Archive for category Health Care
First from The Commonwealth Fund:
In 2013, more than one-third (37%) of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared with as few as 4 percent to 6 percent in the United Kingdom and Sweden.
And the second from JDI conservative Andrew Sullivan:
When a private sector system means you have ten times as many people failing to get basic treatment as in Britain’s uber-socialized NHS, you realize just how great the market failure is. I’m all for markets, but the facts seem to me to reveal that in healthcare, they are toxic to most people’s actual, you know, health. In what other area does socialism work so much better than capitalism? Isn’t that a first order question conservatives should address?.
The US healthcare system is a grotequely expensive disaster; plagued with inefficiencies, disconnected from the needs and wants of patients, distorted by massively misaligned priorities and goals, it consumes vast amounts of our national wealth without delivering corresponding benefits. More and more, it seems to me that healthcare and defense are exemplars of American dysfunction. Delivering sub-par outcomes in exchange for exorbitant amounts of money, driven by fear and a deep-seated mindset of scarcity, both healthcare and defense are expressions of American’s sense of vulnerability. We overspend on defense to keep us safe against military and other threats and we overspend on healthcare in a frantic desire for wellness. In both cases, our actions undermine our goals.
One of the challenges in managing health care costs is the way in which they’re distributed across the population.
According to the Agency on Healthcare Research and Quality, in any year 5% of the population accounts for 50% of health care expenditures, the top 10% of health care users account for 64% of overall spending. In any given year, 50% of the population accounts for only 3% of overall health care spending. To put it another way, 50% of the population accounts for 97% of health care spending. These numbers have been relatively stable since the 1970s. Half the population is responsible for a negligible portion of overall healthcare spending in any given year.
Who are the 5% that spends half the health care dollars in any year? They are persons with cancer, heart disease, pulmonary disease, mood disorders, and trauma.
To put it another way, healthcare spending is concentrated on a small portion of the population during any given year. The problem in managing health care costs whether it’s at a personal level or at the national level is their unpredictability.
We don’t know which persons are going to be in accidents or be diagnosed with cancer or heart disease in any given year. In our system, even persons without insurance, receive treatment; given the massive costs of the big five, those persons are likely going to not be able to pay the bills. So they get spread to the rest of us in the least efficient way possible.
Many of the individual plans that have caused the brouhaha about their cancellation don’t meet ACA minimum coverage standards. That’s why they’re being cancelled. At a consumer level, they were crappy products – people paid for them and got little for them in return. The reason the ACA established minimum levels of coverage was simply because people with inadequate health insurance are a lot like people without any health insurance.
Via TPM (emphasis added):
The Medicaid expansion field is tentatively set for 2014, and the nation is split down the middle: 25 states (plus D.C.) are expanding, and 25 states are not, according to the Kaiser Family Foundation.
… according to the foundation, 4.8 million Americans won’t be covered as the law intended in those non-expanding states. They don’t qualify for Medicaid now, but would have under the expansion, and they don’t make enough money to qualify for financial help to buy private coverage.
States with either a Republican governor or a GOP-controlled chamber in the legislature (or both) are opting out. In Utah, 57,850 people will not get health coverage due to the lack of Medicaid expansion. In Texas, the number will be 1,046,430.
Senator Rafael (“Ted”) Cruz (R-TX), yesterday:
“Obamacare is reducing health care options, increasing costs and hurting jobs. It has no place in Texas and must be repealed so we can empower Americans and their families by offering real health care choices rather than a government-written menu of plans they don’t want and can’t afford.
President Obama should take his broken promises tour elsewhere so Texans can continue focusing on the solutions that have allowed our state to become and remain the nation’s economic and job creation powerhouse.”
Texas needs health care reform more than any other state. In addition to having the highest rate of people without health insurance in the nation, Texas also has the largest number of children without health insurance and the highest rate of poor adults without health insurance.
Therefore, it’s fair to ask if Senator Cruz has his own health care plan that’s better than the ACA. Actually, he does! Through his wife’s employer, Goldman Sachs, he’s enrolled in a fabulous health insurance policy worth at least $20,000 per year, including an $8,500/year federal subsidy.
Oh, you wanted to know if Senator Cruz has come up with a better health care plan for ordinary Americans? No, nothing.
But the sabotage is a story, too. A huge one. It’s almost without precedent in American history, and the precedent it does have includes some of the ugliest chapters in this nation’s history. It gets coverage, yes. But not nearly the coverage it deserves. As is so often the case—as with Benghazi, as with Fast and Furious, as with the IRS—the bigger scandal is on the Republican side.
What’s that precedent?
. . . to find obstinacy like this, you have to go back, yes, to the pre-Civil War era. The tariff of 1828, the Kansas-Nebraska Act, which led to the civil war in “Bloody Kansas” and ultimately to the Civil War itself. Not comforting thought. But it’s where we are.
The biggest story is from Politico.
Then, in the months leading up to the program’s debut, some states refused to do anything at all to educate the public about the law. And congressional Republicans sent so many burdensome queries to local hospitals and nonprofits gearing up to help consumers navigate the new system face-to-face that at least two such groups returned their federal grants and gave up the effort. When the White House let it be known last summer that it was in talks with the National Football League to enlist star athletes to help promote the law, the Senate’s top two Republicans sent the league an ominous letter wondering why it would “risk damaging its inclusive and apolitical brand.” The NFL backed off.
It just gets worse and worse, Tomasky:
Now, with people trying to sign up, some Republican legislators are openly saying that they won’t permit their staffs to answer constituents’ questions about Obamacare. This is really the main job of a member of Congress, especially a House member: People call up all the time with questions about how to slice their way through the federal government’s briar patches, and you have caseworkers on duty—typically a couple in Washington and several more back home in the district regional offices—whose job is exactly that.
Purdum quoted Kansas Rep. Tim Huelskamp as saying he instructs his staff to refer callers to Kathleen Sebelius. But Huelskamp is not alone. Tennessee’s Diane Black says she doesn’t feel comfortable referring people to navigators. Utah’s Jason Chaffetz is referring people back to the administration, saying: “We know how to forward a phone call.”
I think this quote from Mother Jones says it all:
As one White House official told the Post, “You’re basically trying to build a complicated building in a war zone, because the Republicans are lobbing bombs at us.”
There’s a lot more to be said about Republican sabotage of the ACA. But this is a good start.
Talking Points Memo weighed in today with a jubilant headline: Final Word On Obamacare Coverage: Cheaper Than Expected. What actually happened was the U.S. Department of Health and Human Services is predicting that private for-profit individual health insurance premiums will be lower than originally estimated by the Congressional Budget Office.
In other words, “cheaper than expected” is not the same thing as cheaper. Health insurance premiums have been skyrocketing across the country for years. Even a reduction at this point means the insurance is overpriced. The ACA requires everyone not covered by employer-sponsored plans to purchase individual health insurance with their own money, unless qualified for Medicaid. In addition to the monthly premiums, “insured” individuals have to pay for any non-preventive health care themselves until they reach the deductible, which can be as high as $2,000. The deductible, coinsurance and copay expenses can amount to as much as
$5,950 $6,350 [h/t Ronald D. Hunt for the California rates]. The deductible and out-of-pocket limitations are subject to annual inflationary adjustments. These policies are effectively USELESS for many people, yet the insurance companies still get their monthly premiums.
Also, this is NOT the final word on premiums. FDL’s Jon Walker (emphasis added):
The HHS is extremely happy the premiums are lower than some old CBO estimates but that is a silly metric to judge by. More PR than policy.
It is important to note that no one really knows how many people and which type of people will sign up. These premiums are also simply based on insurers best guesses. After this first year when companies have real data we could potentially see some significant changes in premiums in either direction. 2015 not 2014 will be the real test from a policy perspective.
More info: Healthcare.gov
The evidence is overwhelming that the Affordable Care Act has had little to no impact on full-time versus part-time job growth, and as Fox News personalities continue to push the myth, they find themselves in direct contradiction with analysis put forth by actual economists.
[T]he administration has had four years to work on implementation. The fact they couldn’t work out all these problems during that incredibly long lead time is not a reassuring sign.
“Yes – Fox News actually just admitted that Obamacare would reduce the deficit. Republicans have continually repeated the lie that Obamacare increases the deficit; it doesn’t.”
From Fox News’ September 6 2012 Democratic National Convention coverage:
Full video HERE.
This chart shows both the increase in revenues and costs and the line in the middle shows the impact on the deficit by year. If the line is below zero then it reduces the deficit and if the line is above zero – it increases the deficit. You can see…the estimate is that it reduces the deficit: Source
The new estimates reflect a couple of factors. The Congressional Budget Office lists them:
- An increase of $168 billion in projected outlays for Medicaid and CHIP;
- A decrease of $97 billion in projected costs for exchange subsidies and related spending;
- A decrease of $20 billion in the cost of tax credits for small employers; and
- An additional $99 billion in net deficit reductions from penalty payments, the excise tax on high-premium insurance plans, and other effects on tax revenues and outlays—with most of those effects reflecting changes in revenues.
Jonathan Cohn at the New Republic digs into the details and rebuts those Republicans who INCORRECTLY say Obamacare now costs double:
To figure out the cost of health care reform, CBO looks at each of the law’s component parts and, for accounting purposes, groups them into different categories. It calls one category “gross cost of coverage expansions” – that’s the amount of money the federal government will spend to help people get insurance, mostly by offering Medicaid to more people or giving people subsidies they can use to help offset the cost of private insurance. Last year, CBO estimated that the gross cost of coverage expansion from 2012 through 2021 would be $1.445 trillion. Now CBO thinks the gross cost will be $1.496 trillion. The number shifted, in part, because the CBO has changed its projections for economic growth. (MSNBC’s Tom Curry has a nice explanation of this.) But, in the context of such a large a budget projection, that’s barely any difference at all.
With shutdown fever gripping the Republican party and the commentariat, it’s easy to argue the Republicans have clearly gone insane. Their tactics – from repeatedly holding votes to repeal the ACA to threatening to shutdown the government to threatening to crash the world economy by refusing to raise the debt limit – are self destructive behaviors of a party gone crazy. I disagree. Republicans have not gone crazy. From the conservative perspective, America is careening wildly toward destruction – worse it’s self-destruction in the form of “creeping socialism” symbolized by the Affordable Care Act. Republicans are pursuing tactics that can be understood simply as “Desperate times require desperate measures.”
Conservative critiques of the ACA portray it as a government takeover of health care that will lead to catastrophic outcomes – brutal rationing of care and prescription medications, senior citizens denied health care, a nameless faceless board in DC dictating to doctors what treatment their patients can receive (one scenario actually included doctors being issued government controlled iPads that would transmit treatment instructions from DC to the doctors – my boss made company management attend a speech by the ill informed MD claiming this outcome). If you live in Teabagistan, you’ve heard these stories and you’ve never heard them debunked. You and your friends have linked and shared atrocity tales about the outcomes of socialized medicine in other countries (a favorite meme is that Canadians are all frantic to come the US for health care because they’re being denied life saving treatment in Canada – usually some experimental treatment). Again, those stories have been debunked but you’ve never heard it because in Teabagistan, nobody hears the debunking and if they do, they dismiss it as a liberal conspiracy. For the teabaggers, the ACA is not just a bad policy, it is an existential threat to America. If it is allowed to go into full effect, the ACA will destroy America.
Believing we face such dire circumstances, the teaparty contingent in Congress (driven by their base which believes we face such circumstances), is fully prepared to do anything to “save” America. They were sure the Supreme Court would strike down the ACA. They were certain they could recapture the Senate and White House in 2012. Those things didn’t happen. Legitimate, normal avenues of preventing the ACA from taking effect, normal avenues for repealing it were closed. Repeated House votes to repeal it haven’t worked (despite the obvious problem with those repeated votes, conservative voters read articles saying “House votes to Repeal Obamacare” and then read that it’s still going into effect and conclude some devious force must be at work to frustrate an outcome they believe should be happening). So conservatives are left with drastic measures. If you genuinely believe the ACA is an America destroying bill, a government shutdown and all the attendant disruption is a small price to pay to “save” America. It doesn’t hurt that many teabaggers genuinely believe the government is irrelevant on a daily basis anyway.
Better to suffer through what conservatives believe will be short term discomfort than allow the ACA catastrophe to occur.
This month, millions of Americans will receive letters from their employers explaining the state health insurance marketplaces (formerly known as exchanges). I know because my job required me to send the letter to a sizable number of people.
If past experience is any guide, at least two-thirds of the people who receive the letter will glance at it, be confused and come to my office with questions already answered in the letter. The remaining third will be split between people who threw it away without reading it, people who read and understood it, and people who didn’t read it, didn’t understand it and are confused and/or angry. People have heard so much disinformation that I will spend the rest of the month and probably a good chunk of October debunking lies, correcting misinformation and calming terrified people. Read the rest of this entry »
This story made the rounds:
LOUISVILLE, Ky. — A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare.
The man is impressed. “This beats Obamacare I hope,” he mutters to one of the workers.
“Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn’t. If he signs up, it’s a win-win, whether he knows he’s been ensnared by Obamacare or not.
Since the many exchanges will be run by the states (Utah included), the dreaded Federal takeover of health care won’t happen.
The crush of people don’t greet Diaz-Dempsey with tea party dogma or amateur constitutional scholarship. No one is there to complain about the individual mandate or heckle about death panels. They have questions.
They wonder if they could get coverage despite having a pre-existing medical condition, how much it will cost them. They ask if Indiana has a similar program, or if this was only for Kentucky. Could they just enroll their child? They talk about their sons and daughters, neighbors going without health care, and ask about the subsidies.
The vast majority are relieved to learn about the health exchange. Linda Parrish, 47, showed up at the table and gushed to Diaz-Dempsey: “This is what I’ve been waiting on.” Parrish has health insurance, but her best friend doesn’t.
If people sign up through the state exchanges and get insurance believing they’ve somehow avoided the dreaded Obamacare and then don’t have to pay fines because they have insurance, they’re going to be relieved. The law will have done what it was designed to do, namely get more people covered by insurance – which is a good thing.
Our conservative peers have now spent close to five years in near hysterics about health care reform. We’ve been subjected to never ending flow of lies and a veritable ocean of disinformation. If that disinformation campaign ends up helping the law, that would be at least a little bit funny.
First of all, let’s remember where the so-called Affordable Care Act (aka “Obamacare”) came from. It was invented by the right-wing Heritage Foundation.
That was then, this is now. These days, Heritage president and former South Carolina senator Jim DeMint is on a campaign to convince Republicans to shut down the government in order to defund the Affordable Care Act. According to DeMint:
“This might be that last off-ramp to stop Obamacare before it becomes more enmeshed in our culture.” The law “is not about getting better health care,” he continued. Uninsured Americans “will get better health care just going to the emergency room.”
This was a myth when George W. Bush said it, and it’s still a myth.
The so-called “free” care at emergency rooms is a result of The Emergency Medical Treatment and Active Labor Act or (EMTALA), which requires hospitals that accept Medicare or Medicaid funding to treat patients for emergency medical conditions regardless of legal status or ability to pay. But EMTALA only applies to medical emergencies like heart attacks or serious injury. It does not offer any treatment for chronic conditions, leaving the millions of Americans with diabetes who need regular access to medication to stay alive, or asthma patients, or women diagnosed with breast cancer without access to care.
The right-wing keeps saying “just go to the emergency room,” and there is not enough push-back on that from the reality-based community.
“Elysium,” Director Neill Blomkampf’s dystopian vision of a 2154 where the poor (including Matt Damon) are condemned to live on the planet-wide shantytown on the Earth’s surface, while the rich dwell in comfort on an orbiting space station is inspiring a right-wing freakout.
Breitbart News claims the movie is chock full of decidedly 2013-era liberal propaganda on issues including illegal immigration and universal health care.
“Particularly towards the end, the political messages are just so overt, I don’t know how you can watch it without thinking of current events and connecting the dots that the director obviously intended to connect,” says Breitbart’s Christian Toto.
“It’s not just hypocritical to say this movie isn’t political, it’s hilarious,” Dan Gainor, VP of Business and Culture at the Media Research Center, told Faux News’ 411. “Filmmakers wear their politics on their sleeves, but it helps their careers to push liberal agendas.”
Roger Schlafly of Eagle Forum argues that both “Elysium” and Brad Pitt’s “World War Z” “seem to be saying that the Earth is being overrun by barbarians, and the only way to preserve a civilized society is to build walls to keep out the intruders, and to kill them when they try to invade.” He claims “Elysium” is “a warning against unrestricted immigration.” He suggests that “World War Z” has a similar message and that its zombie invasion is an allegory for immigration.
Entertainment Weekly opined, “If you are a member of the 1%, ‘Elysium’ is a horror movie. For everyone else, it’s one step shy of a call to arms.”
Sci-fi fans will tell you, good science fiction isn’t really about the future. Like Blomkampf’s first film “District 9,” “Elysium” is a reflection of the present.
UPDATE: Media Matters:
Conservatives aren’t angered by the political subtext they see in Elysium. They’re angry that it’s an accurate portrayal of the world their ideology will ultimately create — and that is a reality they cannot confront.