Category Archives: Health Care

Poor Whites Obey Republican Party and Die Sooner

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Seriously, this is a startling statistic — American white people without a high school diploma have lost four years of life expectancy since 1990. Four years is a lot.

And lesser-educated white women got smacked worse — they lost five years of life expectancy, while the men lost only three.

Interestingly, the life expectancy of blacks and Hispanics without high school diplomas increased in the same time period; see the charts. What appears to be happening is that the life expectancy of less-educated whites is leveling off to be the same as less-educated African Americans. It seems whiteness alone is not the built-in advantage it used to be.

The reasons for the decline remain unclear, but researchers offered possible explanations, including a spike in prescription drug overdoses among young whites, higher rates of smoking among less educated white women, rising obesity, and a steady increase in the number of the least educated Americans who lack health insurance.

Another factor to consider is that the percentage of Americans without a high school diploma is a lot smaller now than it was in 1990. Americans without a high school diploma made up 22 percent of the population in 1990 and are now 12 percent. The whites remaining in the no-diploma pool may be those who are just plain not coping with life in the 21st century very well, for one reason or another. I’d be interested to know if this group is disproportionately living in rural rather than urban areas; the article doesn’t say. And whatever is slamming the less-educated whites is not affecting less-educated nonwhite Hispanics.

Medicare Getting Stingier With Power Scooters

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It’s been a couple of years, but I’m sure many of you remember Matt Taibbi’s description of a Tea Party rally in Kentucky:

Scanning the thousands of hopped-up faces in the crowd, I am immediately struck by two things. One is that there isn’t a single black person here. The other is the truly awesome quantity of medical hardware: Seemingly every third person in the place is sucking oxygen from a tank or propping their giant atrophied glutes on motorized wheelchair-scooters. As Palin launches into her Ronald Reagan impression — “Government’s not the solution! Government’s the problem!” — the person sitting next to me leans over and explains.

“The scooters are because of Medicare,” he whispers helpfully. “They have these commercials down here: ‘You won’t even have to pay for your scooter! Medicare will pay!’ Practically everyone in Kentucky has one.”

A hall full of elderly white people in Medicare-paid scooters, railing against government spending and imagining themselves revolutionaries as they cheer on the vice-presidential puppet hand-picked by the GOP establishment. If there exists a better snapshot of everything the Tea Party represents, I can’t imagine it.

I’m sure that not “everybody” in Kentucky got a power scooter. But it appears the power scooter industry is very unhappy with the feds days, because they’re tightening up on the power scooter give-a-ways.

Wheelchair suppliers raised concerns Wednesday about a new government program that requires Medicare contractors to sign off before power wheelchairs can be delivered to elderly and disabled consumers.

Federal health officials countered that the changes are needed because nearly 80 percent of the power wheelchair claims submitted to Medicare don’t meet program requirements. That error rate represents more than $492 million in improper payments annually.

Reading between the lines a bit — it seems two different kinds of fraud have been going on. Some people in the motorized scooter industry are making money on improper payments, obviously. But it also appears some of the old folks are being scammed into thinking that they’re getting a free chair and only find out after delivery that they have to pay for it, because they don’t meet Medicare requirements for getting it for free.

So in a test program, Medicare is tightening up on the motor-scooter-application process. The old folks have to meet face-to-face with a doctor first, who writes a prescription for the chair. Then an authorization request is sent to Medicare by either the doctor or the chair supplier. The chair cannot be delivered until after Medicare has approved the request.

An attorney for the Scooter Store complained that every request submitted under the new program has been denied. Can’t be good for business, I guess.

I shouldn’t be too sanguine about the power scooters, since with all my back issues I may end up needing one someday. But I have long wondered about all the advertisements on the teevee, whether there was really such a big volume of Medicare-paid scooters that it warranted the advertising. So now we know, there isn’t.

Daily Caller: 83 Percent Propaganda

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From the Daily Caller:

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

From SourceWatch:

The Doctor Patient Medical Association (DPMA) and the Patient Power Alliance (PPA) work to repeal health care reform and call themselves a “a nonpartisan association of doctors and patients dedicated to preserving free choice in medicine.” The organization is a member of the National Tea Party Federation and the “American Grassroots Coalition.”

Republicans Don’t Do Health Care Reform

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I hesitate to call any part of the Republican Party “pragmatic,” but apparently some of them have some sense that the entire American public might not see things the way they do.

So over the past several days I’ve seen news stories saying some congressional leaders want to keep some parts of Obamacare. The fix they are in is that some parts of the ACA are now in effect, and most of those parts have proved to be popular.

For example, 2.5 million young adults are now insured on their parents health care plan who couldn’t get insurance before. To date, the ACA has said Medicare recipients $3.5 billion on prescription drugs. Several hundred thousand seniors have taken advantage of the various free preventive care screenings now available to them. This summer $1.3 billion in rebate checks are going out to people who were overcharged for their insurance.

On top of that, if the Supremes strike down the ACA this summer, the Medicare system could be thrown into chaos, at least temporarily.

So, over the past few days I’ve seen several news stories saying that some congressional Republicans are planning to keep the “good” Obamacare bits. In particular, they want to keep the provision that allows children to stay on their parents’ insurance until age 26; they want to eliminate the prescription drug doughnut hole; and they want to provide that insurance companies have to insure people with pre-existing conditions.

However, as soon as one of these stories comes out, another story comes out saying that other congressional leaders demand complete and unconditional repeal. No walkbacks. John Boehner seems to take both positions, on alternate days.

At TPM, Sahil Kapur writes that Republicans are being warned not to go wobbly on Obamacare.

FreedomWorks and Club for Growth, two powerful conservative interest groups that are fresh off of purging the Senate’s longest-serving Republican for insufficient fealty to the right, are flexing their muscles.

“The Club for Growth supports complete repeal of Obamacare. And complete doesn’t mean partial. It means complete,” said Barney Keller, a spokesman for the group. “We urge the so-called ‘tea party’ Republicans to keep their promises to voters and continue to fight for complete repeal as well.”

The “pragmatists,” relatively speaking, want to have a fallback position in case the ACA is entirely overturned and the benefits people had begun to enjoy from it dry up. They want to be able to say to voters that they can still have their 20-something children on their health care benefits and that the doughnut hole can still be closed.

As for insurance for pre-existing conditions, there is no way the private insurance industry can do that without the individual mandate, a complication that Republicans refuse to address. But the ideological purists don’t want to promise anything.

Dean Clancy, who leads health care advocacy for FreedomWorks, said the group “would be very concerned about bills to resurrect parts of Obamacare.”

He said Republicans should take no responsibility for the broken system that would result.

“It would be the height of folly for Republicans to say, OK, this is our problem now,” he said. “It’s not the Republicans’ fault if 25-year-old slackers suddenly are dropped from mom and dad’s health insurance policy. It’s not the Republicans’ fault if various other provisions of Obamacare are no longer on the books. … The American people need to have a chance to reflect on the fact that the Democrats basically rammed an unconstitutional bill down their throat.”

We could quibble about who is ramming what, and where.

A few days ago Jonathan Chait recalled that Republicans promised a comprehensive health care reform plan in 1993, when they defeated “Hillarycare.”

In 1993, Bill Clinton tried to reform health care, and it appeared a strong enough threat that Republicans devised their own plan in response. It was a great way to send the message “we have a plan, too.” When Clinton’s plan collapsed, he made feelers toward the GOP plan, but Republicans turned against it, promising instead to start over in the next Congress.

For the next sixteen years, Republicans did zero to advance the cause of comprehensive health-care reform.

I don’t remember them even talking about it, except to pooh-pooh people who complained about the health care system. We have the best health care system in the world, after all [/sarcasm].

In 2009, President Obama started working on health-care reform, and Republicans again insisted they really truly did want to reform the health-care system, just not in this particular way. Plan? TBD. Then they won control of the House and promised to immediately get to work on a replacement plan. Result: zero. Evidence of any progress toward said plan: zero.

Recently Rep. Paul Ryan told editors of the Washington Examiner that it would be a mistake for Republicans to offer any specific legislation before the November election. Instead, they should offer a “vision.” I take it “vision” is the new “bullshit.”

Back to Jonathan Chait:

In the same interview, Ryan says maybe Republicans will reform the deductibility of health insurance: “On tax treatment of health care, some of our folks really like deductions, others like the tax credit route.” That sounds like a possible first step. Except the Ryan budget already assumes that it will close trillions of dollars in tax deductions like that for employer-provided health care, and then it plows all that revenue back into lower tax rates. So, no money for tax credits or any other way to support health insurance.

The health care system is very complicated and made up of countless moving parts that have to work together. That’s why the ACA was so long and complicated. I think Republicans are not intelligent enough to come up with their own legislation, and I will believe that until they prove me wrong and come up with something. And at the rate they are going, I won’t live long enough to see that.

Right’s Idea of Bias: Any News That Might Reflect Well on Obama

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In an article called “Spin of the Times: Bias cloaked as Front-Page News,” Glenn Reynolds of Instapundit complains that the New York Times runs news stories that are biased in favor of “Democrats and leftish ideas.”

His example of this is a recent article called “In Hopeful Sign, Health Spending Is Flattening Out.” The article looks at the fact that health care costs in the U.S. have risen much less sharply than expected in the past couple of years, which of course is good news to anyone who cares about, you know, American citizens and the American economy.

Is the story biased toward “Democrats and leftish ideas”? Here’s the weird part — Reynolds does not show that the article misrepresents or leaves out facts to make the article appear to be favorable to the Left. He quotes the article itself to argue that some of the cost slowdown is because of the recession, not because “Obamacare” is working.

The article is full of caveats and to-be-sures like this: “The growth rate mostly slowed as millions of Americans lost insurance coverage along with their jobs. Worried about job security, others may have feared taking time off work for doctor’s visits or surgical procedures, or skipped nonurgent care when money was tight.” Or this: “Some experts caution that there remains too little data to determine whether the current slowdown will become permanent, or whether it is merely a blip caused by the economy’s weakness.”

But, we’re told, “[M]any other health experts say that there is just enough data to start detecting trends — even if the numbers remain murky, and the vast complexity of the national health care market puts definitive answers out of reach.”

At this point, an editor might have spiked the story, commenting that all we’ve got are dueling experts who admit that they don’t really know what’s going on amid their “murky” numbers.

But the story is that health care costs in the U.S. have risen much less sharply than expected in the past couple of years. This is from the article:

In 2009 and 2010, total nationwide health care spending grew less than 4 percent per year, the slowest annual pace in more than five decades, according to the latest numbers from the Centers for Medicaid and Medicare Services. After years of taking up a growing share of economic activity, health spending held steady in 2010, at 17.9 percent of the gross domestic product….

… The implications of a bend in the cost curve would be enormous. Policy makers on both sides of the aisle see rising health care costs as the central threat to household budgets and the country’s fiscal health. If the growth in Medicare were to come down to a rate of only 1 percentage point a year faster than the economy’s growth, the projected long-term deficit would fall by more than one-third.

That’s a significant bit of data. Just because the data don’t clearly show why it’s happening doesn’t mean it isn’t happening.

If you read the New York Times story — which Reynolds doesn’t link to, of course — you see that it provides a number of possible reasons for the slowdown in cost increase, some of which reflect well on the Obama Administration and some of which do not. And it provides the “bad for Obama” possible reasons first, before going on to the “maybe Obama’s policies have something to do with this” reasons. Reynolds quotes those “bad for Obama” reasons with approval and then complains the article is biased because … well, why? Because it then goes on to provide some “good for Obama” reasons as well?

What Reynolds is saying is that this bit of news must be suppressed until someone can show decisively that it’s really a bad thing that is all Obama’s fault.

And what makes this even more hysterical is that Reynold’s piece is published in the New York Post, one of the nation’s foremost purveyors of pure, old-fashioned yellow journalism. For example, in today’s Post there’s an article by a guy named Glenn Reynolds with an alarming headline about spin and bias at the New York Times, but if you read the article it’s just a highly biased piece about a Times article that really isn’t biased at all. Reynolds just doesn’t like it because it isn’t anti-Obama enough for his taste.

Mitt’s Radical Health Care Plan

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IMO the biggest mistake made by the Obama Administration regarding the Affordable Care Act was not failing to include a public option. It was the fact that the Administration didn’t saturate the nation’s media with public service ads explaining clearly how it would work when it all went into effect. And because most of the big stuff in the law wont go into effect until 2014, the Right has had plenty of time to lie and frighten people into thinking “Obamacare” will kill Grandma.

Polls continue to show that more people than not don’t like the ACA (although one suspects many of the “don’t likes” are liberals who want single payer). So the Right has been vowing to “repeal and replace” the ACA. However, they flounder a bit on the subject of what “replace” will mean.

Now we’re beginning to get some idea of what Mittens would do as president, and it’s not pretty. He’s essentially warming up John McCain’s ideas from the 2008 campaign. For those of you who don’t remember, McCain’s basic idea was to eliminate the tax exclusion for employers who provide health insurance benefits, thereby phasing out such benefits and dumping everyone into the private market. Then, the miracle of “free market competition” would cause insurance costs to go down and provide people with better options. That’s the theory, anyway.

But Mittens also has to steer away from anything resembling his Massachusetts plan, because it’s too much like “Obamacare.” So, says Brian Beutler,

… neither Romney nor McCain’s plans allow individuals to pool risk in insurance exchanges, require insurers to sell insurance to all comers without price-discriminating against sick people or fight the adverse selection problem by requiring both sick and healthy people to enter the pool. Romney isn’t calling for those reforms — because though they would solve the problems with his outline, they would also add up to “Obamacare.”

In short … this would be a nightmare. It would be all the bad things about the long-standing status quo, but on steroids.

On top of that, Romney has embraced some version of Paul Ryan’s Medicare plan, privatizing Medicare and providing seniors with subsidies to buy insurance on the private market. And he wants to eliminate Medicaid and just give block grants to the states to come up with their own programs to provide health care for the poor. In many states, that’s pretty much guaranteeing that the poor will be left to heal themselves.

See also Jon Healey, “Mitt Romney vs. employer-provided healthcare insurance.”

Eat It, Scalia

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I haven’t had a chance to react to this week’s Supreme Court drama. So let me just link to some other reactions.

Dahlia Lithwick was reasonably upbeat after the first day of arguments. Not so by the end of it. “It’s not a good day for the Affordable Care Act,” she writes. “This morning’s argument requires the justices to start from the assumption that the court will strike down the individual mandate (the issue argued exhaustively yesterday) and asks them to pick over the carcass, to determine what, if anything, survives.”

The most illuminating comment is by Charles Pierce.

I think Justice Antonin Scalia isn’t even really trying any more….He hung in there as long as he could, but he’s now bringing Not Giving A Fuck to an almost operatic level….

…It is plain now that Scalia simply doesn’t like the Affordable Care Act on its face. It has nothing to do with “originalism,” or the Commerce Clause, or anything else. He doesn’t think that the people who would benefit from the law deserve to have a law that benefits them. On Tuesday, he pursued the absurd “broccoli” analogy to the point where he sounded like a micro-rated evening-drive talk-show host from a dust-clotted station in southern Oklahoma. And today, apparently, he ran through every twist and turn in the act’s baroque political history in an attempt to discredit the law politically, rather than as a challenge to its constitutionality.

See also John Cole, who has a long roundup of many other reactions. Worth reading.

Update: Krugman —

Given the stakes, one might have expected all the court’s members to be very careful in speaking about both health care realities and legal precedents. In reality, however, the second day of hearings suggested that the justices most hostile to the law don’t understand, or choose not to understand, how insurance works. And the third day was, in a way, even worse, as antireform justices appeared to embrace any argument, no matter how flimsy, that they could use to kill reform.

We’re been calling the Roberts court “corporatist,” but the weird thing here is that the insurance industry wants the mandate. This reveals at least some of them to not be so much pro-corporation as pro-Republican Party.

Anyone else who doesn’t get why the broccoli defense is stupid needs to read Krugman’s entire column.

Update: “Justice Scalia is an oxymoron.”