Examining Who Runs the United States
A former C.I.A. officer with experience in Turkey wrote a provocative essay this summer about the “deep state.” The phrase refers to a parallel “secret government” embedded in the military and intelligence services, whose purpose is to provide a check on electoral democracy.
But Turkey wasn’t the target of the essay, written by Philip Giraldi. He was aiming, as his headline declared, at “Deep State America.”
Mr. Giraldi, executive director of the Council for the National Interest, a foreign-policy advocacy group in Washington, called the American deep state of today an “unelected, unappointed, and unaccountable presence within the system that actually manages what is taking place behind the scenes.”
In contrast to Turkey, where Mr. Giraldi said a covert “deep state” had taken root in the security realm, the American deep state of his description consists of visible people like the Clintons and the former C.I.A. director David H. Petraeus, concentrated around New York and Washington, who live at the fertile nexus of government and corporate power: Capitol Hill aides and legislators who cash in as lobbyists; former politicians who earn millions speaking to banks, or landing sinecures with them; technocrats who ricochet between Goldman Sachs and the Treasury Department; billionaire kingmakers dangling political donations; thinkers whose tanks are financed by corporations with a financial stake in their research.
Now if this sounds like the rant of a lefty conspiracy theorist, consider the article’s home: a magazine called The American Conservative, a contrarian thorn in the side of the establishment right.
The “deep state” metaphor seems to be ascendant as a way to explain present American realities. The writer Peter Dale Scott, professor emeritus of English at the University of California, Berkeley, last year published a similarly minded book called“The American Deep State,”which emphasized the role of security contractors, oil companies and financial firms. Meanwhile, Mike Lofgren, a Republican who spent 28 years as a congressional aide before quitting in 2011, has used “deep state” to describe a subterranean cross-party consensus on issues like “financialization, outsourcing, privatization” — a consensus, Mr. Lofgren has written, from which the public is distracted by above-ground debates over “diversionary social issues such as abortion or gay marriage.”
A former C.I.A. officer with experience in Turkey wrote a provocative essay this summer about the “deep state.” The phrase refers to a parallel “secret government” embedded in the military and intelligence services, whose purpose is to provide a check on electoral democracy.
But Turkey wasn’t the target of the essay, written by Philip Giraldi. He was aiming, as his headline declared, at “Deep State America.”
Mr. Giraldi, executive director of the Council for the National Interest, a foreign-policy advocacy group in Washington, called the American deep state of today an “unelected, unappointed, and unaccountable presence within the system that actually manages what is taking place behind the scenes.”
In contrast to Turkey, where Mr. Giraldi said a covert “deep state” had taken root in the security realm, the American deep state of his description consists of visible people like the Clintons and the former C.I.A. director David H. Petraeus, concentrated around New York and Washington, who live at the fertile nexus of government and corporate power: Capitol Hill aides and legislators who cash in as lobbyists; former politicians who earn millions speaking to banks, or landing sinecures with them; technocrats who ricochet between Goldman Sachs and the Treasury Department; billionaire kingmakers dangling political donations; thinkers whose tanks are financed by corporations with a financial stake in their research.
Now if this sounds like the rant of a lefty conspiracy theorist, consider the article’s home: a magazine called The American Conservative, a contrarian thorn in the side of the establishment right.
The “deep state” metaphor seems to be ascendant as a way to explain present American realities. The writer Peter Dale Scott, professor emeritus of English at the University of California, Berkeley, last year published a similarly minded book called“The American Deep State,”which emphasized the role of security contractors, oil companies and financial firms. Meanwhile, Mike Lofgren, a Republican who spent 28 years as a congressional aide before quitting in 2011, has used “deep state” to describe a subterranean cross-party consensus on issues like “financialization, outsourcing, privatization” — a consensus, Mr. Lofgren has written, from which the public is distracted by above-ground debates over “diversionary social issues such as abortion or gay marriage.”
No, Bernie Sanders is not going to bankrupt America to the tune of $18 trillion
The big policy headline today comes from the Wall Street Journal, which delivers this alarming message:
Price Tag of Bernie Sanders’ Proposals: $18 Trillion
Holy cow! He must be advocating for some crazy stuff that will bankrupt America! But is that really an accurate picture of what Sanders is proposing? And is this the kind of number we should be frightened of?
The answer isn’t quite so dramatic: while Sanders does want to spend significant amounts of money, almost all of it is on things we’re already paying for; he just wants to change how we pay for them. In some ways it’s by spreading out a cost currently borne by a limited number of people to all taxpayers. His plan for free public college would do this: right now, it’s paid for by students and their families, while under Sanders’ plan we’d all pay for it in the same way we all pay for parks or the military or food safety.
But the bulk of what Sanders wants to do is in the first category: to have us pay through taxes for things we’re already paying for in other ways. Depending on your perspective on government, you may think that’s a bad idea. But we shouldn’t treat his proposals as though they’re going to cost us $18 trillion on top of what we’re already paying.
And there’s another problem with that scary $18 trillion figure, which is what the Journal says is the 10-year cost of Sanders’ ideas: fully $15 trillion of it comes not from an analysis of anything Sanders has proposed, but from the fact that Sanders has said he’d like to see a single-payer health insurance system, and there’s a single-payer plan in Congress that has been estimated to cost $15 trillion. Sanders hasn’t actually released any health care plan, so we have no idea what his might cost.
But health care is nevertheless a good place to examine why these big numbers can be so misleading. At the moment, total health care spending in the United States runs over $3 trillion a year; according to the Centers for Medicare and Medicaid Services, over the next decade (from 2015-2024), America will spend a total of $42 trillion on health care. This is money that you and I and everyone else spends. We spend it in a variety of ways: through our health-insurance premiums, through the reduced salaries we get if our employers pick up part or all of the cost of those premiums, through our co-pays and deductibles, and through our taxes that fund Medicare, Medicaid, ACA subsidies, and the VA health care system. We’re already paying about $10,000 a year per capita for health care.
So let’s say that Bernie Sanders became president and passed a single-payer health care system of some sort. And let’s say that it did indeed cost $15 trillion over 10 years. Would that be $15 trillion in new money we’d be spending? No, it would be money that we’re already spending on health care, but now it would go through government. If I told you I could cut your health insurance premiums by $1,000 and increase your taxes by $1,000, you wouldn’t have lost $1,000. You’d be in the same place you are now.
By the logic of the scary $18 trillion number, you could take a candidate who has proposed nothing on health care, and say, “So-and-so proposes spending $42 trillion on health care!” It would be accurate, but not particularly informative.
There’s something else to keep in mind: every single-payer system in the world, and there are many of them of varying flavors, is cheaper than the American health care system. Every single one. So whatever you might say about Sanders’ advocacy for a single-payer system, you can’t say it represents some kind of profligate, free-spending idea that would cost us all terrible amounts of money.
Since Sanders hasn’t released a health care plan yet, we can’t make any assessment of the true cost of his plan, because there is no plan. Maybe what he wants to do would cost more than $15 trillion, or maybe it would cost less. But given the experience of the rest of the world, there’s a strong likelihood that over the long run, a single-payer plan would save America money. Again, you may think single-payer is a bad idea for any number of reasons, but “It’ll be too expensive!” is probably the least valid objection you could make.
Health insurance costs keep rising. And this year, the biggest cause was prescription drug prices
Health insurance costs keep rising. And this year, the biggest cause was prescription drug prices
The actuarial service firm Milliman recently released the its 2015 Medical Index, which tracks the hypothetical costs of a family of four with health insurance coverage through an average employer-sponsored preferred provider organization.
Initiated in 2001, this index is unique in that it measures the collective costs of healthcare benefits instead of focusing on just an employer’s share or the premiums.
To no great surprise, the MMI index rose in 2015, reaching $24,671, compared to $23,215 in 2014 and $22,030 in 2013. The 5.4 percent cost increase in 2014 was the smallest in the history of the MMI, but 2015 represents a larger percentage increase (6.3 percent). Since the initial reading in 2001, the MMI index has shown an almost tripling of costs.
This year, prescription drug costs are leading the charge. Pharmaceutical costs grew by 13.6 percent over the previous year, considerably higher than the 6.8 percent average growth over the last five years.
Thanks to this increase, 15.9 percent of the total healthcare spending for the hypothetical family of four is now taken up by prescription drug costs.
All costs are increasing, but the employee’s portion of the cost is increasing at a higher rate. Defined as the total of payroll deduction and out-of-pocket costs, over the last five years, the employee’s cost burden has increased by almost 43 percent compared to 32 percent for employer’s costs. For 2015, employer contributions covered 58 percent of the costs ($14,198) while employee costs of $10,473 were split between $6,408 in employee contributions (26 percent of the total) and $4,065 in out-of-pocket costs (16 percent of the total).
Broken down into the components of spending, the largest components are inpatient facility care and professional services (physicians and other support personnel). Both take up 31 percent of the cost. Outpatient care takes up 19 percent of the costs; pharmacy charges are 16 percent of the costs; and the remaining 9 percent covers miscellaneous costs — things such as medical equipment, home health care, and ambulance transport.
With Jeremy Corbyn Elected as New Leader, Britain’s Labour Party Takes a Hard Left Turn
LONDON - Britain’s opposition Labour Party on Saturday took a remarkable leftward turn, electing as its leader Jeremy Corbyn, a longtime socialist committed to nationalizing key industries, scrapping Britain’s nuclear missile system and reversing the centrist policies of previous leaders such as Tony Blair.
The result of the contest, announced on Saturday morning in London, gave stewardship of the Labour party to the hard left for the first time in more than three decades, a development seen here as one of the most surprising upsets in modern British politics.
As Europe continues to feel the aftershocks of the financial crisis of 2008, voters have been increasingly attracted to the political extremes, with support growing both for socialist parties on the left and nationalist ones on the right. The Labour leadership result could now shift the main opposition party in Britain closer to the types of positions taken by other leftist parties that have become prominent across Europe, including Syriza in Greece and Podemos in Spain.
Mr. Corbyn, 66, has been a lawmaker for more than three decades but never served in government, preferring to campaign, often for unfashionable causes, and frequently rebelling against the party line.
He only made it into the contest at the last minute, gaining the 35 nominations he needed from fellow lawmakers, thanks to the support of some colleagues who did not support him but thought he should take part.
Yet his program, which includes nationalizing energy and rail companies, printing money to boost the economy and scrapping Britain’s Trident nuclear missile system, has struck a chord with many activists and new, often young supporters.
Crucially, he took advantage of a rule change that allowed candidates to recruit sympathizers who, for a small fee, could sign up as registered supporters of the Labour Party and gain a vote in the contest.
Much like Senator Bernie Sanders, the Vermont independent who has ignited liberal passions in the race for the Democratic presidential nomination in the United States, Mr. Corbyn is promising radical approaches to longstanding problems.
How to get health insurance when you’re ineligible for both Medicaid and premium assistance in the state exchange
September 11, 2015
by Diane Archer
Because the Supreme Court gave states the option of expanding Medicaid, it has forced about four million people today into an insurance no man’s land. These four million people live in states that have still chosen not to expand Medicaid. They have incomes too high to qualify for Medicaid and too low to qualify for a subsidy in their state exchanges. The federal government does not subsidize premiums of people who earn less than the federal poverty level in the state exchanges.
The twenty states that have not expanded Medicaid to date have made it very hard for people caught in this “coverage gap.” Medicaid can be a life-saving benefit. And, unless people in this coverage gap move to a state that has expanded Medicaid, they are ineligible for it. Today, more than half a million people cannot get needed mental health care because they live in states that have not expanded Medicaid.
If they stay put, to get health insurance, people in states that have not expanded Medicaid have no choice but to take on more work. That can mean working two full-time jobs. But, according to the Kaiser Family Foundation, more than half of people caught in this gap have full-time or part-time jobs already and 86 percent of them live in the south.
In Texas, to qualify for Medicaid, your income must be less than 20 percent of the federal poverty level. Only if people can raise their income above 100 percent of the federal poverty level will the federal government pick up a large percentage of their insurance premium through the exchange.
‘Value-based’ payment a threat to Hawaii health care
By Stephen B. Kemble, M.D.
Honolulu Star-Advertiser, Sept. 6, 2015
Honolulu Star-Advertiser, Sept. 6, 2015
The architects of the federal Affordable Care Act (ACA) blamed high U.S. health costs on excessive and unnecessary care.
We are told, “fee-for-service drives volume” and new payment models will pay for “value, not volume.”
This rationale is flat-out false in Hawaii.
Thanks to our Prepaid Health Care Act, we had the most cost-effective health care system in the country, with broad risk pooling, comprehensive benefits, no deductibles and low co-pays, and relying largely on small independent physician practices paid with fee-for-service.
Prior to the ACA, we had the best benefits, the lowest per-capita Medicare spending, and among the lowest health insurance premiums in the country.
Believing it to be the root of the problem, the Centers for Medicare and Medicaid Services (CMS) is pushing to replace fee-for-service with “value-based payment.” Doctors and hospitals are to be paid “up-front,” with bundled payment for an episode of care or prepaid care for an insured population.
Unlike with fee-for- service, the incentive under “up front” payment is to minimize “volume” of services.
To counter the perverse incentive to minimize necessary care, the ACA demands that physicians computerize and provide detailed documentation to measure and reward “quality.”
“Value-based payment” also creates a perverse incentive to avoid poorer, sicker, more complex patients whose care would likely cost more and might bring down quality metrics.
The ACA provides for risk adjustment, transferring money from plans with healthier to those with sicker populations, but this, too, requires detailed data from doctors on diagnosis and severity of illness.
Risk adjustment formulas are complex and easily gamed, and we are already seeing extensive “up-coding” of diagnoses by doctors, hospitals and health plans to maximize payment.
Regulators Need to Scrutinize Health Insurance Mergers
Two proposed mergers involving four of the nation’s biggest health insurers could reduce competition in an important industry. That’s why federal and state regulators need to closely study these deals and, if necessary, force the companies to sell some parts of their businesses.
Earlier this summer, Anthem agreed to acquire Cigna for $48 billion, and Aetna announced a $37 billion takeover of Humana. The antitrust division of the Justice Department and state governments are reviewing the deals. If regulators approve both transactions, the number of big national health insurers would drop from five to three.
The companies say that being bigger will give them the ability to negotiate lower prices with hospitals, physicians and drug makers and make health care more efficient. Not surprisingly, trade associations representing doctors and hospitals are not thrilled by that idea. They say these mergers will not only hurt them, but will hit consumers with higher premiums and other costs.
There is no doubt that insurers are trying to grow to get more leverage in negotiations with health care providers that have themselves become bigger in recent years. Many hospitals have bought up other hospitals and physician practices. That earlier wave of mergers among health care providers led to higher medical costs in many parts of the country. Regulators and courts should never have approved some of those deals.
The Affordable Care Act, the health reform law, wisely requires insurers to spend at least 80 percent of premium revenue on medical care. But that rule would not prevent them from charging higher premiums as they face less competition. There is no guarantee that insurers will fully pass on the lower prices they negotiate with doctors and hospitals to consumers, experts say.
Because the health insurance industry is fragmented, these mergers will not have the same impact across the country. In some metropolitan areas and in the market for certain kinds of insurance, like Medicare Advantage plans, some consumers will no doubt have fewer choices. But in places where the merging companies do not compete with each other, there will be little or no change. Antitrust regulators have to do a detailed geographic and product-by-product analysis for each deal and for both mergers taken together.
One Symptom in New Medical Codes: Doctor Anxiety
By ROBERT PEAR
SEPTEMBER 13, 2015
TERRE HAUTE, Ind. — The nation’s health care providers are under orders to start using a new system of medical codes to describe illnesses and injuries in more detail than ever before. The codes will cover common ailments: Did a diabetic also have kidney disease? But also included are some that are far less common: whether the patient was crushed by a crocodile or sucked into a jet engine.
The more than 100,000 new codes, which will take effect on Oct. 1, have potential benefits, as they will require doctors to make a deeper assessment of many patients.
But the change is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly. Some doctors and hospitals are already obtaining lines of credit because they fear that the transition to the new system will cause cash-flow problems.
“It’s a sea change for physicians,” said Dr. Pardeep Kumar, a 46-year-old internist here who is counting down to Oct. 1. “We will have to be very much more specific.”
Under the new coding regime, government programs and private insurers will require doctors, hospitals, clinics and nursing homes to report vastly more information about the care they provide. Dr. Kumar, who is in practice with his wife, and physicians across America will try to answer questions like these:
Did a diabetic also have kidney disease, eye problems or nerve damage? Did a patient with high blood pressurealso have signs of congestive heart failure? Was that broken finger on the left or right hand? Was the fracturein the top, bottom or middle of the finger?
Was the patient bitten by a horse, a snake or a shark? Pecked by a turkey? Crushed by a crocodile? (Code W58.13.) Or sucked into a jet engine? (Code V97.33.)
The new catalog of codes includes more than 100 for goutand more than 200 for diabetes. In a sign of the times, the government lists more than 30 codes for injuries caused by acts of terrorism.
The codes, from the 10th revision of the International Classification of Diseases, or ICD-10, have significant implications for patients. For example, Dr. Kumar said, doctors may need to perform additional tests to help determine if a patient with high blood pressure has heart failure.
ICD-10 includes 68,000 diagnostic codes, compared with 14,000 in the current compendium. The number of codes for inpatient hospital procedures will expand to 87,000, from 4,000.
What I Learned While Wearing a Heart Monitor
AT REST, I COULD FEEL MY HEART POUNDING OUT A DOUBLE BEAT. IT FELT LIKE FALLING IN LOVE, ONLY I WASN’T.
MY CARDIOLOGIST EXPLAINED THAT ONE OF MY HEART’S LOWER CHAMBERS — A VENTRICLE — SOMETIMES PUMPED WHEN IT SHOULDN’T, CAUSING A SENSATION OF AN OVERLY STRONG DOUBLE BEAT. “I’M 99.9 PERCENT CERTAIN IT’S BENIGN,” HE SAID.
CONFIDENT IN HIS DIAGNOSIS, MY DOCTOR ADVISED AGAINST FURTHER TESTS AND VISITS. I THUS AVOIDED THE UNEASE I ALWAYS HAVE ABOUT MEDICAL TESTS. AS A HEALTH ECONOMIST, I KNOW THAT MANY AREN’T NECESSARY. AS A PATIENT, I’M NOT CONFIDENT I KNOW WHICH ONES.
AS MY PALPITATIONS PERSISTED, SO TOO DID MY CONCERN. BY NOT ORDERING ADDITIONAL TESTING AND FOLLOW-UP, WAS MY DOCTOR USING HEALTH CARE RESOURCES WISELY OR TOO WISELY? WAS I THE PATIENT FOR WHOM ADDITIONAL TESTS WOULD BE BENEFICIAL OR WASTEFUL?
THE HEALTH ECONOMISTS AMITABH CHANDRA AND JONATHAN SKINNER TELL A CAUTIONARY TALE ABOUT MEDICAL TECHNOLOGIES LIKE ADVANCED IMAGING AND TESTING. SOME ARE VALUABLE FOR SOME PEOPLE BUT ARE USED IN A GREAT MANY MORE FOR WHOM IT IS WASTEFUL. WHEN APPLIED TO THE POPULATION WITH THE RIGHT RISK FACTORS, VARIOUS TESTS OF THE HEART CAN SAVE LIVES. WHEN APPLIED TO A POPULATION AT VERY LOW RISK, A GREAT DEAL OF IT DOES LITTLE BUT ADD TO OUR HEALTH CARE BILL, WASTE PATIENTS’ TIME AND LEAD TO UNNECESSARY PROCEDURES, WHICH CARRY THEIR OWN RISKS.
AFTER THE EXCHANGE OF A FEW EMAILS, MY DOCTOR ORDERED AN AT-HOME, 30-DAY HEART MONITOR. IT’S A MARVEL OF MODERN TECHNOLOGY. ELECTRODES ON MY CHEST FED MY HEART’S RHYTHM, OVER WIRES, TO A RECORDER ON MY BELT, WHICH WIRELESSLY COMMUNICATED THE DATA TO MY PHYSICIAN. WITH ONBOARD SOFTWARE, IT CONTINUOUSLY MONITORED FOR SIGNS OF A HEART ATTACK.
AT REST, I COULD FEEL MY HEART POUNDING OUT A DOUBLE BEAT. IT FELT LIKE FALLING IN LOVE, ONLY I WASN’T.
MY CARDIOLOGIST EXPLAINED THAT ONE OF MY HEART’S LOWER CHAMBERS — A VENTRICLE — SOMETIMES PUMPED WHEN IT SHOULDN’T, CAUSING A SENSATION OF AN OVERLY STRONG DOUBLE BEAT. “I’M 99.9 PERCENT CERTAIN IT’S BENIGN,” HE SAID.
CONFIDENT IN HIS DIAGNOSIS, MY DOCTOR ADVISED AGAINST FURTHER TESTS AND VISITS. I THUS AVOIDED THE UNEASE I ALWAYS HAVE ABOUT MEDICAL TESTS. AS A HEALTH ECONOMIST, I KNOW THAT MANY AREN’T NECESSARY. AS A PATIENT, I’M NOT CONFIDENT I KNOW WHICH ONES.
AS MY PALPITATIONS PERSISTED, SO TOO DID MY CONCERN. BY NOT ORDERING ADDITIONAL TESTING AND FOLLOW-UP, WAS MY DOCTOR USING HEALTH CARE RESOURCES WISELY OR TOO WISELY? WAS I THE PATIENT FOR WHOM ADDITIONAL TESTS WOULD BE BENEFICIAL OR WASTEFUL?
THE HEALTH ECONOMISTS AMITABH CHANDRA AND JONATHAN SKINNER TELL A CAUTIONARY TALE ABOUT MEDICAL TECHNOLOGIES LIKE ADVANCED IMAGING AND TESTING. SOME ARE VALUABLE FOR SOME PEOPLE BUT ARE USED IN A GREAT MANY MORE FOR WHOM IT IS WASTEFUL. WHEN APPLIED TO THE POPULATION WITH THE RIGHT RISK FACTORS, VARIOUS TESTS OF THE HEART CAN SAVE LIVES. WHEN APPLIED TO A POPULATION AT VERY LOW RISK, A GREAT DEAL OF IT DOES LITTLE BUT ADD TO OUR HEALTH CARE BILL, WASTE PATIENTS’ TIME AND LEAD TO UNNECESSARY PROCEDURES, WHICH CARRY THEIR OWN RISKS.
AFTER THE EXCHANGE OF A FEW EMAILS, MY DOCTOR ORDERED AN AT-HOME, 30-DAY HEART MONITOR. IT’S A MARVEL OF MODERN TECHNOLOGY. ELECTRODES ON MY CHEST FED MY HEART’S RHYTHM, OVER WIRES, TO A RECORDER ON MY BELT, WHICH WIRELESSLY COMMUNICATED THE DATA TO MY PHYSICIAN. WITH ONBOARD SOFTWARE, IT CONTINUOUSLY MONITORED FOR SIGNS OF A HEART ATTACK.
Chronic Kidney Disease Can Be Dubious Diagnosis
Is it really possible that half of the population older than 70 has chronic kidney disease?
International guidelines adopted in 2012 make it seem that way. They define the disease in terms of how efficiently kidneys filter the waste from our blood, a measure called the glomerular filtration rate. Healthy young people commonly have G.F.R.s of about 120. A G.F.R. lower than 60 or another marker of kidney damage (such as protein in the urine) for more than three months means chronic kidney disease.
At which point, patients become scared. “When you’re told you have a disease, that’s a bad day,” said Dr. Ann O’Hare, a nephrologist at the University of Washington in Seattle who specializes in treating older adults. “Patients worry about dialysis, because that’s what they associate with kidney disease.”
Chronic kidney disease causes no symptoms until its later stages, and most seniors with the diagnosis are told they’re at Stage 3, of five — sudden, unwelcome news. Because Medicare uses these benchmarks for billing and reimbursement, they’ve become, in effect, the official definition of the disease for older Americans.
But wait a minute. Kidney function declines with age in almost everyone, and the proportion of older people with G.F.R. readings below 60 approaches 50 percent, studies have found. As the older adult population grows, the prevalence may rise even higher.
Review: In ‘Black Man in a White Coat,’ a Doctor Navigates Bruising Terrain
As a student at Duke University Medical School in the mid-1990s, Damon Tweedy once treated a black teenager who was hysterical and having a late-stage miscarriage. He made a flailing attempt to take her history — she denied being pregnant and said she had no bad habits — whereupon his supervisor barreled in and barked, “When is the last time you smoked crack?”
The patient was indeed an addict, and the nurse on duty said later that she should have her tubes tied because “I don’t think people like her should be allowed to get pregnant again.” Dr. Tweedy was filled with unpleasant, uneasy questions, and not just about his own newbie incompetence. Were the white doctor and nurse making racist and class-driven assumptions? Was he? What did that say about him as a black man?
He wrestles with similar doubts throughout “Black Man in a White Coat,” an account of his admirable and often lonely path from working-class Maryland — his father cut meat in a grocery store — to his current life, as an assistant professor of psychiatry at Duke.
On one level the book is a straightforward memoir; on another it’s a thoughtful, painfully honest, multi-angled, constant self-interrogation about himself and about the health implications of being black in a country where blacks are more likely than other groups to suffer from, for instance, heart disease, diabetes, stroke, kidney failure and cancer. “Being black can be bad for your health,” he says.
California voters sharply disagree on low-cost healthcare for immigrants
California has adopted a series of laws in recent years to help people in the country illegally, and polls show broad support for a pathway to citizenship for the estimated 2 million such immigrants living in the state.
But it's a different story when it comes to providing them healthcare benefits.
California voters are sharply divided over whether free or low-cost health insurance should be granted to those who reside in the state without legal status, according to a new USC Dornsife/Los Angeles Times poll.
The poll found that about 48% of voters believed that immigrants who live here illegally should be eligible to receive free or low-cost health insurance through Medi-Cal or a similar program. A statistically equal 47% said the group should not be eligible, while about 6% said they didn't know or refused to answer the question.
Backing for the benefit is split along ethnic lines, with 69% of Latino voters but only 39% of white voters responding that the group should be eligible. And it had an ideological cast as well: 68% of Democrats supported eligibility, yet only 19% of Republicans agreed.
Opposition was most passionate among supporters of Republican presidential candidate Donald Trump, 90% of whom opposed eligibility. Opposition among backers of other candidates ranked substantially lower.
Support has been growing for years among Californians for new immigration policies that would offer a path to citizenship for those in the country illegally. But Californians have remained somewhat conflicted, as the poll underscored, when it comes to offering costly services to those immigrants before they attain legal status.
Immigrant rights activists have pushed a proposal to provide state-funded healthcare for people who reside in California without legal status. They came close to succeeding this summer, but lawmakers scaled back the proposal after cost estimates ran into the hundreds of millions of dollars.
Instead, legislators set aside $40 million in the most recent state budget to provide Medi-Cal coverage to children younger than 19 years old, regardless of legal status.
The responses might have been different if the question had focused on only children who are in the country illegally, said Drew Lieberman of Greenberg Quinlan Rosner Research, a Democratic firm that conducted the poll with the Republican firm American Viewpoint.
David Kanevsky of American Viewpoint said that although past research has shown that Californians are liberal on a lot of immigration issues, the "issue is not resolved" when it comes to government benefits that involve financial compensation for those in the country without authorization.
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