A Public Hospital That Serves the Poor — With Lawsuits
December 24, 2014
More than a century ago, Alabama enshrined a basic protection in the state’s constitution shielding its poorest citizens from being forced to pay debts they couldn’t afford.
But a public hospital in the mostly rural southeast corner of the state has found a way around the law. Before patients can receive treatment at Southeast Alabama Medical Center, they must sign a form waiving that legal protection, clearing the way for the facility to seize funds from their pay or bank accounts to cover medical debts.
ProPublica and NPR reported last week that nonprofit hospitals, which are legally required to offer discounted care to the poor, often sue low-income patients and garnish hefty portions of their pay.
December 29th, 2014
by Uwe Reinhardt
M.I.T. economist Jonathan Gruber, whom his colleagues in the profession hold in very high esteem for his prowess in economic analysis, recently appeared before the House Committee on Oversight and Government Reform. Gruber was called to explain several caustic remarks he had offered on tortured language and provisions in the Affordable Care Act (the ACA) that allegedly were designed to fool American voters into accepting the ACA.
Many of these linguistic contortions, however, were designed not so much to fool voters, but to force the Congressional Budget Office into scoring taxes as something else. But Gruber did call the American public “stupid” enough to be misled by such linguistic tricks and by other measures in the ACA — for example, taxing health insurers knowing full well that insurers would pass the tax on to the insured.
During the hearing, Gruber apologized profusely and on multiple occasions for his remarks. Although at least some economists apparently see no warrant for such an apology, I believe it was appropriate, as in hindsight Gruber does as well. “Stupid” is entirely the wrong word in this context; Gruber should have said “ignorant” instead.
Stupid Versus Ignorant
“Stupid” means “unable to learn.” The American people, or for that matter any other people on earth, are not unable to learn. Just ask any military officer what youngsters with varied socio-economic backgrounds and without advanced formal education can learn if properly taught, as they are routinely when enrolled in the best educational institution in the United States, namely the armed forces.
“Ignorant” means “lacking knowledge.” It is altogether different from “stupid.” Can anyone seriously deny that large numbers of American voters are ignorant of the intricacies of many issues in public policy, especially when they involve economic analysis?
There are good reasons for this lack of knowledge.
Why American voters are often ignorant on policy questions. First, most public policies are highly complex and involve troublesome economic and ethical trade-offs among desirable goals. Mastering them takes careful study.
Second, Americans on average work substantially more hours per year than do citizens in most other developed nations. Voters in the U.S. simply do not have time to delve as deeply into these complexities as more narrowly focused experts can. I personally, for example, must confess complete ignorance on the intricacies of many policy issues outside my professional purview — for instance, global warming and climate control.
Third, hard as it is to be objectively and accurately informed on particular issues of public policy, there are large and well-financed industries on both sides of the political spectrum that bombard the public with judiciously biased information. And rather than enlightening the public on issues of public policy, the business model of the television media and some of the print media has gravitated more and more towards channeling preferred ideologies and carefully biased information. Thus the innocent idea to compensate physicians for helping their patients with composing living wills quickly became Third Reich“death-panels,” and the duly elected President of the United States found himself openly smeared as a Nazi.
Finally, and this must be said candidly as well, throughout the ages and to this day many members of the public have shown no interest in public policy at all, unless it hurts their own pocketbooks. Of that segment of the public, for example, the first century Roman poet Juvenal wrote in dismay, “Duas tantum res anxius optat, panem et circenses.” (Its anxious longing is confined to two things–bread and circus games.) These preoccupations can make people seek nourishment at the public trough all the while cursing government interference in their lives, as was so vividly reported in Benjamin Applebaum’s and Robert Gebeloff’s “Even Critics of Safety Net Increasingly Depend on It” in The New York Times(February 12, 2012). I am grappling with the search for an adjective to describe this peculiar posture. Is “ignorant” good enough?
The Ubiquity of Spinning
Ebola response shows flaws in US system
By Felice J. FreyerGLOBE STAFF
The threat of Ebola over the last several months tested the nation’s ability to cope with an unfamiliar disease, raising troubling questions about what will happen when the next dangerous new germ arrives on US shores.
After Thomas Eric Duncan was misdiagnosed in a Dallas hospital and later infected two nurses with the deadly virus, government agencies and hospitals around the nation responded quickly to prevent another such incident. But it took that calamity in October to trigger measures that, critics say, a well-prepared system would have had in place.
“The approach has been shutter the firehouse until there’s a fire,” said Dr. Paul E. Jarris, executive director of the Association of State and Territorial Health Officials.
Federal money for public health and hospital readiness has been drastically cut since the now-forgotten fears of avian flu a decade ago, and an estimated 50,000 public health workers’ jobs have been eliminated amid state and federal cutbacks in recent years. And yet, public health officials say, the Ebola response demonstrated the importance of government’s role in communicating with health care institutions and the public.
The United States lacks a central authority and coordination among a constellation of federal, state, and local agencies, said Dr. Irwin Redlener, director of Columbia University’s National Center for Disaster Preparedness. In the United Kingdom and Canada, he said, national health systems permit the federal government to designate Ebola hospitals and to set clear, mandatory protocols.
“What we have here,” Redlener said, “are a collection of random acts of preparedness.”
The appointment of federal Ebola “czar” Ronald Klain has helped galvanize a response, Redlener said, and the nation is probably now, finally, ready to cope with the threat of Ebola.
“Again,” he said, “we’re laser-focused on what happened yesterday.”
But what will happen tomorrow?
It could be something much scarier than Ebola.
Supreme uncertainty: The future of the Affordable Care Act in Maine
Posted Jan. 03, 2015, at 5:59 a.m.
More than a year has passed since the federal government welcomed Healthcare.gov into the world. After some sleepless nights during those first tumultuous months, President Barack Obama’s administration saw its newborn health insurance marketplace slowly gain footing.
Today, Healthcare.gov is finally walking. But on wobbly legs. And some of the other kids don’t want to play with it.
Many Americans wonder how the insurance marketplace — a signature component of Obama’s Affordable Care Act — will turn out. The next year will prove a key test, as consumers continue sorting out what the health reform law means for them, politicians wage war over its many provisions, and the Supreme Court weighs a case that could bring it to its knees. Or not.
Here’s what to expect from year two and beyond for the ACA in Maine.
