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Category: Health Care

Trump just likes being mean to people

Trump’s rule: If you don’t have something nice to say about someone, say it even louder.

I find it difficult to believe that Trump has particular feelings, one way or the other, over care and treatment of transgender kids, except that it makes a convenient cudgel for him to rile up the troops.

“DeWine has fallen to the Radical Left. No wonder he gets loudly booed in Ohio every time I introduce him at Rallies, but I won’t be introducing him any more. I’m finished with this ‘stiff.’ What was he thinking.”

I mean, DeWine is about as reliably Right as you can find. But after taking the time to look at what the Ohio lege’s gender-affirming health care ban would do, he took a principled stand and said, “No, this is going to hurt people.”

Which just teed him up for Trump’s criticism because, hey, hurting people is what Donald is all about.

thehill.com/homenews/lgbtq/438

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The Enduring Fantasy of Trump’s Bestest Ever Beautiful GOP Health Care Plan

Trump keeps magically saying he can give everyone better, cheaper, more-inclusive insurance. But he never shares the details.

Donald Trump and the GOP held a majority in both the House and the Senate for the first two years of his presidency.

Despite the fact that Donald campaigned in 2016 on replacing the ACA with something more inclusive — “I am going to take care of everybody … Everybody’s going to be taken care of much better than they’re taken care of now.” — and despite the fact, just before his inauguration, he pinky-swore that he had a detailed Much More Better Great Bestest health care plan to replace the ACA that was just about ready to be printed, voted on, and passed, once he was in office …

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

[…] Trump said his plan for replacing most aspects of Obama’s health-care law is all but finished. Although he was coy about its details — “lower numbers, much lower deductibles” — he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell (R-Ky.). “It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said.

[…] As he has developed a replacement package, Trump said he has paid attention to critics who say that repealing Obamacare would put coverage at risk for more than 20 million Americans covered under the law’s insurance exchanges and Medicaid expansion. “We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

… he then just turned to Congress and basically punted it over to them. Because he had no actual plan. 

“Trust me.”

The GOP-controlled Congress tried. They spent all of 2017 crafting and recrafting and negotiating within their caucus to get some sort of “repeal and replace” passed. The closest they got was the AHCA, which kicked a bunch of people off of insurance and didn’t cover pre-existing conditions, and which ended up being defeated in a last-second vote by Sen. John McCain in July. Subsequent efforts to just “repeal” and “repeal but delay repeal for two years” also failed.

(Ironically, just as the ACA almost foundered on the gap between folk on the far left of the Dems who wanted a much more sweeping health insurance reform, and the Blue Dog Dems who wanted something much more conservative, the GOP’s efforts were stymied. on conservative Senators and House members who wanted flat-out repeal, and more moderate GOP congressfolk who insisted on a much softer landing.)

The GOP basically gave up in Election Year 2018, but still lost control of the House in that fall’s election, largely over their shenanigans against the ACA, which people suddenly realized they actually kind of liked (or liked more than the status quo ante).

Which brings us to now, when the Trump Administration is seeking to get the ACA defeated in court, while promising that it has (or will have Real Soon Now) the Much More Better Great Bestest health care plan to replace the ACA. It says that, not because it has such a plan (it still doesn’t), but because it expects the GOP in the Senate to write such a plan — something even Mitch McConnell isn’t willing to do.

So instead, Donald has declared he never really wanted it written and voted on before the 2020 election anyway, and will instead actively campaign on how Beautiful and Great his Brand New Plan will be after the election when he inexplicably expects to have control back of the House for the GOP, and so will be able to have something written for him that will be Truly Awesome.

I imagine one can judge the veracity of the full set of tweets by that final line there.

The problem is, no matter how many think tanks and Senators and policy wonks and zany off-hand comments by the President one throws into the picture, what Donald wants, framed in a way that’s acceptable to his own party, is simply impossible.  Mathematically impossible.

Here’s the problem: Insurance companies are completely correct in saying that people with pre-existing conditions tend to need to spend more on medical care, and therefore are more costly to insure.

There’s no getting around that. You can argue over what constitutes a pre-existing condition (unless you’re an insurance company customer before the ACA, because it was then whatever insurance companies wanted to say it was, from having been pregnant to having diabetes to having once smoked to living in the wrong neighborhood to having had acne to having anything that might possibly every remotely be arguably related to something that you now wanted coverage for), but the bottom line is, literally, the bottom line.

If you are going to actually fully cover people regardless of their pre-existing conditions, you have to spend money. Much more money than if you do what insurance companies always want to do (cover only healthy people who won’t ask for the money back that they spent on premiums). Which means either taking that money from the taxpayers (like in a Medicare-for-All scenario), or maximize the risk pool with even fully healthy people so that everyone is mandated to buy insurance and spends marginally more than they would if they were only covering just themselves (if they were lucky enough to not have any “pre-existing conditions”) (which is the approach the ACA took, based on Romneycare, based on what the Heritage Foundation recommended before the Right decided that Obama had stolen the idea and therefore it was the Worst Idea Ever).

The alternative to spending money is to pretend that you are protecting pre-existing conditions. For example, you can require insurance companies to cover everyone, but allow them to charge more for some people — i.e., a person can theoretically get insurance despite their pre-existing conditions, it’s just prohibitively expensive to actually get. Or you can create a special “high risk pool” taxpayer-supported insurance program, and then scrimp on the money you put into it, or distribute it as block grants to the states regardless of inflationary costs or how actual medical care demand is balanced. Those kind of solutions let you claim with a semi-straight face you are protecting people, while in reality throwing them to the dogs.

Of course, you could just go ahead and overtly throw them to the dogs. Some conservative GOP folk think that’s fine — if you can’t pay more, you can go pound sand, I got mine, screw you.

But Trump claims that sort of Randian attitude is unthinkable. But he thinks he will be able to get away with not having to explain the magical details of how he’ll do all these wonderful thing. Like the real estate developer he is, he’ll run on “principles.” just as he tweeted above: Lower costs! Lower Deductibles! Much Better! Everyone covered! We love pre-existing conditions! Puppies and Unicorns for all! We double-dog promise that’s what you’ll get — trust us!

Given the gaps, the people kicked off coverage, the hits to folk who have pre-existing conditions that were coded into the few actual GOP plans proposed over the past couple of years, it’s hard to believe that’s a message that’s going to go over well.

Do you want to know more?

Trump finds a new avenue of attack on the ACA

He couldn’t do it through Congress, and hasn’t quite managed it by Executive Order, so …

Donald Trump has made “Repeal (and, I guess, Replace)” of the Affordable Care Act one of his priorities since Day 1 of his election. He’s tried (and failed) to wrangle Congress into doing it for him. He’s chipped away steadily at it through executive action, undoing implementation orders from the Obama era. He’s now escalated his efforts to do so on a judicial basis

Trump’s Justice Department has decided to file a brief in the appeal of a Texas judge’s ruling that the entire ACA (“Obamacare”) is unconstitutional because the GOP Congress got rid of the individual mandate. The brief is in support of that ruling, thus expanding  the DoJ’s previous positions in the case that only portions of the law should be tossed out. Now, it’s Get rid of everything as the official Justice Dept. position.

Were the 5th Circuit to uphold that position, both the short-term and long-term effects would be catastrophic. On the short-term side it would throw private insurance and public assistance into turmoil. On the long-term side, it would mean a return to the pre-ACA days:

  • Returning to Pre-Existing Condition restrictions that prevented millions of Americans from getting health insurance (at all, or at affordable levels), and locked people into jobs for fear that they wouldn’t requalify for health insurance if there was too long a gap between employment positions
  • Returning to having lifetime and annual coverage limits
  • Returning to letting insurance companies charge more for women’s health coverage
  • Dumping 15 million people off Medicaid
  • Eliminating no-charge preventative services for older Americans on Medicare
  • Removing required minimal coverage standards for health insurance policies (ambulatory care, emergency care, hospitalization, maternity and newborn care, mental health and substance use care, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive care, chronic disease management, and pediatric dental and vision care)
  • Removing state exchanges that provided structured comparisons of medical insurance plans
  • Removing medical loss ratio standards that required insurance companies to expend money primarily on coverage, not on executive salaries.
  • Kicking off extended dependent coverage to age 26
  • Etc.

The only “positive” aspect of this is that, regardless of how the 5th Circuit (and then the Supreme Court, one can assume) rules on this, Trump has prominently handed a huge issue to the Democrats in 2020. Protecting health care was a major component of the message in 2018 that won the Dems the House (and arguably staved off greater losses in the Senate). It polls as the most important issue for Democratic voters, while repealing the ACA is much further down the list for Republicans.

Trump has long touted “Repeal and Replace” as his goal, even though the replacements proposed have been weak beer in terms of actually helping those whom the ACA provided care for. With this move, Trump’s administration is seeking solely to Repeal; any “Replace” will be a long time coming, as we devolve to the far-more-Darwinian status quo of a decade ago, where health care was for those who could afford what insurance companies chose to charge.

But, then, despite claims to the contrary, that’s clearly been Trump’s desire all along.

Do You Want To Know More?

In case you thought all that ACA Repeal stuff was dead and gone

It’s not. The GOP are just waiting for a November win to get rid of the ACA, including pre-existing medical conditions (vague promises to the contrary notwithstanding). They’ve actually said that.

Again, remember why the ACA was passed:

1. People dying (or just chronically suffering, and unable to work) from lack of insurance coverage (no, you can’t go to the ER to treat your cancer, heart disease, or diabetes), either because their employers didn’t have to provide it, because they couldn’t afford individual policies, or because they had some vague “pre-existing condition” that meant insurance companies could either deny coverage or jack up the costs through the roof.

2. People being driven into bankruptcy because of medical bills on policies that had annual and lifetime caps, or that didn’t include critical coverage, or that didn’t cover things that, oh, hey, pre-existing conditions again!.

3. Because the basic ideas behind the ACA were supported by both the GOP and conservative think tanks like the Heritage Foundation … until it was a Democrat that was pushing them into law.

The GOP politicians today seems mainly concerned with getting rid of #3. If #1 or #2 happen again, well, none of them are likely to suffer that way.

Something to remember this November.




Opinion | Get Sick, Go Bankrupt and Die – The New York Times
What the midterms mean for the future of health care.

Original Post

How odd. ACA info has been deleted from the Medicare site

Regardless of how one feels about the Affordable Care Act, it not only remains the law, but people on Medicare remain interested how the ACA interacts with that program. Unfortunately, you can’t find that out any more at the Federal Government’s Medicare site. Because, I’m sure, for completely legit and public service-oriented reasons.




Affordable Care Act page quietly removed from Medicare website
The removal of Medicare.gov’s Affordable Care Act page obscures information about a law still in place, and severs links to a page with information about the Marketplace.

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Guns and Nutters

I’m all in favor of getting people access to the mental health they need.

But what if they don’t want it?

We are, in this country, very sensitive to civil liberties. So in case it hasn’t escaped you, if The Power to Take Away Guns is the first step on the road to tyranny (as we keep being told), then The Power to Commit People To Mental Hospitals is right up there with it. You just have to look around the world and history to see that.

Unless someone has committed a demonstrable crime, it’s very, very hard to force them to start treatment, let alone continue treatment. And, honestly, while that’s sad, I’m not sure it’s the wrong course.

And let’s not even start with Trump (or his GOP cohorts), who’ve taken to talking a big game about mental health to deflect from the idea of gun restrictions:

After other mass shootings, Trump has suggested the need for mental health reform. But just this week, for the second year in a row, his budget proposed deep cuts to the nation’s mental health programs and programs meant to help prevent crime in schools and assist them in recovery from tragedies.

He has also proposed slashing billions of dollars from other social safety nets like Medicaid, which millions of Americans rely on to get mental health treatment, and he’s pushed the repeal of Obamacare, which includes coverage protections for those with mental illness.

And, of course, when presented with an opportunity to address the idea of potentially mentally ill people getting firearms, he was happy to throw the idea under the bus.

Policy experts and lawmakers have tried reforming the background check system to include more people, but Trump’s reversal of an Obama-era regulation did the opposite. The rule required the Social Security Administration to report people on disability insurance who had severe mental illness and required someone else to file for them, to the FBI’s background check system to prohibit them from purchasing a gun.

(Though that one’s a bit more nuanced, as the issue at hand is not mental illness per se, but violent mental illness. Needless to say, though, Trump’s action here was anything but nuanced.)

There are, as always, no quick and easy answers, and mass shootings of this sort are, themselves, statistical aberrations of the sort that make very poor public policy (as anyone who’s had to take off their shoes at the airport knows too well). But people calling for more proactive treatment of mental illness need to consider the implications of some of the suggestions they are making. And people calling for more care to be available to people with mental illness shouldn’t be implicitly be adding “… if they can afford it” to their policy statements.

 




How the alleged Florida shooter escaped years of warnings – POLITICO

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Donald Trump is very proud that a minority of people approve of him

You can always tell when Donald Trump has a polling result that isn’t wretched: he immediately tweets about it, even if the rest of the time he studiously ignores the polls (and just makes handwaving statements about his amazing popularity).

In this case, it’s a single outlying poll, showing a 45% approval. Um … whoopie?

That’s not that great a number. In the same December of their term, Barack Obama had a 49 percent approval rating; George W. Bush (three months on from 9/11) had nearly 85 percent approval.

It’s also an outlier; 538’s aggregate of surveys shows a 37% approval, 56% disapproval.

Still, assume the 45% approval is right. Indeed, given its extraordinary nature, if Donald is pushing that number, he must have a lot of faith in it. To me, though, picking out a single number from a poll and ignoring the rest is the height of dishonesty. If Donald is going to trumpet one result from the poll, he should stand by all of them.

So what does the poll itself have to say?

The basic approval rating is, as Donald notes, 45%; that’s about evenly split between strongly and somewhat approving. The disapproval rating is 59%; 39% strongly disapprove.

59% think the country is off on the wrong track.

Looking at whom the survey respondents trust in Congress, Republicans get the nod (though only a weak plurality) in the economy, jobs, national security, and immigration. Dems get the plurality approval in health care, the environment, energy, and education. If an election was held for Congress in the respondent’s district today, a narrow plurality would vote Dem.

Looking at policy priorities, healthcare reform is a majority top priority (and a vast majority important or top priority). Important or top priorities include Investigating Trump/Russia, reforming Medicare and Social Security, reforming bank regulations, reforming immigration, and passing a DACA bill.

In fact, a very solid majority think passing a DACA bill is somewhat or very important, and a narrow plurality believe that’s important enough to prompt a government shutdown if not done.

On the other hand, a majority indicated a low priority or no desire to build Trump’s wall.

A plurality support the GOP tax reform (and a solid majority think it at least somewhat important to pass the bill), though a plurality think it will increase their taxes. A very narrow (and low) plurality think it will have a positive impact on the national and state/local economies, job creation, and employee wages, while having a negative impact on income inequality and government debt. A majority, though, don’t believe the corporate tax reduction will benefit average Americans.

A solid majority oppose a government shutdown, and think that Congress should take all necessary steps to avoid it. A majority do not believe funding the Trump wall is important enough to warrant a shutdown. On the other hand, a solid majority think providing hurricane recovery aid to Texas and Florida and Puerto Rico, and increasing defense and homeland security, and renewing CHIP, are worth a shutdown to achieve.

A plurality have unfavorable opinions of Mitch McConnell. Paul Ryan. and Nancy Pelosi. A plurality have no opinion of Chuck Schumer. A plurality have a favorable opinion of Mike Pence.

A narrow plurality have an unfavorable impression of Jeff Sessions (Atty Genl) and Betsy Devos (Education). A narrow plurality have a favorable impression of Rex Tillerson (State), Rick Perry (Energy), Ben Carson (HUD), John Kelly (WH Chief of Staff), with a larger favorable impression of James Mattis. There was a tie between favorable, unfavorable, and never-heard-of for Steve Mnuchin (Treasury).

The plurality have never heard of Tom Price (HHS), Sonny Perdue (Agriculture), Wilbur Ross (Commerce), Elain Chao (Transportation), David Shulkin (VA)or Ryan Zinke (Interior), Scott Pruitt (EPA), Alexander Acosta (Labor).

A majority have an unfavorable opinion of Trump, and of Republicans in Congress. A plurality have an unfavorable opinion of Democrats in Congress, Jared Kushner, Steve Bannon, Kellyanne Conway, Jeff Sessions

A majority have a favorable opinion of Melania Trump. A majority have no opinion of or have never heard of Hope Hicks, Gary Cohn, and Robert Mueller.

Neither side has the plurality in better handling sexual misconduct and harassment, though the Dems fare marginally better than the GOP there.

Almost two-thirds think sexual harassment and misconduct is a big problem in the entertainment industry. A plurality believe that about the news media and the federal government. A majority think it’s at least somewhat of a problem in state and local government, the finance industry, the tech industry, blue collar workspaces, white collar workspaces, Republican politics, and Democratic politics.

Interestingly enough, a plurality say it is not a problem in their own workplace.

Sexual misconduct allegations are considered credible by the majority against Bill Clinton, Harvey Weintein, Bill O’Reilly, Matt Lauer … and (by 53%) Donald Trump.

They are considered credible by a plurality against Roy Moore, Mark Halperin, Charlie Rose, John Conyers, Al Franken.

Sexual misconduct issues are considered pretty much equal in impact between the Republicans and the Democrats, though the Dems are considered marginally better at dealing with such issues. In the case of elected officials, the majority feel that credible accusations should lead to a resignation; leaving it up the voters is a significant minority.

In the specific case of Al Franken, a vast majority thought the Ethics Committee should investigate the matter; a narrow majority thought he should resign; a plurality thought he should be expelled. On the other hand, a significant majority thought Roy Moore should be expelled from the Senate if he wins his election. A large majority think that Congress should formally investigate credible accusations of sexual misconduct even if they occur before the member is sworn in.

The plurality think Trump tells the truth “Never” (33%), and the national news media “Some of the Time” (a significant majority believe some or most of the time). Overall, the plurality believe the national news media over Trump.

A narrow plurality do not consider Trump a strong leader, but do consider him knowledgeable, do consider him racist, don’t think he keeps his promises.
A majority do not think him too liberal, nor think him too conservative; do consider him sexist, do not think him honest or trustworthy, do not think he cares about “people like me,” do not think he is compassionate, do believe he is thin-skinned, and significantly think him reckless

So, Donald — are you going to write big graphic banners for those results, too? “45% approval rating — and racist, sexist, untrustworthy, dishonest, uncaring, uncompassionate, thin-skinned, and reckless.”

I’d pay money to see that tweet.

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How would you feel if your surgery was up to a community vote?

Should the surgery you want — the surgery you feel you need — be circulated among the community and local churches for their approval?




washingtonpost

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Practicing medicine without … a computer?

So this initially heart-tugging tale of a rural doctor who’s been practicing medicine in Maine since 1968, has never bought (or learned how to use) a computer, now being forced out of medicine by the state … has a few more dimensions to it.

1. Not to go all ageist, but should an 84-year-old doctor consider retirement?

2. The state’s issue is that there’s supposed to be reporting from doctors into a database tracking opioid prescriptions. That’s not for nothing, and there’s likely related things a doctor might be asked to report in for public health reasons. If the physician cannot (and will not) do that — is it _un_reasonable for the state to prevent them from practicing?

3. If the doctor in question never touches computers, and has never bothered to learn, does that imply anything about the accessibility to up-to-date information and training that a doctor should be assumed to have? Are they actually keeping up with medical advances?

4. If the only “high tech” the doctor has is a landline phone, how are records for individuals sent to hospitals as needed? Hand-carried? Snail-mail? Is that a concern?

5. If we say, “Well, the doctor works in some poor rural community that desperately needs a doctor, and doesn’t need someone with all the latest-greatest information and databases and toys,” are we also saying that rural communities should have second-rate medical care, or that we’re happy if patients just get the treatment they need 80% of the time, or that our only societal choices for that community are to either have no doctor or have one that doesn’t measure up?

6. People (esp. tax-sensitive people) tend to pooh-pooh the idea of broadband access as a human right. If that’s a (legal, if not also medical) necessity for a doctor to practice in a community … that begins to sound like a human right, or at least societal obligation, to provide such service.

It’s a more interesting story in its implications than at first blush.




Elderly doctor: I lost my license because I don’t know how to use a computer | Ars Technica
Doc says her paper records are just fine—state medical board disagrees.

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How Health Care and the Free Market collide, with unfortunate results

Health Care has faded a bit from the immediate set of Things the GOP Are Doing That Are Going To Hurt A Lot of People (in favor of some other things), but it’s worth bookmarking this particular thought.

The conservative health care counter-reformer insists that the Free Market is the only way to go. “Only when insurance carriers and medical providers are utterly unfettered, unregulated, unmonitored, free to price themselves however they see fit will Americans get the health care they truly need.”

I will assume, for sake of argument, that this is a legitimately believed thing, not a rhetorical device to justify greed and rapine.

The problem is that this argument is demonstrably false. It might be true for, say, hammers. Or pea gravel. Or tea candles. People can buy these things, if they need them, if the price is what they want to pay for them, is the reputation of the seller is suitable, if the distribution model is free to adjust to demand and supply — that all works for basic, simple, commodities.

But it utterly fails for medical care. Because a lot of people who need medical care need it right freaking now or else they may die.

When you are sick, injured, suffering an acute condition or even realizing that you have a chronic condition that needs treatment, your demand is high. You may not have the time to review the best providers, the optimal cost and payment arrangements, the longer-term consequences of particular choices, or the figuring out how to make the short-term arrangements to get the treatment that is needed.

Whether it’s a heart attack or the flu, the demand is inflexible, and the ability to rationally decide upon options is limited.

A system designed for intelligent and empowered consumers who can “take it or leave it” around the transaction will fail miserably applied to health care. Because when you are sick you need and want treatment right now. It’s not like a car purchase, where you can say, “Hmmm, that seems pricey; if they can’t drop their price, I guess I’ll walk away and keep driving my old clunker.” Sick people don’t have that option.

Remember that when someone next suggests deregulating the medical care and insurance industry. Health care and the free market mix very, very poorly.

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“The Miracles of Jesus under Trumpcare”

Ah, Compassionate Conservatism® at its most sacred. What Would Jesus Legislate for Health Care? Find out!

(What’s that you say? The GOP has given up on repealing the ACA? Ha. They’ll hit it from Executive Orders, cut at it by tax reform, attack it through the budget, and do whatever they can to return to the status quo ante, where the Greatest Health Care in the World was available to anyone … who could afford it.)

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When is a “bailout” not a bailout?

It’s demonstrable that arguing Donald Trump’s policy proclamations are incoherent at best, dishonest at worse, is a futile gesture, as neither Trump nor his most rabid supporters care.

But it’s still worth noting, just for the record, that the whole “Obamacare insurance company bailout” argument both incoherent and dishonest, and that’s Trump’s proclamations will drive up both insurance premiums and the federal deficit. But, hey, it might cause the ACA to “collapse,” so it’s a big win for Trumpism, right?




No, Trump Did Not Cancel ‘Bailouts for Insurers’

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“Death Panels” have always been real

One of the great calumnies of the original debate over the ACA — and one still heard today — is that it would set up “death panels” that would make life-or-death decisions over the people they considered worthy or unworthy of spending health care money on. “Your child / grandmother / spouse is of [no] value, therefore they shall be allowed to live [die].” The idea of government bureaucrats passing such judgments was seen to be horrifying, and represented a profound source of paranoia about the ACA.

But as anyone who had ever argued on the phone with an insurance company over coverage already knew, “death panels” (bureaucrats making life-and-death decisions over whom to spend money on or not) have always been with us — in the form of the insurance companies and their internal “Hey, we need to cut our payout spending” committees and “specialists.” Even today, under the ACA, as the attached article demonstrates.

Part of this inevitable — money is a finite resource, and the demand on it is arguably infinite. But we find the making of such decisions, whether for purposes of increased profitability or for some vague tyrannical / political reason, to be revolting. Which lets people accuse the ACA (or single-payer, or whatever other Marxist-Socialist Conspiracy of the Week is getting play in Breitbart) of doing something awful (whether it is or not) which is already a feature of the existing system.

The question, of course, is: given a world of finite resources [1] that are going to be allocated and triaged in some fashion, driven by motivations or goals that may or may not be agreeable, with whom would you rather argue:

1. A private for-profit insurance company who has the last word on what the fine print of the policy really means, and shoals of lawyers to resist any effort to take you to court (or, more likely, forced arbitration with an arbitrating company that is paid by the insurance company itself) if you disagree.

2. A governmental agency [2] that might be just as bureaucratic but which, as a political concern, is subject to public pressure — an outraged Congressman, bad press, etc.?

Neither is ideal, but neither is a world of finite resources, and as the attached story indicates, the idea of a “free market” somehow saving us from all this turmoil and torment is a grave fallacy [3].

Something to consider as the health insurance debate progresses, and Trump and his GOP sometimes-supporters try to turn the clock back to the days when all of these decisions were made with an eye to how to maximize profitability for the insurance companies.

——

[1] Unless you are independently wealthy, in which case there are never any “death panels.” But that’s not how most people feel comfortable thinking of the system.

[2] Again, it’s worth noting that this particular case represents option 1, even though it takes place under the ACA. But let’s assume we’ve moved into a completely nationalized health system.

[3] There’s a reason why the scenes of Bob Parr trapped in a job as insurance adjuster in the early part of The Incredibles resonates so much.




Insurance company sends letter to 9-month-old boy explaining he’s too expensive to keep alive

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When drug companies want MORE side effects

When humans hears a long, laundry list of things, they tend to tune it out. The result?

  • If you list a dozen possible serious side effects of a drug, people will be concerned.
  • If you list a dozen possible serious side effects mixed in with a dozen minor side effects, people will be less concerned.
  • Even if you emphasize the serious ones in larger, bolded red print, people will apparently mentally sum it up as “It side effects,” and be less concerned.
  • (And, I suspect, if you rattle off three dozen side effects as fast as you can in a lower town of voice in the middle of the commercial, it has even less effect.)

I’m pretty sure the pharmaceutical companies are aware of this.




Whoops: Drug ads gloss over risks with a mind trick—that’s backed by the FDA
Drug makers are supposed to be forthcoming with health risks—and the more the better.

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For all you cretins saying “Why bother helping Puerto Rico recover?”

… and then adding, implicitly or explicitly, “It’s not like they’re real Americans anyway, amirite?” Believe it or not, and ignoring the human toll on the island that you seem to be so willing to do (“I mean, they don’t even talk American!”), it appears that PR is a major manufacturing site for pharmaceuticals that save lives of, yes, other Americans on the mainland.

The products affected are smaller-volume bags of sodium chloride, known as saline, and dextrose. These normally ubiquitous solutions are used to rehydrate patients and to dilute medications from antibiotics to painkillers to cancer drugs. Their manufacturer, Baxter International, has said that “multiple production days” were lost in the wake of Hurricane Maria, and it has set up an allocation system for hospitals based on past purchases.

[…] More than four dozen FDA-approved drugmaking facilities are in Puerto Rico, including ones owned by Pfizer Inc., Merck, Eli Lilly, Johnson & Johnson, Bristol-Myers Squibb and Amgen. The plants produce treatments for cancer and HIV, as well as immunosuppressants for patients with organ transplants. Among the top-selling medications manufactured there are the blood thinner Xarelto and the cholesterol drug Lipitor, according to a report by Healthcare & Life Sciences Review.

While some of the plants were damaged, the delays in getting power and water restored have also been an issue, as well as being able to haul via truck and ship in and out raw materials and the finished pharma products. Hell, given the devastation it’s been hard for workers to come into the plants, those which haven’t had to evacuate.

So, yeah, maybe doing more to help those fellow Americans would actually be helpful to all Americans. Crazy idea, I know, but it just might work.




washingtonpost

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Trump panders to theocrats, at the cost of LGBT and Women

Because of course he did.

First off, he expanded the ease of letting companies off the hook for the contraception mandate. “Gee, we’re devoted religiously to not spending money on our female employees to have birth control, because then we can keep their wages down the rest of the time by claiming that they’ll need all this time off for having kids because they keep getting pregnant.”

One new rule offers an exemption to any employer or insurer that objects to covering contraceptive services “based on its sincerely held religious beliefs.” Another regulation offers a new exemption to employers that have “moral convictions” against covering contraceptives.

Because employment is fungible, so anyone who is stuck at an employer who feels their moral stance outweighs the moral stance of their employees can easily just walk out that door and find a job somewhere else, the sluts.

Two rules were issued because just religious objections weren’t enough.

The Trump administration has legal reasons for issuing two rules, one for religious objections and one for moral objections. Most lawsuits attacking the mandate assert that it violates a 1993 law protecting religious liberty. The administration acknowledges that the law, the Religious Freedom Restoration Act, “does not provide protection for nonreligious, moral conscientious objections.”

But, the administration says, “Congress has a consistent history of supporting conscience protections for moral convictions alongside protections for religious beliefs.”

So my headline misspeaks. It’s not just about theocrats, it’s about anyone who has a moral objection. Of course, anyone can claim a “moral” objection. The line between “moral” and pretty much any other justification or bias or hang-up is a short one. Ultimately, this sets a precedent for saying, “If you don’t agree with something in a law, you can just kinda skip doing it.” That’s probably not the message they want to be sending, but I guarantee it will raise further objections to all sorts of laws, which will get selective support depending on what it is and who else dislikes it.

In passing, the Trump Administration further hand-waves off any idea that contraception might be a medical treatment for certain conditions. But it notes it’s doing the nation a favor by making sex less risk-free.

The new rules also suggest that the contraceptive mandate could promote “risky sexual behavior” among teenagers and young adults.

For a serial philanderer, it seems odd that Trump is so gung-ho now about preventing “risky sexual behavior.” Of course, Trump doesn’t really care about these rules; this is Pence / Sessions territory here. Trump is interested only insofar as it solidifies his paradoxical evangelical base.

Meanwhile, the Justice Dept. made it clear that religious objections would apply to more than just nassssty birth control.

The twin actions, by the Department of Health and Human Services and the Justice Department, were meant to carry out a promise issued by President Trump five months ago, when he declared in the Rose Garden that “we will not allow people of faith to be targeted, bullied or silenced anymore.” Attorney General Jeff Sessions quoted those words in issuing guidance to federal agencies and prosecutors, instructing them to take the position in court that workers, employers and organizations may claim broad exemptions from nondiscrimination laws on the basis of religious objections.

Mr. Sessions’s guidance issued on Friday directs federal agencies to review their regulations with an eye to expanding their protections for religious believers. Conservative religious individuals and organizations have objected for years to nondiscrimination laws that have affected whom they can hire and fire, whom they can serve and how they can operate. The new directive affords them far broader latitude.

It’s the “Get Out of Discrimination Laws Free (If You Claim That God Told You It’s Okay To Discriminate)” card. And just the sort of thing that Jeff Sessions (and MIke Pence) salivates over as how the government should work, and how people should be allowed to discriminate willy-nilly (but only the right kind of discrimination).

It’s a sad day, frankly. Conservative religionists (or moralists) have long wanted this kind of protection, without realizing the implications. If someone can fire a person because of religious objections to their behavior, well that may sound great if it’s because they’re dirty homosexuals, or people who have children out of wedlock, or even, maybe, heretics and sinners of a different (or not) faith. What happens when someone says, though, “I have a moral objection to Baptists, because I think they are bad people who discriminate against the innocent, so if I find out one of my employees is Baptist, they’re outta here.” Or perhaps, “I morally consider male circumcision to be child abuse, so I have the right to inquire about any employee with male children, and fire their asses if they’ve done such a thing.”

Those conservatives should remember that discrimination is only a “good” thing when you’re the group in the majority, the group in charge. The demographics do not favor those moral persuasions. Which means their presumptions of being in the majority aren’t necessarily sound ones for long.

Other articles noted or quoted:
— https://nytimes.com/2017/10/05/us/politics/trump-birth-control.html
— https://www.thecut.com/2017/10/trump-administration-roll-back-birth-control-mandate.html




Trump Administration Rolls Back Birth Control Mandate – The New York Times
New rules vastly expand religious exemptions from an Obama-era requirement for employers to include birth control coverage in their health insurance plans.

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You don’t think they’re trying to sabotage the ACA, do you? Well, of course!

Reduced enrollment period, weekend outage windows, reduced assistance budget, reduced advertisement / reminders about enrollment … it’s almost as if they want ACA exchange usage to go down, especially among younger, healthier people, further driving up the price of insurance … which they can then blame on the ACA.

If you can’t fix it, break it!




4 Things The Trump Administration Has Done To Ensure Obamacare Enrollment Is More Difficult This Year
Tom Price failed to get the Affordable Care Act repealed and replaced during his brief tenure as Health and Human Services Secretary, but the surgeon-turned-congressman did manage to do some real d…

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Oh, hey, look, Congress uninsured 9 million children and pregnant women

Though, to be fair, it wasn’t through some intentional belt-tightening free-marketing tax-cutting cruelty-injecting policy action, but by simply never getting around to renewing the CHIP program.

Advocates for children’s health started worrying months ago that congressional incompetence would jeopardize the nation’s one indisputable healthcare success — the Children’s Health Insurance Program, which has reduced the uninsured rate among kids to 5% from 14% over the two decades of its existence.

Their fears turned out to be true. Funding for CHIP runs out on Saturday, and no vote on reestablishing the program’s $15-billion appropriation is expected for at least a week, probably longer. That’s the case even though CHIP is one of the few federal programs that has enjoyed unalloyed bipartisan support since its inception in 1997. The consequences will be dire in many states, which will have to curtail or even shut down their children’s health programs until funding is restored. Hanging in the balance is care for 9 million children and pregnant women in low-income households.

But I’m sure the GOP-led Congress has Top Men working on a solution. Top. Men.

What happened? The simple answer is that congressional Republicans’ last harebrained attempt to repeal the Affordable Care Act got in the way. A funding bill for CHIP seemed to be well on its way to enactment until a week or so ago. That’s when the effort to pass the egregious Cassidy-Graham repeal bill sucked all the air out of the legislative room.

Well, at least they had their priorities straight.




Time’s up: As CHIP expires unrenewed, Congress blows a chance to save healthcare for 9 million children
Congressional dysfunction has placed a healthcare program for kids in jeopardy.

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Arguing about rights is two parts semantics, one part cruelty

Is health care a “right”? Well, US Senator Ron Johnson (R-WI) clearly doesn’t think so. Like food and shelter, he considers them “privileges.”

Do you consider food a right? Do you consider clothing a right? Do you consider shelter a right? What we have as rights are life, liberty, and the pursuit of happiness. We have the right to freedom. Past that point, everything else is a limited resource that we have to use our opportunities given to us so that we can afford those things.

Of course, it’s kind of hard to have that “right” to life (let alone liberty or the pursuit of happiness) without health care, food, or housing. Not that Sen. Johnson (who, with a personal wealth of $36 million is the seventh-wealthiest person in Congress) will ever have to worry about “affording those things.”

I do feel, as a personal philosophy, a need to separate out rights that are intrinsic to an individual, qualities that cannot be taken away but must be respected. The right to personal conscience (speech, religion, etc.) is that sort of thing.

I, myself, do not consider health care and food and shelter a “right” in that same fashion. But I do consider them societal obligations, part of the social contract. If society means anything other than a thinly veiled war of all against all (as Hobbes would put it), then it means banding together to be sure that nobody starves, nobody dies of preventable illness, nobody freezes to death in the street during the winter.

Not that Sen. Johnson, again, will ever have to worry about those things for himself or his immediate loved ones. That he doesn’t worry about them for anyone else, though, speaks volumes.




Republican senator calls health care, food, and shelter a ‘privilege’
Senator Ron Johnson was asked by a high school student whether he considered health care a right.

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It ain’t over ’til the Fat Lady doesn’t worry about her Medicaid being cut off

Yes, it’s great that John McCain seems to have thrown a wrench into the Graham-Cassidy Repeal-and-not-really-Replace mess. But three things to consider:

  1. There’s still a week-plus before the end of the reconciliation period. Plenty of time for someone to cut some deals to get McCain, or Paul, or any other potential hold-outs (maybe even a Dem) to flip to Yes.
  2. That ends the reconciliation-based attempts this year. The clock can start back up again on 1 January. Will the GOP be more or less likely to follow through on this, when they are so close, during an election year?
  3. McCain doesn’t seem to be objecting to the content of the bill, but to how it was shoved through the Senate at breakneck speed, with no CBO score, no input from the Dems, only one brief set of hearings planned, and a minimum 90 second floor debate planned. In theory, if the GOP decide to look like they are playing nice next year, McCain will have no problem voting for a bill that does exactly what Graham-Cassidy does.

The ACA — and Medicaid, and the health insurance coverage for tens of millions of Americans — will remain at risk as long as the GOP holds the White House and both chamber of Congress.




McCain Comes Out Against Last-Ditch Obamacare Repeal Effort
Sen. John McCain (R-AZ) issued a lengthy statement Friday afternoon announcing his opposition to the last-ditch Obamacare repeal effort in…

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