 12th in 2005.
When the researchers compared risk factors among the 13 countries, they found very little difference in smoking habits between the U.S. and the comparison countries—in fact, the U.S. had faster declines in smoking between 1975 and 2005 than almost all of the other countries. In terms of obesity, researchers found that, while people in the U.S. are more likely to be obese, this was also the case in 1975, when the U.S. was not so far behind in life expectancy…
The researchers say that the failure of the U.S. to make greater gains in survival rates with its greater spending on health care may be attributable to flaws in the overall health care system. Specifically, they point to the role of unregulated fee-for-service payments and our reliance on specialty care as possible drivers of high spending without commensurate gains in life expectancy.
“It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them,” said lead author Peter Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School of Public Health. “But what really surprised us was that all of the usual suspects — smoking, obesity, traffic accidents, homicides, and racial and ethnic diversity are not the culprits. The U.S. doesn’t stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy.”
This story, shyly hiding on page A15 of today’s New York Times, unarguably exposes the Glenn Becks, the Rush Limbaughs and the Sarah Palins — among so many others — for the filth they are. And ignorance, as in Palin’s case, is no excuse. The truth is out there, Sarah, hidden in the pages of books and the tubes of the internet. Go look.
As for the Becks and the Limbaughs and the Congressional troglodytes of both parties, a just Lord would, as their ends approached, bring each of them before life panels. There they would be sentenced to death by modern medicine — weeks or months entombed in dead bodies kept warm by pumps and tubes as the tenants cursed their own cruelty.
In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer…
It shows that palliative care is the opposite of all that rhetoric about ‘death panels,’ ” said Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine and co-author of an editorial in the journal accompanying the study. “It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life…”
Those getting palliative care from the start, the authors said, reported less depression and happier lives as measured on scales for pain, nausea, mobility, worry and other problems. Moreover, even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis, they typically lived almost three months longer than the group getting standard care, who lived a median of nine months.
The other day I mixed a can of Campbell’s Cream of Chicken into left-over brown rice. I added a can of tuna, stirred vigorously. After cooking it into a sort of casserole, I ate it. Yummy.
Isn’t it strange how we find ourselves doing what our parents did at the same age? At 73 (just my age now) “D”, as we called my dad, was a widower who lived alone and existed on concoctions often involving canned soups and leftovers.
D was proud that he could make do on his own, inventing dishes that reflected his frugality. Brimming with pride, he would don his threadbare cook’s apron. He’d ask a grandchild to tie it behind him because he could not manage that arm twist any more.
Then out would come the big pot, the cans, the small custard dishes containing, well, limp leftover carrots, shriveled peas, and always, it seemed, lumpy mashed potatoes.
His grown kids might dutifully nibble at the resulting cacophony of tastes, but the grandchildren, culinary cowards, would either suddenly remember a pressing date, or say they had just finished a “huge” meal.
As for me, I’d generally eat it unless there was fuzzy stuff atop a custard cup leftover. One time I stayed with my dad for several days before my wedding, and he stirred up a breakfast blend in a frying pan.
“This salt pork’s been here a while, but it’s okay, I’m sure,” he promised as he tossed it in. That was my first experience with food poisoning. Luckily I had three days to recover before the wedding, and so all was well.
As D grew into his late 80s, he had his meals delivered. Having lived on institutional food most of his life, he thought the steam table meals were tasty. So good, in fact, that he put the unfinished portions in the trusty custard cups and saved them for “later.” Trouble was “later” might mean a few weeks.
As the years went by, and D outlived his friends, he became depressed and less and less able to take care of himself properly, though he would insist he was okay. In his 90s, he began to feel as if he had had enough of life. “One thing about old age,” he would say, ”if something goes wrong with your body you can be sure it will never get better.”
One day my brother Jerry visited and bravely began clearing out the aging leftovers from the fridge. Jerry is not demonstrative unless he’s talking politics, but this time was an exception. Holding up a particularly rancid leftover, he turned to his father and said, “Someday you’re going to kill yourself eating this stuff.”
“So?” my father replied. It didn’t, either. He made it to 97, and died of being worn out.
With the Democrats’ health-care-industry bill nearing passage, the President has finally begun to make use of his extensive leadership skills.
The more active role is a change for the White House, which for months gave wide latitude to Congress as it shaped a bill.
A Senate aid who requested anonymity because he was not authorized to discuss the closed-door meetings said that the White House has signaled it will “convene and run” meetings from now on as lawmakers strive to reach a consensus, reflecting a “significant uptick” in the Obama administration’s involvement.
The Democratic leadership welcomes a more hands-on White House, as Obama’s imprimatur could provide political cover to members casting a tough vote in an election year.
It’s initially counterintuitive that a bill to reform the world’s 37th-best health-care system in the world’s richest country would be a tough vote. After all, when the Democrats were still using the bait-and-switch tactic with the public option, something like two-thirds of those polled were on board. As that got watered down to a Medicare buy-in, cleverly pitting the 20- and 30-somethings against the 50s and 60s crowd, support naturally dropped, but was still above 50% until it became clear that the Democrats would once again cave to the super-rich and the corporations that front for them.
But Obama, being The One, now appears at the critical moment. Will he follow through on any of his campaign promises, such as a public option, not increasing taxes on the middle class to benefit the wealthy, and so on?
President Obama told top Democratic House members on Wednesday that he favored a tax on insurance companies offering more-expensive healthcare plans as a means of extending insurance to millions of people who are not covered, according to a person familiar with the meeting.
The so-called “Cadillac tax” is a feature of a healthcare bill that cleared the Senate before the Christmas holiday. But the House has chosen another financing method — a tax hike on the wealthy.
Powerful labor unions at the core of the Democratic base are opposed to the Cadillac tax, saying that in some cases union members gave up wage increases in return for richer healthcare benefits.
Obama’s preference may put pressure on the House to adopt the Senate tax as part of a compromise between the two bodies. Obama made his views known at a late-afternoon meeting with House Speaker Nancy Pelosi (D- San Francisco) and other senior Democrats.
I admit that I voted for Obama assuming he’d be a pretty bad President, so I’m not really disappointed in his performance policy-wise. But I thought he was a better politician than this.
The Democrats gain control of the White House and both houses of Congress and use that control to make none of the changes they promised. When the biggest domestic-policy question in a generation comes along, they operate with Cheney-like secrecy, cut back-room deals with precisely those corporations at the root of the problem, ensure that such deals preclude any meaningful reform in Congress, and finally off-load the costs of the whole insurance- and drug-company giveaway onto the middle class. They really have very little chioce; after all, if they didn’t, some Republican somewhere would be angry.
Funny thing is, no Republicans will be voting for Reid or Dodd’s replacement or Dorgan’s replacement. And not that many Democrats will, either; the intensity gap has been large for quite a while. To me it looks like the Democrats will end up barely controlling the Senate given that Lieberman is really a Republican; on the bright side, a margin like 54-46 would make Lieberman dispensable. The House, with its 81-vote margin, is probably safely in Speaker Pelosi’s hands, but losses, I predict, will be heavy in 2010.
And heavier in 2012, unless the party invests a huge amount of money in PR and spin to persuade people to enjoy being forced to buy insurance now, and wait four or five years for the presumed benefits. Americans are not that dumb, they understand the Democrats have cheated them once again. They also see the Democrats chuckling behind their hands at the thought that Americans have nowhere else to go.
Which may be accurate. So we’ll just stay home then, and let the Democrats buy their votes from insurance company executives.
McClatchy’s Joseph Galloway is a journalist who writes books with generals, and features this compliment from Norman Schwarzkopf in his bio: “The finest combat correspondent of our generation — a soldier’s reporter and a soldier’s friend.”
So it’s always interesting to see how far left many of his opinions are. For example, he’s underwhelmed by the Senate’s health-care bill.
Absent from the legislation now is anything that even remotely threatens the profits and the big bonuses and the private jets and the gold-and-marble office towers of the health care and insurance and pharmaceutical corporations.
The pirates of Wall Street and the political charlatans have won.
The American people, especially those who are sick and poor or sick and middle class or just poor and middle class and afraid that one day they will get sick, have just lost.
What we needed was principled and determined leadership in the White House and on Capitol Hill. What we got from the people whom we elected and sent to Washington to clean house and shape up a corrupt system was much ado, and then nothing.
So why isn’t the failure of the health-care reform initiative an epochal example of the failure of leadership? Democrats know who I mean…
Or perhaps you don’t agree that having dumped the public option and the Medicare buy-in to get Lieberman and/or Snowe, Senate Democrats have neither of those two votes, so they’re looking around for some piece of the store that has not yet been given away.
They’ve forced millions of Americans to buy insurance, which is useless. I don’t need insurance against something that’s certain to happen, I need health care. Most of those Americans can’t afford insurance, so government will have to pony up the money that supplies the insurance companies with profits. Why do I have to pay taxes that get handed over to insurance companies?
And they’ve removed any hint of a competitor for those insurance companies. Medicare won’t expand, and we’ll all have no option but to purchase insurance from private corporations with histories of lawlessness, dishonesty, and disregard for public welfare. Do you believe that having insurance means you’re covered when you get sick? Ask the 1.5 million Americans who filed for bankruptcy last year, of whom over 60 percent are estimated to have been driven to the extreme by problems that included significant medical bills.
Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.
“Unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country,” says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. “If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that’s the major finding in our study.”
Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say.
“That was actually the predominant problem in patients in our study — 78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services,” says Woolhandler. “Other people had private insurance but got so sick that they lost their job and lost their insurance.”
The Democrats consider forcing everyone to buy private insurance, which is unlikely to cover you in extremes, to be a step forward. It is, for the insurance companies; but not for me, as one of the forty-some million uninsured Americans.
Then there’s the timed phase-in of the so-called benefits over a period long enough to include two or three election cycles. This is a trick Congress uses to look as if it’s doing something without making any commitments that some money-making war in some remote location can’t pre-empt.
This bill is certainly historic, in other words, but not in a positive way. It’s a holiday gift to the insurance and drug industries, following on the lavish presents bestowed earlier on the perpetrators of the recent financial farce. Remember, after all, that the Democrats handed $787 billion to Wall Street firms and their bankers and insurers, precisely the culprits in the disastrous chicanery that led to the bubble that ruined so many. Now the same folks are handing billions per year for the foreseeable future to the drug and insurance companies, without even a hint of a means of riding herd on those vicious organizations. Or as Jim Dean at Democracy for America puts it,
…the bill doesn’t actually “cover” 30 million more Americans — instead it makes them criminals if they don’t buy insurance from the same companies that got us into this mess.
It seems the Democrats have once again failed to act on their promises. In particular, the Democrat in the White House has neglected to act when he could have. Yes, the bill is being written by Congress, not the White House, because the Obama administration decided to go the opposite way of the Clinton attempt, which largely handed a bill to Congress to be passed or, as it happened, rejected. Politically, as with everything Obama does, this is a good strategy, because something will come out of it, and that’s the only goal for the administration.
But Obama is the main reason the bill sucks so much. He started by taking the only reasonable option off the table; then he exerted no leadership to force things, whether by gambling on pressure through stating publicly what he wanted, or working behind the scenes for a consistent goal. By making it clear that all he wanted was some bill, he created the situation in which there was no threat of extreme actions from the left, only from the right. Thus Snowe and Lieberman can affect the content of the bill, but Feingold and Sanders can’t. If he had ever come strongly for a public option, there’d be one in the bill. If he’d supported anything at all, it would be in the bill. But he didn’t, because the only thing he really wants is whatever gets the votes.
If they pass a bill similar to the current Senate version, I’ll be rooting for the Democrats to lose Congress again.
Why the Medicare buy-in is a fine idea — probably better than an anemic “public option” that has been practically strangled pre-birth by the insurance lobby. This from Gooznews.
…The decade before people enter Medicare (55 to 64) is the time of life when many people develop the chronic diseases that will make them the most expensive patients in Medicare once they get there. Diabetes, heart disease and many cancers often emerge in late middle-age. Intervening when the warning signals of these diseases first appear can moderate or even eliminate many of these costly conditions.
Medicare is the ONLY insurer with a long-term interest in engaging in this kind of health care system-delivered secondary prevention. Every other insurer has a self-interest in kicking the can down the road because they know it will be the government and taxpayers that ultimately pick up the tab when those chronic conditions become the most costly…
I can’t imagine any of the three gentlewomen giving a good goddamn what I think, but unless the final bill is a whole lot better than the House version I expect to be urging my Senators and my Representative to oppose the health care reform bill, and the President to veto it.
It is of course possible that the more conservative Senate will remove the abortion restrictions and turn the public option into something with at least a shred of meaning. But I wouldn’t bet on it.
As I understand the House bill, the Democratic leadership traded away the public option in all but name, and allowed the abortion restrictions to be tacked on, in exchange for ten votes. In other words, gut the only relevant item and destroy something else on your way out, and you can demonstrate leadership. Thanks, Madame Speaker, heckuva job.
Since this bill’s public option will cost more than private insurance, it will do nothing to drive down costs; but the federal legal mandate to buy insurance will have been issued. What will this be? A windfall for the insurance companies, who are the source of the original problem.
Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.
But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies — a bailout under a blue cross.
The Democrats have once again proven where their allegiances lie. Everyone has to believe in something, and they believe they want to be re-elected. Where’s the money for the next campaign coming from? The corporations any reasonable government would rein in. So they sell us out. Again. At least the Republicans are honest about trying screw us.
“Personally and politically, Pelosi won big on health care”, says the McClatchy headline. Nuff said.
I think I’ll pull out Bulworth, at least I’ll laugh until the ending.
After hitting the Medicare Part D doughnut hole, this old rooster became so confused he wound up at a demonstration in support of Colonel Sanders:
If my initial take turns out to be accurate, it’s a sad moment for the country, as it appears the Democrats have caved once again. “Oh what a night!” said Speaker Pelosi, my representative, and in that she did not lie.
When will people learn? Homer Simpson asks. Democracy doesn’t work! Or at least the Democrats don’t. First the Presidential candidate takes the only reasonable solution off the table, possibly fearing that he’ll follow in the footsteps of Jay Billington Bulworth and be assassinated by a representative of an insurance company. Of course, he was only following one of the leaders of his party, the Speaker of the House, who took her Constitutional duty to investigate White House crimes off the table to increase her party’s shot at power.
Next the now-elected President, who promised transparency and openness, negotiates a back-room deal that lets the drug companies, about a third of the problem, off the hook for the equivalent of pocket change.
Gradually the usefulness of the health care bill is eroded by the majority Democrats continuously moving toward the corporatist Republican right in the vain hope of getting some political cover.
And it turns out they’ll need a lot of cover. Giving away so much in the abortion-rights area won’t play well with the country, let alone the Democratic base. Setting up a public option that will cost more than private insurance, while requiring everyone to have insurance of some sort, simply caves 100% to the insurance companies, who constitute the other two-thirds of the problem.
Such an option is a slap in the face to anyone who wanted what the term was supposed to mean. The point of a public option is to do the function as efficiently as government is capable of. Medicare shows that such a method works, and provides society with some means of controlling costs. That’s why the Republicans and the insurance and drug industries oppose such a plan. Now we know the Democrats do too.
Everyone knows the reasons Congress won’t allow us decent health care: they’re owned by the insurance and drug companies. And the banks, of course. It’s not because they can’t find the money; eliminate insurance altogether, and presto, you pay for universal health care. And we’re not even talking about the couple billion a week we waste on foreign wars to enrich the oil companies. That’d pay for a lotta health care.
Yes, the bill does appear to strip insurance companies of their antitrust exemptions at the same time it compels millions of new customers to purchase their products. If you trust corporations, and you don’t mind the restrictions on abortion funding, then you’ll be fine with that.
We need a second political party in this country. If this travesty is what the Speaker and her majority call a strong bill to take to the negotiations with the much more conservative Senate, God help us. I wonder if we might not start to see challengers to the Democrats from the center (what the TM calls the left), similar to those conventional Republicans are seeing from the far right.
Let’s hear it for the death panels, Lewis Lapham more or less says:
Like the military industrial complex, the medical industrial complex invites the practice of large-scale fraud, the hospital surcharges for an apple or an artificial limb comparable to the cost-overruns paid by the Pentagon for a cruise missile or a wrench. The “waste” and “inefficiency” in the system is its bone and marrow. Of the $304 billion appropriation levied by the seven richest pharmaceutical companies in 2007, $97 billion was allotted to marketing and sales promotion ($27 billion in the form of free meals and drug samples given to attentive physicians), another $76 billion to payroll (earnings worth $29 million to the Chief Executive of Johnson and Johnson, $25 million to the Chairman of Wyeth), lastly $40 billion (13% of the whole), to Research and Development…
Which isn’t to suggest that our doctors forswear the Hippocratic Oath, or that our politicians abandon hope of squeezing the pus out of the health care system. But where is the blessing to be found in the wish to live forever? A substantial fraction of the annual tithe collected by the medical industrial complex is the invoice ($528 billion) submitted to payees in the last, often wretched, years of their lives.
The corpses in waiting serve as sacrificial offerings placed on the altars of the god in the ATM. Plato thought it “shameful” to provide medical help “not for wounds or some seasonal illnesses” but because one “is filled with gases and phlegm, like a stagnant swamp…” Socrates in the dialogue with Glaucon strengthens the argument with the observation that it is wrong to prolong lives no longer “profitable either to themselves or anyone else.” Medicine, he says, isn’t intended for such people, “not even if they are richer than Midas.”
Most days David Brooks’s columns just make me mildly impatient. Not this time. Read what he says in today’s New York Times about President Obama and healthcare.
And while we’re on the subject, take a look at this depressing story out of Wisconsin, where a group of merciful and compassionate doctors tried to apply intelligence to end-of-life decisions — only to run into Sarah Palin and her fellow deathers. Of all the lies and hypocrisies spread by the GOP in this summer of discontent, surely this has been the most ignorant, the most cruel.
Watch the repulsive physician/senator Tom Coburn as he comforts a grief-stricken Oklahoma constituent with a sick husband. Oklahoma voters (their other senator is James Inhofe) have a lot to answer for.
Those poor, ignorant, deluded dupes at the town hall meetings almost got it right. But death panels aren’t just on the way; they’re already here.
One of them is named Colin McEnroe, whose talk show used to be the only bright spot on your dial if you were tuned to WTIC in Hartford. But he was, as you will see from his blog posting below, afflicted with empathy. And so he was fired, and now it’s wall-to-wall Limbaugh wannabes. (Speaking of walls and Limbaugh wannabes, you used to see this message a lot in public toilets: A man’s ambition must be small, To write his name on a shithouse wall.)
I got my mother back to the nursing home. A few weeks later, she contracted another devastating infection. I met her in the hallway of a different hospital, lying on a gurney in a very backed-up warren of emegency rooms. She had severe diarrhea, and the whole situation was an icky, messy nightmare, and the hospital had nowhere to put her, and we were stuck in a hallway, and none of the doctors who were making the big decisions — not her primary care guy or her neurosurgeon — were going to be anywhere near this 2 a.m. ordeal.
No too long after that, I became my mother’s death panel. I had found a lovely, quiet room for her in the nursing home. I got flowers for it every day. I had Maggie working with me to make her comortable. I forged alliances with the other nurses too, and then I brought hospice in, over the objections of my mother’s primary care doctor, an old-time guy who just didn’t see things this way.
She had almost stopped eating. Her neck was not healing. Her Alzheimer’s was exacerbated by all the stress. The infections were coming at her fast and furious. She didn’t have an acute fatal condition. She had a bunch of non-fatal conditions that had collected around her in sort of a whirlpool, pulling her down.
I, “this Jack, joke, poor potsherd” was what was left on this earth to love her and fight for her. And all we ever did, from that day forward was try to make her comfortable and happy. We didn’t do any more tests, because we knew she was dying and hurting. We actually saved you taxpayers a lot of money, not that I gave a damn. I just wanted to do the right thing, and this felt so right.
She died September 11. Her last days were much better than the ones that preceded my decision to be her death panel.
There is no death panel in the 2009 health care bill.That’s just a made-up thing.
But if there were death panels, they would not be taking the place of some really good system we have right now that provides perfectly targeted care to patients who need it and can benefit from it. The truths of life and death are so much more complicated and rich than any healthcare debate can make them seem. In the case of my mother, you could almost say that she received bad health care until I decided it was OK for her to die.
The gun-toting wackos showing up to protest the idea of helping people are, to Richard Hofstadter fans, modern instances of The Paranoid Style in American Politics.
American politics has often been an arena for angry minds. In recent years we have seen angry minds at work mainly among extreme right-wingers, who have now demonstrated in the Goldwater movement how much political leverage can be got out of the animosities and passions of a small minority. But behind this I believe there is a style of mind that is far from new and that is not necessarily right-wing. I call it the paranoid style simply because no other word adequately evokes the sense of heated exaggeration, suspiciousness, and conspiratorial fantasy that I have in mind. In using the expression “paranoid style” I am not speaking in a clinical sense, but borrowing a clinical term for other purposes. I have neither the competence nor the desire to classify any figures of the past or present as certifiable lunatics. In fact, the idea of the paranoid style as a force in politics would have little contemporary relevance or historical value if it were applied only to men with profoundly disturbed minds. It is the use of paranoid modes of expression by more or less normal people that makes the phenomenon significant.
“More or less normal” is a pretty broad range, most likely including, for example, Chuck Grassley, who after talking up the idea that health-care reform includes death panels is now blaming the meme on the far left. As if there were such in America. Paranoia strikes deep, into your heart it will creep… But not as fast as corporate money creeps into your campaign coffers if you spout the right nonsense. Ask Kent Conrad.
Where do right-minded spouters look for inspiration? According to Jeff Sharlet, who’s written the book, the answer is surprising even to the jaded.
The Family is about the other half of American fundamentalist power — not its angry masses, but its sophisticated elites. Sharlet follows the story back to Abraham Vereide, an itinerant preacher who in 1935 organized a small group of businessmen sympathetic to European fascism, fusing the far right with his own polite but authoritarian faith. From that core, Vereide built an international network of fundamentalists who speak the language of establishment power, a “family” that thrives to this day. In public, they host the National Prayer Breakfast; in private they preach a gospel of “biblical capitalism,” military might, and American empire. Citing Hitler, Lenin, and Mao as model leaders, the Family’s current leader, Doug Coe, declares, “we work with power where we can, and build new power where we can’t.”
|The Daily Show With Jon Stewart||Mon - Thurs 11p / 10c|
Still, there are some positive signs in the fight over health care. And I don’t just mean the opportunity for folks who really know what they’re talking about, like Andrew Weil, to weigh in on the real issues.
One of the best signs so far is the stand taken by the Progressive Caucus in the House.
Rep. Raúl M. Grijalva (D-Ariz.), co-chair of the Congressional Progressive Caucus, responded to the wavering around the public option by reiterating the threat to block reform that doesn’t include it.
“As we have stated repeatedly for months now, a majority of the members of the Congressional Progressive Caucus will oppose any healthcare reform legislation that does not include a robust public option. Our position has not, and will not, change,” he said. “As Co-Chair of the Progressive Caucus, I look forward to working with my colleagues to develop comprehensive legislation that allows all Americans to choose the healthcare plan that’s right for them and their families. But I will not support any bill that does not include a public option.”
Then there’s Pelosi’s statement today, beginning
As the President stated in March, “The thinking on the public option has been that it gives consumers more choices and it helps keep the private sector honest, because there’s some competition out there.”
We agree with the President that a public option will keep insurance companies honest and increase competition.
As Greg Sargent notes, Pelosi stops short of a full-throated endorsement of a public option, but quoting Obama’s words back at him is a little confrontational. Which to this constituent of hers is more than a little surprising.
Right now it appears to me that the House Progressive Caucus is the best hope for some kind of meaningful reform. If you want to thank and encourage its members, you can do so here. And if you tweet, you can auto-tweet your support.
Reich is right.
The White House wonders why there hasn’t been more support for universal health care coming from progressives, grass-roots Democrats, and Independents. I’ll tell you why. It’s because the White House has never made an explicit commitment to a public option.
Senator Kent Conrad’s ersatz public option — his regional “cooperatives” — won’t have the scale or authority to do what a public option would do. That’s why some Republicans say they could buy it. What’s Conrad’s response? “The fact of the matter is there are not the votes in the United States Senate for a public option. There never have been,” he tells “FOX News Sunday.” Conrad is wrong. If Obama tells Senate Democrats he will not sign a healthcare reform bill without a public option, there will be enough votes in the United States Senate for a public option.
I urge you to make it absolutely clear to everyone you know, everyone who cares about universal health care and what it will mean to our country, that the bill must contain a real public option. Tell that to your representatives in Congress. Tell that to the White House. If you are receiving piles of emails from the Obama email system asking you to click in favor of health care, do not do so unless or until you know it has a clear public option. Do not send money unless or until the White House makes clear its support for a public option.
This isn’t just Obama’s test. It’s our test.
Republican Tom Coburn is a medical doctor, a church deacon, and the junior U.S. Senator from Oklahoma. Here he is on Meet the Press yesterday:
Look, the, the idea that we ought to talk about our future health and what our family and what we want done is a good idea, it’s legitimate. What is not legitimate is having government even weigh in on it. It is intensely personal; your health care, your plans, your family. There is no role for government in that. And where we’ve seen a role — and, and this happens all the time, which goes to one of the things that never gets talked about in health care — is we have statements, living wills. We have people who have made those very tough decisions. And then, because they’ve made them, but because of the malpractice situation and liability, they’re ignored. And we still intubate and put people onto ventilators that never wanted it because a family member threatens through a situation, even though you have that end of life counseling there.Help me out here. Does Coburn mean, for instance, that government should keep its grubby paws off a woman’s decision to have an abortion? That he would defend Dr. Kerkorian? Would he oppose any effort by “the government” to punish medical malpractice? To regulate or otherwise control drugs and their prescription by doctors? Does all that stuff about ventilators and intubations mean anything, and if so, what? That he wants death panels but only if he’s on them?
The most validating aspect of the current health-care debate, so called, is seeing how straightforwardly the Democratic party is dumping all the claims it made during the most recent election in exchange for campaign contributions from the scummiest parts of American society. Disturbing, but validating.
The late, great Senator Paul Wellstone (D-Minnesota) once said “If you don’t fight hard enough for the things you believe in, at some point you have to realize you don’t really believe in them.”
Can you name anything — anything — in this health care battle that Democrats have been willing to fight for? Like really go to the mat for?
Naturally the true believers will excuse any and every compromise The One deigns to grace us with. We are so lucky to have him to take care of us! We dare not criticize or obstruct whatever crumbs his generosity grants.
Of course Wellstone’s quote applies to the rest of us as well, and the only thing that might put some fight back in the Democrats is if we constantly harangue them. Some right-minded members of Congress have managed to force a vote on single payer in the House in September. Make it your mission this August to contact your Representative regularly and demand that they vote for single payer health care. Tell your Senators too. Go to their town hall meetings, and to their offices as well, now that they are on break.
And when you talk to them or their staff, don’t worry about their political calculations, or [tell] them you’re okay with a weak public option. Just demand single payer.
Or, alternatively, call ’em up and tell them how happy you are that Obama and the Democrats are giving away the store in an obviously futile attempt to bring feral Republicans (but I repeat myself) and immoral corporations (ditto) on board.
How could real, honest, intelligent people overcome the gun-toting racists who are shouting down any discussion of health care? Simple.
“Make me do it” was the advice of Franklin Delano Roosevelt to reformers when faced with legislation he desired but did not have the votes for in Congress. Mr. Obama is not exerting that plea for people power. Were he to do that, he would be encouraging daily public hearings in the Senate and the House on the bureaucratic waste, greed, overbilling, collusion, and fraud that many in the corporate world have inflicted with their costly, pay or die health care industry.
It is up to the people of our country to “make him do it” whether this year or next. A mere one million immediate calls to members of Congress by one million assertive citizens will start sobering up these legislators who think they can get away with another sale of our public trust.
The Congressional switchboard is 202-224-3121. The full Medicare, single payer bill (backed by nearly ninety legislators) is H.R. 676. The go-to citizen group for your sustained engagement is singlepayeraction.org. The rest is up to you, the majority, who want to put the people first.
From Paul Krugman’s blog:
A correspondent writes in, denouncing my latest column, and says that if things go my way we’ll end up with the government providing health care to everyone, which will “destroy the American way of life.”
Hmm. There’s a country this correspondent — and many others who denounce “socialized medicine” — should look at. It’s a country where there is, indeed, a substantial private health insurance industry, which pays 35 percent of medical bills. But the government pays a larger share — 46 percent. (Most of the rest is out-of-pocket spending.)
The country is called the United States of America.
The New York Times reports that nearly three-quarters of Americans favor a government-run Medicare-like health care plan that’s open to everyone. This is a serious and direct threat to the existing power structure, and as such a perfect measure of whether The One is really gifted, or simply fluent. Let us hope for the former, because we need it.
What really surprised me is not that
No. What surprised me was that the Times straightforwardly asked the single most relevant question.
When anti-single-payer people are pressed to the wall, they’ll often say, “Well, do you want your health care run by the government?” No reasonable person is completely comfortable saying yes. But considering that the alternative is insurance companies running your health care, I was happy to see the Times mention what pollwatchers have long known.
The Times poll asks, Do you think the government would do a better or worse job than private insurance companies in…
For the first question, it’s Better by 50-34. Two years ago it was 30-44. For the second, it’s gone from 47-37 to 59-26. Another reason to thank George W. Bush.
No semi-intelligent semi-rational being falls for the insurance company propaganda about private enterprise doing things cheaper because they have the profit motive. If you’re assuming I’m that dumb, you can expect business from other locales.
Bernie Sanders, the only actual socialist in the Senate, is right again.
He’s pushing a single-payer health care system, he’s got a petition, and he’s asking people to contribute their stories.
Clearly single payer is the cheapest way, which is precisely why it hasn’t happened. The American health care system, like pretty much every part of American economic life, is designed to concentrate wealth. Any actual health care given or received is incidental to the process.
As the petition says,
The U.S. does not get what it pays for. We rank among the lowest in the health outcome rankings of developed countries, and on several major indices rank below some third-world nations…
It also points out that the number of insurance company bureaucrats has grown at 25 times the rate of the number of physicians. Ah! That’s where all the money’s going…
So sign the damn petition already!