Imaginary Health Care Horrors
by Paul Krugman
There’s a lot of fuzzy math in American politics, but Representative Pete Sessions of Texas, the chairman of the House Rules Committee, recently set a new standard when he declared the cost of Obamacare “unconscionable.” If you do “simple multiplication,” he insisted, you find that the coverage expansion is costing $5 million per recipient. But his calculation was a bit off — namely, by a factor of more than a thousand. The actual cost per newly insured American is about $4,000.
Now, everyone makes mistakes. But this wasn’t a forgivable error. Whatever your overall view of the Affordable Care Act, one indisputable fact is that it’s costing taxpayers much less than expected — about 20 percent less, according to the Congressional Budget Office. A senior member of Congress should know that, and he certainly has no business making speeches about an issue if he won’t bother to read budget office reports.
But that is, of course, how it’s been all along with Obamacare. Before the law went into effect, opponents predicted disaster on all levels. What has happened instead is that the law is working pretty well. So how have the prophets of disaster responded? By pretending that the bad things they said would happen have, in fact, happened.
Costs aren’t the only area where enemies of reform prefer to talk about imaginary disasters rather than real success stories. Remember, Obamacare was also supposed to be a huge job-killer. In 2011, the House even passed a bill called the Repealing the Job-Killing Health Care Law Act. Health reform, opponents declared, would cripple the economy and in particular cause businesses to force their employees into part-time work.
Well, Obamacare went into effect fully at the beginning of 2014 — and private-sector job growth actually accelerated, to a pace we haven’t seen since the Clinton years. Meanwhile, involuntary part-time employment — the number of workers who want full-time work but can’t get it — has dropped sharply. But the usual suspects talk as if their dire predictions came true. Obamacare, Jeb Bush declared a few weeks ago, is “the greatest job suppressor in the so-called recovery.”
Finally, there’s the never-ending hunt for snarks and boojums — for ordinary, hard-working Americans who have suffered hardship thanks to health reform. As we’ve just seen, Obamacare opponents by and large don’t do math (and they’re sorry when they try). But all they really need are a few sob stories, tales of sympathetic individuals who have been impoverished by some aspect of the law.
Remarkably, however, they haven’t been able to find those stories. Early last year, Americans for Prosperity, a Koch brothers-backed group, ran a series of ads featuring alleged Obamacare victims — but not one of those tales of woe stood up to scrutiny. More recently, Representative Cathy McMorris Rodgers of Washington State took to Facebook to ask for Obamacare horror stories. What she got instead was a torrent of testimonials from people whose lives have been improved, and in some cases saved, by health reform.
Steven Keating’s doctors and medical experts view him as a citizen of the future.
A scan of his brain eight years ago revealed a slight abnormality — nothing to worry about, he was told, but worth monitoring. And monitor he did, reading and studying about brain structure, function and wayward cells, and obtaining a follow-up scan in 2010, which showed no trouble.
But he knew from his research that his abnormality was near the brain’s olfactory center. So when he started smelling whiffs of vinegar last summer, he suspected they might be “smell seizures.”
He pushed doctors to conduct an M.R.I., and three weeks later, surgeons in Boston removed a cancerous tumor the size of a tennis ball from his brain.
At every stage, Mr. Keating, a 26-year-old doctoral student at the Massachusetts Institute of Technology’s Media Lab, has pushed and prodded to get his medical information, collecting an estimated 70 gigabytes of his own patient data by now. His case points to what medical experts say could be gained if patients had full and easier access to their medical information. Better-informed patients, they say, are more likely to take better care of themselves, comply with prescription drug regimens and even detect early-warning signals of illness, as Mr. Keating did.
Pay for Performance Extends to Health Care in New York State Experiment
For a generation, doctors in New York City’s economically depressed neighborhoods have been the ugly ducklings of the medical hierarchy. Many are foreign born and foreign trained, serve mostly minority and immigrant patients, and often run high-volume practices to compensate for Medicaid’s low rate of payment.
Now these doctors are in the vanguard of an experiment to transform New York State’s health care services for the poor from a disorganized hodgepodge into coordinated networks of doctors, hospitals and other practitioners.
Medicaid officials hope to inspire these providers to work together and take a more active role in looking after their patients’ health, rather than simply waiting for them to show up when ill. The hope is that if they can do a better job of getting patients to, for example, quit smoking or manage their diabetes, doctors could reduce costly visits to hospitals and their emergency rooms.
Versions of this model, commonly called accountable care organizations, are appearing around the country for Medicare recipients, with mixed results. New York, which has the country’s largest Medicaid budget, is committing more than $1 billion a year for five years to the experiment. If it works, more could follow.
THE NEW HEALTH CARE
Red Meat Is Not the Enemy
Aaron E. Carroll
There are people in this country eating too much red meat. They should cut back. There are people eating too many carbs. They should cut back on those. There are also people eating too much fat, and the same advice applies to them, too.
What’s getting harder to justify, though, is a focus on any one nutrient as a culprit for everyone.
I’ve written Upshot articles on how the strong warnings against salt and cholesterol are not well supported by evidence. But it’s possible that no food has been attacked as widely or as loudly in the past few decades as red meat.
As with other bad guys in the food wars, the warnings against red meat are louder and more forceful than they need to be.
Americans are more overweight and obese than they pretty much have ever been. There’s also no question that we are eating more meat than in previous eras. But we’ve actually been reducing our red meat consumption for the last decade or so. This hasn’t resulted in a huge decrease in obesity rates or deaths from cardiovascular disease.
The same reports also show that we eat significantly more fruits and vegetables today than we did decades ago. We also eat more grains and sweeteners.
This is the real problem: We eat more calories than we need. But in much of our discussion about diet, we seek a singular nutritional guilty party. We also tend to cast everyone in the same light as “eating too much.”
I have seen many people point to a study from last year that found that increased protein intake was associated with large increases in mortality rates from all diseases, with high increases in the chance of death from cancer or diabetes. A close examination of the manuscript, though, tells a different story.
This was a cohort study of people followed through the National Health and Nutrition Examination Survey, or Nhanes. It found that there were no associations between protein consumption and death from all causes or cardiovascular disease or cancer individually when all participants over age 50 were considered. It did detect a statistically significant association between the consumption of protein and diabetes mortality, but the researchers cautioned that the number of people in the analysis was so small that any results should be taken with caution.
The same reports also show that we eat significantly more fruits and vegetables today than we did decades ago. We also eat more grains and sweeteners.
This is the real problem: We eat more calories than we need. But in much of our discussion about diet, we seek a singular nutritional guilty party. We also tend to cast everyone in the same light as “eating too much.”
I have seen many people point to a study from last year that found that increased protein intake was associated with large increases in mortality rates from all diseases, with high increases in the chance of death from cancer or diabetes. A close examination of the manuscript, though, tells a different story.
This was a cohort study of people followed through the National Health and Nutrition Examination Survey, or Nhanes. It found that there were no associations between protein consumption and death from all causes or cardiovascular disease or cancer individually when all participants over age 50 were considered. It did detect a statistically significant association between the consumption of protein and diabetes mortality, but the researchers cautioned that the number of people in the analysis was so small that any results should be taken with caution.
Always farmer was Rocks no one challenging them .........!!!!
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