Enemies of the Poor
by Paul Krugman
Suddenly it’s O.K., even mandatory, for politicians with national ambitions to talk about helping the poor. This is easy for Democrats, who can go back to being the party of F.D.R. and L.B.J. It’s much more difficult for Republicans, who are having a hard time shaking their reputation for reverse Robin-Hoodism, for being the party that takes from the poor and gives to the rich.
And the reason that reputation is so hard to shake is that it’s justified. It’s not much of an exaggeration to say that right now Republicans are doing all they can to hurt the poor, and they would have inflicted vast additional harm if they had won the 2012 election. Moreover, G.O.P. harshness toward the less fortunate isn’t just a matter of spite (although that’s part of it); it’s deeply rooted in the party’s ideology, which is why recent speeches by leading Republicans declaring that they do too care about the poor have been almost completely devoid of policy specifics.
Let’s start with the recent Republican track record.
The most important current policy development in America is the rollout of the Affordable Care Act, a k a Obamacare. Most Republican-controlled states are, however, refusing to implement a key part of the act, the expansion of Medicaid, thereby denying health coverage to almost five million low-income Americans. And the amazing thing is that they’re going to great lengths to block aid to the poor even though letting the aid through would cost almost nothing; nearly all the costs of Medicaid expansion would be paid by Washington.
Heroic Measures
by Bill Keller
LISA BONCHEK ADAMS has spent the last seven years in a fierce and very public cage fight with death. Since a mammogram detected the first toxic seeds of cancer in her left breast when she was 37, she has blogged and tweetedcopiously about her contest with the advancing disease. She has tweeted through morphine haze and radiation burn. Even by contemporary standards of social-media self-disclosure, she is a phenomenon. (Last week she tweeted her 165,000th tweet.) A rapt audience of several thousand follows her unsparing narrative of mastectomy, chemotherapy, radiation, biopsies and scans, pumps and drains and catheters, grueling drug trials and grim side effects, along with her posts on how to tell the children, potshots at the breast cancer lobby, poetry and resolute calls to “persevere.”
In the last month or two, her broadcasts have changed tone slightly; her optimism has become a little less unassailable. As 2013 ended, the cancer that had colonized her lymph nodes, liver, lungs and bones had established a beachhead in her spine, the pathway to her (so far tumor-free) brain. She was deemed too sick to qualify for the latest drug trial. She is bedridden at New York’s Memorial Sloan-Kettering Cancer Center, which has embraced her as a research subject and proselytizer for the institution.
Lisa Adams is still alive, still blogging, and insists she is not dying, but the blog has become less about prolonging her survival and more about managing her excruciating pain. Her poetry has become darker.
“The words of disease become words my brain gravitates to,” she pecked the other day after a blast of radiation. “The ebb and flow of cancer, Of life. And so too, Inevitably, Of death.”
In October 2012 I wrote about my father-in-law’s death from cancer in a British hospital. There, more routinely than in the United States, patients are offered the option of being unplugged from everything except pain killers and allowed to slip peacefully from life. His death seemed to me a humane and honorable alternative to the frantic medical trench warfare that often makes an expensive misery of death in America.
The Left after The Failure of Obamacare
By Shamus CookeJanuary 06, 2014 "Information Clearing House - It’s satisfying to watch rats flee a sinking ship. This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end. A collective sense of relief is a natural response.
By Shamus CookeJanuary 06, 2014 "Information Clearing House - It’s satisfying to watch rats flee a sinking ship. This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end. A collective sense of relief is a natural response.
The rats who propped up the broken boat of Obamacare are a collection of liberal and labor groups who frittered away their group’s resources—and integrity— to sell a crappy product to the American people.
Those in the deepest denial went “all in” for Obamacare— such as some unions and groups like Moveon.org— while the more conniving groups and individuals—like Michael Moore— playacted “critical” of Obamacare, while nevertheless declaring it “progressive”, in effect adding crucial political support to a project that deserved none.
But of course Obamacare was always more barrier than progress: we’ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction— into the pockets of the insurance mega corporations. A couple of progressive patches on the sails won’t keep her afloat. It’s shipbuilding time.
It was painful to watch otherwise intelligent people lend support to something that’s such an obviously bad idea. So it’s with immense relief that liberals like Michael Moore, labor groups, and others are finally distancing themselves from Obamacare’s Titanic failure. Now these individuals and groups can stop living in denial and the rest of us can proceed towards a rational discussion about a real health care solution.
The inevitable failure of Obamacare is not due to a bad website, but deeper issues. The hammering of the nails in the coffin has begun: millions of young people are suddenly realizing that Obamacare does not offer affordable health care. It’s a lie, and they aren’t buying it, literally.
The system depends on sufficient young people to opt in and purchase plans, in order to offset the costs of the older, higher-needs population. Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.
Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance”. Many of the cheapest plans—the obvious choice for most young people— have $5,000 deductibles before the insurance will pay for anything. For poor young people this is no insurance at all, but a form of extortion.
At the same time millions of union members are being punished under Obamacare: those with decent insurance plans will suffer the “Cadillac” tax, which will push up the cost of their healthcare plans, and employers are already demanding concessions from union members in the form of higher health care premiums, co-pays, deductibles, etc.
Lower paid union workers will suffer as well. Those who are part of the Taft Hartley insurance plans will be pressured to leave the plans and buy their own insurance, since they cannot keep their plans and get the subsidy that the lowest income workers get. This has the potential to bust the whole Taft Hartley health care system that millions of union members benefit from, which is one of the reasons that labor leaders suddenly became outraged at Obamacare, after having wasted millions of union member’s dollars propping it up.
Ultimately, the American working class will collectively cheer Obamacare’s demise. They just need labor and other lefties to cheer lead its destruction a little more fiercely.
Changing the structure of health care delivery systems: to benefit the patient, the providers, or the insurers?
By Joshua Freeman, M.D.
Medicine and Social Justice blog, Jan. 12, 2014
Medicine and Social Justice blog, Jan. 12, 2014
In an important series of three articles beginning on the Sunday before the New Year, “Doctors Inc.”, Alan Bavley of the Kansas City Star looked at the increasing acquisition of physician practices by hospitals, and the impact this has on access to, quality of, and cost of health care for patients. The first article, “Medicine goes corporate as more physicians join hospital payrolls,” describes the “what,” that:
“Since 2000, the number of doctors on hospital payrolls nationwide has risen by one-third, according to the American Hospital Association. In the Kansas City area, fully 55 percent of physicians are now employed by hospitals, Blue Cross and Blue Shield of Kansas City estimates. That includes virtually all cardiologists and most cancer specialists.”
These changes are not limited to the KC area; he cites both national data and that from disparate regions such as Spartanburg, SC, and Phoenix, AZ. Part of the reason, the "financial model", which is described in this first article, is that such “integrated” practices generate internal referrals, keeping patients within the system, as well as generating lucrative procedures. Physicians get a piece of the action; they get guaranteed salaries paid in part by the hospital or health system which is getting downstream revenue for their referrals.
And it makes these hospitals and health systems a lot of money, because they can now charge a lot more money. Bavley quotes “Robert Zirkelbach, vice president of America’s Health Insurance Plans, the industry’s trade association. ‘When a hospital buys a practice, its rates will increase in the following year’s contract. Increases of 20, 30 or 40 percent are not uncommon. It’s not 3 or 4 percent, that is for sure.’”
It is also not always good for patients, as Bavley illustrates with examples of people who were referred internally and had delayed diagnosis. (One story discusses a woman discouraged from going to the academic medical center at which I work – full disclosure – for a second opinion regarding her lung cancer; the "reasons" given were both that she “didn’t have time”, and because she would see “young doctors still in training”.) Sometimes it is fine to see doctors within the system, and certainly this can be, and is, encouraged, but discouraging people from seeking outside referrals can also be hazardous to their health.
The Affordable Care Act (ACA) encourages the creation of “Accountable Care Organizations” (ACOs), which would be responsible (at least hopefully, in the best of scenarios) for the health of a population. At a minimum, they would seek to decrease the degree to which the delivery of health care is a series of episodic events paid for individually, instead taking on a global responsibility including inpatient, outpatient, and long-term care. This would, in theory, change the usual patient experience from seeing one (or many) doctors or having one (or many) ER visits, each charged and paid separately, culminating in a hospitalization, and then discharge to one (or many) doctors, or a long-term care facility (paid separately), and failure of care resulting in readmission to the hospital (paid again). The idea is that all levels would be coordinated to provide the best care at the most appropriate (inpatient, outpatient, long-term, home based) level. In some settings, particularly for fully-integrated plans (where the providers of care are also the insurers) such as Kaiser, this works relatively well.
Medicare for all a poverty solution
By James Besante
Albuquerque Journal, Jan. 12, 2014
Albuquerque Journal, Jan. 12, 2014
Fifty years ago on Jan. 11, President Lyndon B. Johnson declared a “War on Poverty” on behalf of the “many Americans [who lived] on the outskirts of hope.”
His vision embraced an unprecedented expansion of health insurance coverage, which Congress achieved by enacting Medicare and Medicaid the following year.
In the case of Medicare, millions of Americans age 65 and older were given access to health care overnight. The new law went far beyond insuring the uninsured elderly; it reduced poverty by lifting crushing medical debt from the shoulders of America’s seniors and their families.
In the years that followed, Medicare continued to dramatically reduce poverty among the elderly. The scope of benefits expanded, and the health of America’s seniors improved, regardless of race or income.
Congress eventually extended Medicare coverage to the severely disabled, and today the program covers approximately 51 million Americans.
As a third-year medical student, every day I take part in the care of New Mexicans who live on the “outskirts of hope”: An uninsured mother with cervical cancer. An asthmatic who cannot afford his medication.
Their stories and suffering are real. My patients are the victims of physical and financial hardships. They are among the Americans for whom Johnson waged his unfinished war.
On this anniversary, I look back at Johnson’s 50-year-war and propose a simple remedy to address the persistent problem of unequal health care access, a solution supported by the majority of American physicians: a single-payer national health care system, or better known as “Improved Medicare For All.”
But wait. Some critics claim Medicare is “broken,” that it’s “bleeding the American economy.”
It is true the American health care system is hemorrhaging money.
But Medicare, with overhead costs of 2 percent, operates far more efficiently than any private health insurance plan, with overhead costs of anywhere from 15 percent to 25 percent.
The private insurance middlemen are the ones raising the costs of the system, without adding value.
Despite this fact, “free-market” advocates push for further privatization by corporate insurers whose primary goal is to maximize profits for their stockholders by raising premiums, restricting services and denying claims
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