Tell the Truth about Bernie’s Health Care Stand
The Clinton campaign just made a serious mistake.
They sent Hillary and Bill Clinton’s daughter Chelsea out on behalf of her mother to bash Senator Bernie Sanders on the issue of health care.
What’s so wrong with that? Don’t all candidates use family surrogates when and where they can? The Kennedys, for example, deployed a horde of kinfolk for Jack’s campaign for president, then Bobby’s, then Teddy’s.
But when it’s the first time (as this was for Clinton the younger), the surrogate should be sure whereof she speaks, and had better stick to talking about her candidate, not the opponent. Unfortunately, Chelsea Clinton misrepresented Senator Sanders’ position, and her premiere performance on the stump backfired, producing a flood of political donations to Sanders.
Here’s what she said: “Senator Sanders wants to dismantle Obamacare, dismantle the [Children’s Health Insurance Program], dismantle Medicare, and dismantle private insurance.” Whew! She would have us believe that the Vermont senator is a one-man wrecking crew, an enraged King Kong – or, to be modern about it, a mendacious Darth Vader – proposing “to go back to an era – before we had the Affordable Care Act – that would strip millions and millions and millions of people off their health insurance.”
Uh, not exactly. In fact, not even close. As Karen Tumulty noted in The Washington Post, Bernie Sanders has long been a champion of a single-payer health care system as the only way to assure that all Americans receive medical coverage. Rather than “strip” millions and millions of people of their health insurance, he wants to be sure millions and millions of people actually get health insurance.
This was Sanders’ position as far back as 1993 when newly-elected President Bill Clinton put First Lady Hillary Clinton in charge of reforming our disheveled and unjust health care system. Her task force huffed and puffed in secret for months, calling in legions of experts and academics, ultimately producing a plan so complicated and impenetrable – not to mention unexplainable – that it would have collapsed of its own ponderous weight even if the Republicans had not propagandized it into a laughing stock of pretensions and inefficiencies that could only make matters worse.
And here’s an ironic note: During that 1993 quest for a health care plan, Secretary Clinton sent Sanders an autographed picture of the two of them, wishing him the best and thanking the senator “for your commitment to real health care access for all Americans.”
Bernie Sanders and the Realists
BY JOHN CASSIDY
During the past few days, a number of liberally inclined commentators have published pieces querying Bernie Sanders’s domestic program, particularly his “Medicare for all” health-care proposal. That’s not particularly surprising. With polls showing Sanders leading, or challenging Hillary Clinton for the lead, in Iowa and New Hampshire, his proposals demand inspection. Until recently, there hadn’t been very much of this.
The latest piece to catch my eye was written by Michael Linden, a former policy adviser on Capitol Hill, who has also worked at the Center for American Progress, a think tank founded by Clinton’s campaign manager, John Podesta. The article, which Linden published on Medium, is entitled “The four policy reasons why I support Hillary Clinton in the Democratic primary.”
Linden writes that Clinton’s domestic proposals, which include raising the minimum wage, eliminating tax loopholes enjoyed by the rich, expanding preschool, and trying to make college more affordable, “push the boundaries of the possible.” He argues that they are also rooted in evidence, confront unavoidable trade-offs, and aim to help the poorest and most vulnerable members of society. To those Democrats who say that Clinton’s program doesn’t go far enough, Linden replies, in essence, that it is important—and actually more progressive—to be realistic about what can be accomplished. He writes:
A boundary-ignoring approach is less likely to produce actual policy change than boundary-pushing. You can be frustrated with the pace of that change and you can wish that our system allowed a president to enact the agenda that got him or her elected, but the historical fact remains that the few cases when federal policy really did take an enormous leap forward are the exception, rather than the rule. So until there is a plausible case that we are on the precipice of one of those rare exception moments, I prefer the approach that offers the possibility—however small—of real gains.
Linden doesn’t question the attractiveness of the vision Sanders is promoting—an America with a universal public health-care system, universal paid leave, free college tuition at state colleges, and a huge infrastructure program. Ultimately, a single-payer health-care system “could offer us enormous benefits,” Linden writes. But he also points out that Sanders, in order to finance such a system, would have to raise taxes sharply. “There’s no realistic chance of getting even a decent fraction of what Sanders has asked for. And if that’s the case, then Sanders has clearly not done the hard work of figuring out priorities, of operating within constraints, of balancing trade-offs,” he writes.
The argument is forcefully made. However, Sanders, as I understand him, isn’t claiming that his ambitious and costly program is realistic in today’s Washington. To the contrary, he says that the political system is so broken, and so in hock to big money, that it is virtually impossible to effect nearly any substantive progressive change. The only way to make big changes, Sanders argues, is to create a mass movement that faces down corporate interests and their quislings. Once this movement materializes, all sorts of things that now seem out of the question—such as true universal health care, free college tuition, and a much more progressive tax system—will become possible.
This, surely, is what Sanders means by the term “political revolution,” which he uses all the time. In a piece published on Thursday, the Washington Post’s Greg Sargent highlighted two things that Sanders had told Andrew Prokop, a reporter from Vox. Speaking in Iowa last week, the Vermont senator said that real change only comes about “when people on the bottom begin to stand up and say enough is enough. That’s true of the civil-rights movement, it is true of the women’s movement, it’s true of the environmental movement, of the gay movement.” In an earlier interview with Prokop, Sanders had differentiated his approach from the President’s: “The major political, strategic difference I have with Obama is it’s too late to do anything inside the Beltway. You gotta take your case to the American people, mobilize them, and organize them at the grassroots level in a way that we have never done before,” he said.
A boundary-ignoring approach is less likely to produce actual policy change than boundary-pushing. You can be frustrated with the pace of that change and you can wish that our system allowed a president to enact the agenda that got him or her elected, but the historical fact remains that the few cases when federal policy really did take an enormous leap forward are the exception, rather than the rule. So until there is a plausible case that we are on the precipice of one of those rare exception moments, I prefer the approach that offers the possibility—however small—of real gains.
Debating 'Medicare for All' System Is Good for Nation's Health, say Doctors
'Single-payer is the only health reform that pays for itself'
The idea of a single-payer healthcare system has entered the presidential debates—and that's a very good thing, a doctors group says, as it is "only equitable, financially responsible and humane cure for our healthcare ills."
In a statement released Friday by the non-partisan Physicians for a National Health Program (PNHP), its president, Dr. Robert Zarr, calls it "a welcome development," and also refutes a number of myths surrounding such a plan, sometimes referred to as a Medicare-for-all plan, including supposed high costs and lack of public support.
On cost, says Zarr, "Single-payer is the only health reform that pays for itself;" in contrast, "keeping the current private-insurance-based system intact is not [affordable.]"
Enacting a single-payer system would entail "[r]eplacing hundreds of insurers and thousands of different private health plans," and that, in turn, would mean "$400 billion in health spending would be freed up to guarantee coverage to all of the 30 million people who are currently uninsured and to upgrade the coverage of everyone else, including the tens of millions who are underinsured."
As far as the myth of lack of support, Zarr cites various surveys showing a single payer system is backed by a majority of Americans, and points to one survey finding as much as two-thirds of Americans support it, not to mention being backed by numerous medical, political, faith-based, and community organizations.
His statement also points to a study published Thursday in the American Journal of Public Health by PNHP members Drs. David Himmelstein and Steffie Woolhandler, who write that in our current privately financed healthcare system, in fact, taxpayers are footing the bill for about 64 percent of U.S. health spending.
The statement comes days after presidential hopeful Bernie Sanders released the details of his healthcare proposal, saying it is "time for our country to join every other major industrialized nation on Earth and guarantee health care to all citizens as a right, not a privilege."
The plan was welcomed by the 185,000-member National Nurses United, with executive director RoseAnn DeMoro writing, "Instead of being held hostage to a corporate system based on profits and price gouging, with Sanders' Medicare for all plan we can finally have a system based on patient need, with a single standard of quality care for all, regardless of ability to pay, race, gender, age, or where you live. That’s a beautiful thing."
Hillary Clinton, however, said during Sunday's Democratic debate that his proposal would threaten the Affordable Care Act (ACA), and would allow Republicans "an opening to come in and tear down everything we have achieved."
"To tear it up and start over again, pushing our country back into that kind of a contentious debate," she said, "I think is the wrong direction."
Clinton, for her part, proposes "defend[ing] the ACA against Republican efforts to repeal it."
According to CIGNA executive-turned-whistleblower Wendell Potter, however, "neither Clinton's nor Sanders' [plan] has much of a chance of being successful unless there are significant changes in the makeup of the Congress that would put Democrats in charge of both chambers again."
And the week before the last debate, as Clinton also took aim at Sanders' healthcare proposal, The Intercept reported that the former secretary of state, "from 2013 to 2015, made $2,847,000 from 13 paid speeches to the [healthcare] industry."
"This means," Zaid Jilani wrote, "that Clinton brought in almost as much in speech fees from the health care industry as she did from the banking industry. As a matter of perspective, recall that most Americans don’t earn $2.8 million over their lifetimes."
Potter said that's a fact that "should concern voters."
Forward to Single Payer Health Care
'Single-payer is the only health reform that pays for itself'
The idea of a single-payer healthcare system has entered the presidential debates—and that's a very good thing, a doctors group says, as it is "only equitable, financially responsible and humane cure for our healthcare ills."
In a statement released Friday by the non-partisan Physicians for a National Health Program (PNHP), its president, Dr. Robert Zarr, calls it "a welcome development," and also refutes a number of myths surrounding such a plan, sometimes referred to as a Medicare-for-all plan, including supposed high costs and lack of public support.
On cost, says Zarr, "Single-payer is the only health reform that pays for itself;" in contrast, "keeping the current private-insurance-based system intact is not [affordable.]"
Enacting a single-payer system would entail "[r]eplacing hundreds of insurers and thousands of different private health plans," and that, in turn, would mean "$400 billion in health spending would be freed up to guarantee coverage to all of the 30 million people who are currently uninsured and to upgrade the coverage of everyone else, including the tens of millions who are underinsured."
As far as the myth of lack of support, Zarr cites various surveys showing a single payer system is backed by a majority of Americans, and points to one survey finding as much as two-thirds of Americans support it, not to mention being backed by numerous medical, political, faith-based, and community organizations.
His statement also points to a study published Thursday in the American Journal of Public Health by PNHP members Drs. David Himmelstein and Steffie Woolhandler, who write that in our current privately financed healthcare system, in fact, taxpayers are footing the bill for about 64 percent of U.S. health spending.
The statement comes days after presidential hopeful Bernie Sanders released the details of his healthcare proposal, saying it is "time for our country to join every other major industrialized nation on Earth and guarantee health care to all citizens as a right, not a privilege."
The plan was welcomed by the 185,000-member National Nurses United, with executive director RoseAnn DeMoro writing, "Instead of being held hostage to a corporate system based on profits and price gouging, with Sanders' Medicare for all plan we can finally have a system based on patient need, with a single standard of quality care for all, regardless of ability to pay, race, gender, age, or where you live. That’s a beautiful thing."
Hillary Clinton, however, said during Sunday's Democratic debate that his proposal would threaten the Affordable Care Act (ACA), and would allow Republicans "an opening to come in and tear down everything we have achieved."
"To tear it up and start over again, pushing our country back into that kind of a contentious debate," she said, "I think is the wrong direction."
Clinton, for her part, proposes "defend[ing] the ACA against Republican efforts to repeal it."
According to CIGNA executive-turned-whistleblower Wendell Potter, however, "neither Clinton's nor Sanders' [plan] has much of a chance of being successful unless there are significant changes in the makeup of the Congress that would put Democrats in charge of both chambers again."
And the week before the last debate, as Clinton also took aim at Sanders' healthcare proposal, The Intercept reported that the former secretary of state, "from 2013 to 2015, made $2,847,000 from 13 paid speeches to the [healthcare] industry."
"This means," Zaid Jilani wrote, "that Clinton brought in almost as much in speech fees from the health care industry as she did from the banking industry. As a matter of perspective, recall that most Americans don’t earn $2.8 million over their lifetimes."
Potter said that's a fact that "should concern voters."
Forward to Single Payer Health Care
By Kay Tillow
Daily Kos, Jan. 17, 2016
A new day is breaking for single payer health care. This concept of publicly funded, universal health care, locked out of the national debate six years ago, has made it on stage in the presidential debates. Millions of people are hearing the concept of single payer (an improved Medicare for all) for the first time, and they like what they hear.
The December Kaiser tracking poll has reported that 58% of people support Medicare for All. Among Democrats the support is 81%, Independents 60%, and Republicans 30%.
Seven more Congresspersons signed on to HR 676 in December and January bringing the cosponsors on Rep. John Conyers’ HR 676, Expanded and Improved Medicare for All, to a total of 60. This is the model single payer legislation in Congress that would assure care to all with no premiums, no co-pays, no deductibles. All medically necessary care, including dental and drugs, would be covered. Everyone would choose their own physician and hospital—no more networks, preferred providers, or surprise bills from someone in the surgical suite who was not on your insurance company’s approved list.
The US is the only industrialized country that has not yet moved to a system of universal healthcare. That failure takes a toll on our health, our lives, our economy. The US pays over $9,000 per capita annually yet the median is under $4,000 in the countries that make up the Organization of Economic Cooperation and Development.
We pay more but get less. We rank 19th out of 19 countries in preventing deaths due to causes that were amenable to medical care. The US does poorly in life expectancy—51st in rank among the countries of the world. We live up to 4 years less than people in the countries that have universal health care systems. Our infant mortality rate is going up instead of down leaving us at 28th in the world. The US rate for maternal mortality is 12.7 per 100,000 live births. Canada’s is 4.8.
In terms of equality, the US has a long way to go. A study by Dr. Adewale Troutman and Surgeon General David Satcher found that there are over 83,000 excess deaths annually among African Americans. Employers whose workforce is predominately female can still charge higher prices for health coverage because of that fact. Insurers who sell on the exchanges can charge up to three times the regular premium because of age. The drugs and care crucial to those with AIDS, MS, epilepsy, leukemia, cancer, mental health and a host of other problems can be priced beyond the reach of patients. Discrimination has not ended.
In December of this year the Kaiser Tracking Poll reported that 46% of the population views the health care reform law passed in 2010 as unfavorable while 40% view it favorably. That is not all attributable to the crazed campaign of misinformation perpetrated by the far right. The very real problems that were not solved by the law plague us with differing impacts on various strata, but leaving no one truly protected. When the ACA is fully implemented, over 30 million will still be uninsured. That alone will bring us 30,000 unnecessary deaths per year.
While the uninsured numbers have diminished, the underinsured, those who nominally have insurance but cannot afford care, are increasing. Over 25% of the insured go without needed care because of the cost. That rises to 46% in low income families. Premiums rise by double digits. Deductibles are now in the thousands. Insurance is no longer a guarantee against bankruptcy. While the provisions of the ACA pour billions into subsidies to the insurance companies, care is priced beyond the means of far too many. Doctors and hospitals are off limits in the networks set up by the insurers who still control our system, and state insurance departments are unable to keep up with regulations.
We deserve better. Across the country and here in Kentucky the single payer movement is gaining support. The city of Vicco in Eastern Kentucky’s Floyd County passed a resolution endorsing HR 676. The city commissioners sent their resolution to Congressman Hal Rogers asking him to sign on. Boyle County has also passed a resolution for HR 676. So has the city of Louisville, the city of Morehead, and the Kentucky House of Representatives. This past year medical students at the University of Louisville organized a student chapter of Physicians for a National Health Program, and a group of their colleagues at the University of Kentucky are working to do the same. A campaign of outreach, education, and activism can win more hearts and minds to this real solution.
We have an immediate fight on our hands to block any backward steps in Medicaid expansion. The new governor has threatened to impose onerous conditions on this best part of the ACA, and all people of good will must demand that our Frankfort representatives stop the threat.
But the current health system will never cover us all, never end the denial of care, never stop the rationing based on the ability to pay. It’s your money or your life in this market-based system.
The costs for those who must purchase insurance will continue to increase. The deductibles and co-pays will rise. Employer-based insurance will continue to depress wages as employers shift more of the costs onto the workers. Cadillac plans are rare. We have mostly broken down junkers.
The essential difference between the US and other countries is that the insurance companies are at the center of our health care system. Their drive for profit is at the core of why health care is so expensive. Over 30% of US health costs are attributable to profits and administrative costs.
Insurance companies and their experts say the high costs are due to overuse of care. It just isn’t true. In the US we visit physicians half as much as those in other countries, and we spend fewer days in the hospital. All of the co-pays and deductibles and all of the cost control efforts written into the ACA are based on this wrong diagnosis.
Marcia Angell, MD, former editor of the New England Journal of Medicine, says that under our current market-based system, we cannot simultaneously improve care and lower costs. Improving care costs more. Cutting costs cuts care. To change those dynamics, we must cut out the cause of the problem—the profit-based insurance companies. That will allow us to remove the administrative wastes and profits and apply those funds to extending care to everyone and improving it for all. It’s the right thing to do! Let’s make it happen.
By Kay Tillow
Daily Kos, Jan. 17, 2016
Daily Kos, Jan. 17, 2016
A new day is breaking for single payer health care. This concept of publicly funded, universal health care, locked out of the national debate six years ago, has made it on stage in the presidential debates. Millions of people are hearing the concept of single payer (an improved Medicare for all) for the first time, and they like what they hear.
The December Kaiser tracking poll has reported that 58% of people support Medicare for All. Among Democrats the support is 81%, Independents 60%, and Republicans 30%.
Seven more Congresspersons signed on to HR 676 in December and January bringing the cosponsors on Rep. John Conyers’ HR 676, Expanded and Improved Medicare for All, to a total of 60. This is the model single payer legislation in Congress that would assure care to all with no premiums, no co-pays, no deductibles. All medically necessary care, including dental and drugs, would be covered. Everyone would choose their own physician and hospital—no more networks, preferred providers, or surprise bills from someone in the surgical suite who was not on your insurance company’s approved list.
The US is the only industrialized country that has not yet moved to a system of universal healthcare. That failure takes a toll on our health, our lives, our economy. The US pays over $9,000 per capita annually yet the median is under $4,000 in the countries that make up the Organization of Economic Cooperation and Development.
We pay more but get less. We rank 19th out of 19 countries in preventing deaths due to causes that were amenable to medical care. The US does poorly in life expectancy—51st in rank among the countries of the world. We live up to 4 years less than people in the countries that have universal health care systems. Our infant mortality rate is going up instead of down leaving us at 28th in the world. The US rate for maternal mortality is 12.7 per 100,000 live births. Canada’s is 4.8.
In terms of equality, the US has a long way to go. A study by Dr. Adewale Troutman and Surgeon General David Satcher found that there are over 83,000 excess deaths annually among African Americans. Employers whose workforce is predominately female can still charge higher prices for health coverage because of that fact. Insurers who sell on the exchanges can charge up to three times the regular premium because of age. The drugs and care crucial to those with AIDS, MS, epilepsy, leukemia, cancer, mental health and a host of other problems can be priced beyond the reach of patients. Discrimination has not ended.
In December of this year the Kaiser Tracking Poll reported that 46% of the population views the health care reform law passed in 2010 as unfavorable while 40% view it favorably. That is not all attributable to the crazed campaign of misinformation perpetrated by the far right. The very real problems that were not solved by the law plague us with differing impacts on various strata, but leaving no one truly protected. When the ACA is fully implemented, over 30 million will still be uninsured. That alone will bring us 30,000 unnecessary deaths per year.
While the uninsured numbers have diminished, the underinsured, those who nominally have insurance but cannot afford care, are increasing. Over 25% of the insured go without needed care because of the cost. That rises to 46% in low income families. Premiums rise by double digits. Deductibles are now in the thousands. Insurance is no longer a guarantee against bankruptcy. While the provisions of the ACA pour billions into subsidies to the insurance companies, care is priced beyond the means of far too many. Doctors and hospitals are off limits in the networks set up by the insurers who still control our system, and state insurance departments are unable to keep up with regulations.
We deserve better. Across the country and here in Kentucky the single payer movement is gaining support. The city of Vicco in Eastern Kentucky’s Floyd County passed a resolution endorsing HR 676. The city commissioners sent their resolution to Congressman Hal Rogers asking him to sign on. Boyle County has also passed a resolution for HR 676. So has the city of Louisville, the city of Morehead, and the Kentucky House of Representatives. This past year medical students at the University of Louisville organized a student chapter of Physicians for a National Health Program, and a group of their colleagues at the University of Kentucky are working to do the same. A campaign of outreach, education, and activism can win more hearts and minds to this real solution.
We have an immediate fight on our hands to block any backward steps in Medicaid expansion. The new governor has threatened to impose onerous conditions on this best part of the ACA, and all people of good will must demand that our Frankfort representatives stop the threat.
But the current health system will never cover us all, never end the denial of care, never stop the rationing based on the ability to pay. It’s your money or your life in this market-based system.
The costs for those who must purchase insurance will continue to increase. The deductibles and co-pays will rise. Employer-based insurance will continue to depress wages as employers shift more of the costs onto the workers. Cadillac plans are rare. We have mostly broken down junkers.
The essential difference between the US and other countries is that the insurance companies are at the center of our health care system. Their drive for profit is at the core of why health care is so expensive. Over 30% of US health costs are attributable to profits and administrative costs.
Insurance companies and their experts say the high costs are due to overuse of care. It just isn’t true. In the US we visit physicians half as much as those in other countries, and we spend fewer days in the hospital. All of the co-pays and deductibles and all of the cost control efforts written into the ACA are based on this wrong diagnosis.
Marcia Angell, MD, former editor of the New England Journal of Medicine, says that under our current market-based system, we cannot simultaneously improve care and lower costs. Improving care costs more. Cutting costs cuts care. To change those dynamics, we must cut out the cause of the problem—the profit-based insurance companies. That will allow us to remove the administrative wastes and profits and apply those funds to extending care to everyone and improving it for all. It’s the right thing to do! Let’s make it happen.
Democratic Candidates Debate ‘Single-Payer,’ But What Does That Mean?
Employee Wellness Programs Use Carrots and, Increasingly, Sticks
Michigan’s Great Stink
by Paul Krugman - NYT
In the 1850s, London, the world’s largest city, still didn’t have a sewer system. Waste simply flowed into the Thames, which was as disgusting as you might imagine. But conservatives, including the magazine The Economist and the prime minister, opposed any effort to remedy the situation. After all, such an effort would involve increased government spending and, they insisted, infringe on personal liberty and local control.
It took the Great Stink of 1858, when the stench made the Houses of Parliament unusable, to produce action.
But that’s all ancient history. Modern politicians, no matter how conservative, understand that public health is an essential government role. Right? No, wrong — as illustrated by the disaster in Flint, Mich.
What we know so far is that in 2014 the city’s emergency manager — appointed by Rick Snyder, the state’s Republican governor — decided to switch to an unsafe water source, with lead contamination and more, in order to save money. And it’s becoming increasingly clear that state officials knew that they were damaging public health, putting children in particular at risk, even as they stonewalled both residents and health experts.
This story — America in the 21st century, and you can trust neither the water nor what officials say about it — would be a horrifying outrage even if it were an accident or an isolated instance of bad policy. But it isn’t. On the contrary, the nightmare in Flint reflects the resurgence in American politics of exactly the same attitudes that led to London’s Great Stink more than a century and a half ago.
Let’s back up a bit, and talk about the role of government in an advanced society.
In the modern world, much government spending goes to social insurance programs — things like Social Security, Medicare and so on, that are supposed to protect citizens from the misfortunes of life. Such spending is the subject of fierce political debate, and understandably so. Liberals want to help the poor and unlucky, conservatives want to let people keep their hard-earned income, and there’s no right answer to this debate, because it’s a question of values.
There should, however, be much less debate about spending on what Econ 101 calls public goods — things that benefit everyone and can’t be provided by the private sector. Yes, we can differ over exactly how big a military we need or how dense and well-maintained the road network should be, but you wouldn’t expect controversy about spending enough to provide key public goods like basic education or safe drinking water.
Yet a funny thing has happened as hard-line conservatives have taken over many U.S. state governments. Or actually, it’s not funny at all. Not surprisingly, they have sought to cut social insurance spending on the poor. In fact, many state governments dislike spending on the poor so much that they are rejecting a Medicaid expansion that wouldn’t cost them anything, because it’s federally financed. But what we also see is extreme penny pinching on public goods.
It’s easy to come up with examples. Kansas, which made headlines with its failed strategy of cutting taxes in the expectation of an economic miracle, has tried to close the resulting budget gap largely with cuts in education. North Carolina has also imposed drastic cuts on schools. And in New Jersey, Chris Christie famously canceled a desperately needed rail tunnel under the Hudson.
Nor are we talking only about a handful of cases. Public construction spending as a share of national income has fallen sharply in recent years, reflecting cutbacks by state and local governments that are ever less interested in providing public goods for the future. And this includes sharp cuts in spending on water supply.
So are we just talking about the effects of ideology? Didn’t Flint find itself in the cross hairs of austerity because it’s a poor, mostly African-American city? Yes, that’s definitely part of what happened — it would be hard to imagine something similar happening to Grosse Pointe.
But these really aren’t separate stories. What we see in Flint is an all too typically American situation of (literally) poisonous interaction between ideology and race, in which small-government extremists are empowered by the sense of too many voters that good government is simply a giveaway to Those People.
Now what? Mr. Snyder has finally expressed some contrition, although he’s still withholding much of the information we need to fully understand what happened. And meanwhile we are, inevitably, being told that we shouldn’t make the poisoning of Flint a partisan issue.
But you can’t understand what happened in Flint, and what will happen in many other places if current trends continue, without understanding the ideology that made the disaster possible.
How to Make Home Birth a Safer Option
by Aron Carroll - NYT
Many medical students are taught this adage: “When you hear hoofbeats, think of horses, not zebras.” It means that we, as physicians, need to remember that common things are common, and that we shouldn’t immediately focus on the rare or esoteric.
As a pediatrician, for instance, I have to constantly remind myself that the vast, vast majority of children are healthy. Just because I encounter mostly sick children in the clinic doesn’t mean otherwise. I see a skewed population.
Recently, a new study comparing the safety of home or birth-center deliveries with hospital deliveries led to headlines proclaiming that babies not born in hospitals were significantly more likely to die. I have no trouble believing that’s the case.
That’s the zebra, though.
There are a number of people in the United States who would rather have their baby at home. I’m going to lay all of my cards (and biases) here on the table: I recoil at this thought. Why? Because pretty much the worst things I saw in residency occurred with a home birth. I can’t help myself. I hear home birth, and I think of zebras.
I, and my wife, feared the deaths of our babies during delivery so much that we chose in-hospital births. Our zeal to minimize that specific risk outweighed any other considerations. If faced with the decision again, I don’t doubt we’d choose the same. But that doesn’t mean everyone prioritizes risks the same way.
Women should also know that if they’re in the hospital, they are more likely to get an induction, augmentation or other labor-related procedure. They’re more likely to get a cesarean section. Their children are more likely to be admitted to the intensive care unit and spend time separated from them after birth. It’s perfectly rational for parents to accept a statistically significant, but relatively rarer, higher risk of one bad outcome to avoid another.
Home births are gaining in popularity. In Britain, about 10 percent of births don’t happen in a hospital. The Centers for Disease Control and Prevention estimates that in 2012, more than 53,000 births took place out of the hospital in the United States. More than 35,000 took place at home, the rest at dedicated birth centers. Out-of-hospital births are a small percentage of overall deliveries, about 1.36 percent, but the rate has been increasing since 2004, when they were about 0.8 percent. In some states, like Alaska (6 percent), Montana (3.9 percent) and Oregon (3.8 percent), out-of-hospital births are even more common.
In Oregon, data is recorded on birth certificates that allows researchers to know which births were planned for the home and which were planned for the hospital. They can compare outcomes.
In 2012 and 2013, researchers found that the rate of perinatal death was significantly higher for births planned at home: 3.9 versus 1.8 per 1,000. That would be an additional death for each 500 births at home. At-home births were also associated with an increased risk of neonatal seizures.
However, the risk of admission to an intensive care unit was significantly lower for those born at home. I recently wrote an editorial in JAMA Pediatrics discussing how increased neonatal intensive care use is a possible example of supply-induced care. In other words, those facilities might sometimes be used because they exist and need to be filled, not because infants need them.
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