Bushies Are Trying to Kill You

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What else can one conclude from this, except that the Bushies have a dastardly plan to kill us, especially the poorer among us? Arian Campo-Flores writes at Newsweek.com that the Bush Administration is “reforming” Medicaid in a way that will cause emergency rooms and even hospitals themselves to close.

The rule, scheduled to take effect on Sept. 1, deals with the arcane world of Medicaid financing. Two provisions in particular dismay many in the health-care field. One limits states’ ability to tap certain funding sources to meet their Medicaid obligations. The other stipulates that Medicaid reimbursements cannot exceed the cost of treating the Medicaid patient. While that provision may sound reasonable, says Larry Gage of the National Association of Public Hospitals, it doesn’t account for the harsh reality confronting medical facilities that treat large numbers of the uninsured. Since these facilities don’t get reimbursed for that treatment, they rely in part on higher-than-cost Medicaid reimbursements. As a result of the new administration rule, many hospitals may need to make drastic cuts in personnel, beds and more.

Nearly a year ago the Institute of Medicine issued three reports (key findings here) saying the nation’s emergency rooms are inadequate and getting worse. Among other things, it found:

  • Demand for emergency care has been growing fast—emergency department (ED) visits grew by 26 percent between 1993 and 2003.
  • But over the same period, the number of EDs declined by 425, and the number of hospital beds declined by 198,000.
  • ED crowding is a hospital-wide problem—patients back up in the ED because they can not get admitted to inpatient beds.
  • As a result, patients are often “boarded”—held in the ED until an inpatient bed becomes available—for 48 hours or more.
  • Also, ambulances are frequently diverted from overcrowded EDs to other hospitals that may be farther away and may not have the optimal services.
  • In 2003, ambulances were diverted 501,000 times—an average of once every minute.

    • After these reports came out, David Brown wrote in the Washington Post:

    The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.

    This is related to the ongoing controversy over disaster response (quoting the key findings from the National Institute of Medicine linked above):

    The emergency care system is ill-prepared to handle a major disaster. [Drawn from all three reports]

  • With many EDs at or over capacity, there is little surge capacity for a major event, whether it takes the form of a natural disaster, disease outbreak, or terrorist attack.
  • EMS received only 4 percent of Department of Homeland Security first responder funding in 2002 and 2003.
  • Emergency Medical Technicians in non-fire based services have received an average of less than one hour of training in disaster response.
  • Both hospital and EMS personnel lack personal protective equipment needed to effectively respond to chemical, biological, or nuclear threats.

    • That going on six years after 9/11 there has been no coherent effort to prepare the nation for biochemical or nuclear attacks goes way beyond the parameters of incompetence, IMO. The ridiculous Department of Homeland Security tosses money at pork projects and “contractors” (with ties to Republicans in Washington, one suspects) who don’t deliver. Yet to fund tax cuts for the rich and Bush’s pointless Iraq War — which is supposed to be about keeping America safer somehow — Bush’s government lets our ability to respond to disasters go to rot.

    On 9/11 New York City actually had surplus medical emergency response. That day the city’s wealth of world-class medical personnel and state-of-the-art facilities mustered a triage army around the Financial District. (I understand this was done on the initiative of New York City’s medical community; Rudy Giuliani didn’t have to ask.) But the nature of the disaster was such that people either got out, or they didn’t. The crack medical teams had little else to do but wipe bloody noses and wash dust out of eyes.

    But poor New Orleans after Katrina was a different story. Kerry Sanders reported for NBC News on September 2, 2005, that the sick, injured and dead alike were being stacked up at the New Orleans airport:

    The stench of death reeks inside portions of the airport here. Other parts of the airport just smell as any hospital would if there was no way to clean up. It is human misery as people are lying in pain, ailing and wailing.

    The pained screams from patients is like fingers on a chalkboard because there is nothing you can do to reach out and help these people. They have limited medical supplies. They do have aircraft coming in. The C-17s, Storm-30s are moving people out of here as fast as they can. …

    … A reporter is supposed to remain detached and just report what’s going on. But, when there is a man lying on the ground, and he’s yelling out to anyone walking by, “Help me! I need some water! Help me!” and there is no one to help this man.

    The moral is, if you’re ever a victim of a natural disaster or terrorist attack, be sure you’re someplace with really expensive real estate. Increasingly, America’s alleged “best health care in the world” is reserved for the well-to-do. Last year Jane Bryant Quinn wrote,

    America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

    To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.

    But now, in true Bush style, the Bush Administration is going to take a grim situation and make it worse. Let’s go back to Arian Campo-Flores at Newsweek.com:

    The administration calculates that the rule change will reduce federal Medicaid expenditures by about $3.8 billion over five years. But Gage and others estimate the impact on hospitals will be much larger. At Grady, where 42 percent of revenue comes from Medicaid, Kellerman estimates that the hit could total $200 million over five years. “Grady is already struggling,” he says. “This would put it out of business.” Were Grady to close, the consequences would be far-reaching: the hospital is the only Level I trauma center (the highest designation) in a 120-mile radius of Atlanta, and one quarter of Georgia’s physicians are trained there.

    Let’s see; the Bushies have run the National Guard into the ground and now they’re fixin’ to close hospitals. This at the very time that disaster and terrorist attack response is supposed to be a critical priority. Does it get dumber, or what?

    See also: The Mahablog, “Je m’amuse” (June 15, 2006).

    Closing In; Cracking Up

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    As Nico Pitney says, the crackup is in full display.

    In a sign of the growing fissure between the White House and its congressional allies over the war, NBC News reports tonight that 11 Republican members of Congress pleaded yesterday with President Bush and his senior aides to change course in Iraq.

    The group of Republicans was led by Reps. Mark Kirk (R-IL) and Charlie Dent (R-PA), and the meeting included Defense Secretary Robert Gates, Secretary of State Condoleezza Rice, Karl Rove, and Tony Snow. One member of Congress called the discussion the “most unvarnished conversation they’ve ever had with the president,” and NBC’s Tim Russert said it “may have been a defining pivotal moment” in the Iraq debate.

    According to Tim Russert of NBC, one of the congressmen flat out told Bush he has no credibility.

    Also, check out this video from VoteVets.org.

    Update: Details of the new Iraq Accountability Act that may be voted on in the House this week.

    “David Broder is the voice of the people.”

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    This is from an article by Jebediah Reed about wild card Dem presidential candidate Mike Gravel.

    Beaming after the Columbia event, Gravel walks with Alter to a nearby Cuban restaurant for a late lunch. On the way they encounter a gray-haired gentleman in owlish glasses. Alter greets him very respectfully. “This is Tom Edsall,” he says. Edsall was a senior political writer for the Washington Post for 25 years. He retired from the paper in 2006 and now writes for the New Republic and teaches at Columbia Graduate School of Journalism.

    Gravel smiles broadly and says, “Hey, can you straighten out David Broder?” Broder, an influential columnist at the Post and the unofficial godfather of the D.C. press corps, has been a target of much criticism from liberal blogs for seeming to provide political cover for Bush on Iraq, even with a majority of Americans now opposing the war. “He doesn’t believe in the power of the people!” Gravel says. Edsall blinks and looks perplexed. “David Broder is the voice of the people,” he replies matter-of-factly. Gravel starts to smile, assuming Edsall is making an absurdist joke. But Edsall is not joking. The two men look at each other in awkward silence over a great gulf of unshared beliefs, then Gravel chuckles and walks ahead into the restaurant.

    Of course David Broder is the voice of the people.

    … these people.

    Unreal.

    About Time

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    A “short leash” Iraq funding bill could come to a vote in the House as early as tomorrow. Karen DeYoung and Jonathan Weisman report for the Washington Post:

    A House Democratic proposal introduced yesterday that would give President Bush half of the money he has requested for the war effort, with a vote in July on whether to approve the rest, hinges on progress in meeting political benchmarks that Iraq has thus far found difficult to achieve. …

    …The plan would make about $43 billion of the administration’s requested $95.5 billion immediately available to fund the wars in Iraq and Afghanistan, train troops from both nations and pay for other military needs. Congress’s approval of the rest, intended to last through September, would await Iraqi passage of restructuring laws, or Bush’s ability to prove that significant progress had been made. The July vote would mark the first time a mandatory funding cutoff would come before Congress.

    The article doesn’t hold out much hope that Senate Dems will go along with this, but the Post has been wrong before.

    Today the President let it be known that he would veto the new House bill, too even though it makes considerable money immediately available to him with no strings attached. From the Washington Post:

    President Bush would veto the new Iraq spending bill being developed by House Democrats because it includes unacceptable language restricting funding, White House press secretary Tony Snow said Wednesday morning.

    Speaking to reporters aboard Air Force One, Snow said of the bill: “There are restrictions on funding and there are also some of the spending items that were mentioned in the first veto message that are still in the bill.”

    Those “spending items” include provision for equipping state National Guard at pre-Iraq War levels. Note that the House bill does not include a timetable or any restrictions on the U.S. military; the demands it makes are specific and apply to the Iraqi government.

    The BooMan says,

    I don’t think he can hold his caucus together on this veto. I’m not saying the GOP would override his veto, but there will be a lot more defections.

    And that’s the point. Over the past several days I’ve argued several times (most recently here) that a bill-by-bill, vote-by-vote process that peels congressional Republicans away from Bush is the only chance we’ve got to end the war before 2009. The point is to render him so isolated and unsupported he’ll have to either comply or leave office. I think this “short leash” approach has a shot of picking up substantial Republican support, because I think Republicans who face re-election next year are becoming increasingly frantic that the war will cost them their seats. Even if this bill doesn’t draw a veto-proof majority, the next one might, or the one after that. There are a number of Iraq War votes to come before Congress before the end of the year.

    Note that the public overwhelmingly disapproved of Bush’s veto of the last bill.

    Meanwhile, Jonathan E. Kaplan and Elana Schor write at The Hill:

    House Speaker Nancy Pelosi (D-Calif.) is threatening to take President Bush to court if he issues a signing statement as a way of sidestepping a carefully crafted compromise Iraq war spending bill.

    Pelosi recently told a group of liberal bloggers, “We can take the president to court” if he issues a signing statement, according to Kid Oakland, a blogger who covered Pelosi’s remarks for the liberal website dailykos.com.

    “The president has made excessive use of signing statements and Congress is considering ways to respond to this executive-branch overreaching,” a spokesman for Pelosi, Nadeam Elshami, said. “Whether through the oversight or appropriations process or by enacting new legislation, the Democratic Congress will challenge the president’s non-enforcement of the laws.”

    I say again that Bush will accept no constraints whatsoever, no matter how mild and reasonable, no matter what public opinion says. The question is, can he keep this game up for 20 more months?

    Bye, Rudy

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    Word is spreading on the Right like wildfire that Rudy Giuliani freely and of his own volition made several contributions to Planned Parenthood in the 1990s. Apparently a “rival campaign” got this information from Rudy’s old tax returns and leaked it. To the Right, supporting Planned Parenthood is worse than admitting to being a Communist devil worshiper.

    Two points: First, the returns in question were filed jointly with Mrs. Giuliani #2, Donna Hanover. Rudy’s probably going to say the contributions were hers, not his. Second, Planned Parenthood is a great organization on the front lines of the fight for reproductive rights. By providing birth control they probably prevent more abortions than they perform, but of course righties are too thick to understand that.

    Word is also spreading, although more slowly, that Fred Thompson is on record of supporting legal abortion in all circustances in the first trimester. (I suspect Fred’s supporters want to elect the character he plays on Law and Order, not Fred himself.)

    Of course, St. Ronald of Blessed Memory managed to straddle the pro v. anti choice fence nicely by speaking out loudly against legal abortion but not actually doing anything to stop it when he was Governor or President. Before the Alzheimer’s got him I ‘spect he was smarter than he let on.

    See No Evil

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    Susan Saulny and Jim Rutenberg write in today’s New York Times (emphasis added):

    For months, Gov. Kathleen Sebelius of Kansas and other governors have warned that their state National Guards are ill-prepared for the next local disaster, be it a tornado a flash flood or a terrorist’s threat, because of large deployments of their soldiers and equipment in Iraq and Afghanistan.

    Then, last Friday night, a deadly tornado all but cleared the small town of Greensburg off the Kansas map. With 80 square blocks of the small farming town destroyed, Ms. Sebelius said her fears had come true: The emergency response was too slow, she said, and there was only one reason.

    “As you travel around Greensburg, you’ll see that city and county trucks have been destroyed,” Ms. Sebelius, a Democrat, said Monday. “The National Guard is one of our first responders. They don’t have the equipment they need to come in, and it just makes it that much slower.”

    For nearly two days after the storm, there was an unmistakable emptiness in Greensburg, a lack of heavy machinery and an army of responders. By Sunday afternoon, more than a day and a half after the tornado, only about half of the Guard troops who would ultimately respond were in place.

    In a nutshell, the governors of several states have been trying to get the White House’s attention on this matter for months, and they’ve been ignored. The needed equipment and personnel did get to Greensburg eventually, but the response was much too slow. When people are buried under rubble or need rescuing from rising flood waters, response time is critical. “Eventually” is not good enough.

    The issue is not confined to Kansas.

    In Ohio, the National Guard is short of night vision goggles and M-4 rifles, said a Guard spokesman, Dr. Mark Wayda. “If we had a tornado hit a small town, we would be fine,” Dr. Wayda said. “If we had a much larger event, that would become a problem.”

    The California National Guard is similarly concerned about a catastrophic event. “Our issue is that we are shortchanged when it comes to equipment,” said Col. Jon Siepmann, a spokesman for the Guard in California. “We have gone from a strategic reserve to a globally deployable force, and yet our equipment resources have been largely the same levels since before the war.”

    In Arkansas, Gov. Mike Beebe a Democrat, echoed the concerns of Ms. Sebelius. “We have the same problem,” Mr. Beebe said. “We have had a significant decrease in equipment traditionally afforded our National Guard, and it’s occasioned by the fact that it’s been sent to the Middle East and Iraq.”

    Today on the Right Blogosphere, a number of bloggers are using highly cherry picked facts to pretend there’s no problem at all. If someday they are the ones buried under rubble and waiting far too long for rescue, however, I suspect they would reconsider.

    Perhaps people who have never themselves lived through a real disaster — natural or otherwise — simply can’t think past the disaster itself to understand that the response to the disaster can be critical to saving lives. And getting people, infrastructure, schools, businesses, and communities back on their feet as quickly as possible can be critical to economies.