Health Care

When Public Is Better

Flickr/Mirsasha
L ong before we thought of founding The American Prospect in 1989, I came to know Paul Starr through a prescient article titled “Passive Intervention.” The piece was published in 1979, in a now-defunct journal, Working Papers for a New Society . As Paul and his co-author, Gøsta Esping-Andersen, observed, the American welfare state is built on terrible, even disabling compromises. Progressives often lack the votes to pass legislation to deliver public benefits directly. So they either create tax incentives or bribe the private sector to do the job, thus inflating a bloated system. “The problem is not too much government activism,” they wrote, “but too much passivity.” Their two emblematic examples were housing and health care. In housing, tax advantages became an inflation hedge for the affluent and drove up prices. Low-income homeownership programs, run through the private sector, had huge default rates. In health care, the political compromises necessary to enact Medicare excluded...

How to Survive a Miracle

A World AIDS Day display in Mississippi on Dec. 1, 2009. (AP Photo/MSU, Kenny Billings)
This week, a baby from Mississippi was “functionally cured” of HIV after doctors treated her aggressively from the time of her birth with anti-retroviral medications. It's the first time a patient’s system has been cleared of the disease with a regular HIV treatment regimen designed to disrupt the ability of the virus to replicate itself. It opens the door for new research that could, theoretically, lead to a cure for AIDS. But while the breakthrough illustrates how far we’ve come in treating the virus since it was first identified three decades ago, it's also a stark reminder of how little progress we’ve made in fighting the spread of the disease. In the dark days of the 1980s, AIDS patients often found themselves turned away from emergency rooms by fearful hospital administrators, and politicians debated putting HIV-positive people into permanent quarantine. The Oscar-nominated documentary “ How to Survive a Plague ,” which has recently been optioned by ABC for a mini-series, shows...

The Once and Future Gov

AP Photo/Eric Risberg
AP Photo/Eric Risberg A merica’s most futuristic governor seems borne back ceaselessly into the past these days. As he shows me around his office on a crisp winter morning, California Governor Jerry Brown points out not just the desk that his father, Edmund “Pat” Brown, used during his own term as governor from 1959 to 1967 but also photos of his grandparents and his great-grandfather, who came to California in the gold rush years. “He knew John Sutter,” Brown says. The only two governors in the past half-century who were native Californians, he points out, were he and his father. At 74, Brown has lost little of the intensity that impressed and occasionally discomfited voters during his first tenure as governor nearly 40 years ago. His outfit—an open-collar shirt under a white pullover sweater, blue jeans—may be West Coast casual, his shaved head may call to mind the Zen monks with whom he’s studied, but Brown’s emotional repertoire does not include laid-back, except when he’s talking...

The Sequester: A Mental-Health Crisis

Flickr/ranchocanyon
Flickr/ranchocanyon I f you've been reading The New York Times , The Washington Post and hearing statements by Republicans denouncing the sequester "hype," you may have been lulled into thinking that it won't be so bad after all. The country has apparently reacted with a "collective yawn" to the $85 billion across-the-board cuts that began last Friday, the Associated Press proclaims. "The sword of Damocles turns out to be made of Styrofoam," the Times reports. But the sword feels much sharper for families, advocates, and local officials who rely on government funding to treat and care for those with mental illness. Starting April 1 , cuts to the Mental Health Block Grant program alone will deprive over 373,000 seriously mentally ill and seriously emotional disturbed children of services, according to a White House fact sheet . Experts also say that nearly 9,000 homeless people with serious mental illness won't receive the outreach and social-work assistance offered by PATH , a vital...

Republican Rationality on Medicaid

Rick Scott, who surprised everyone and did the right thing. (Flickr/Gage Skidmore)
Florida governor Rick Scott, with his skeletal frame, shiny bald pate, nine-figure fortune possibly obtained at least partially through Medicare fraud, and love of humiliating poor people, resembles nothing so much as a comic-book villain. So it was something of a surprise when he announced yesterday that he is reversing his previous position and will allow poor Floridians to receive Medicaid coverage as provided for in the Affordable Care Act. It isn't hard to explain why: the federal government is paying 100 percent of the cost of new enrollees in the first few years, and nearly all the cost thereafter, meaning for a small investment on the state's part it gets a healthier, happier, more productive citizenry. Only a truly despicable politician would turn it down, preferring to see their constituents go without health insurance than get it from the government, as I've argued (OK, "raged" is more like it) before. After the Supreme Court said it its Obamacare decision that states could...

Guns—Not the Mentally Ill—Kill People

Flickr/JenXer
Flickr/JenXer A fter a year of violent tragedies that culminated with the elementary school shooting in Newtown, Connecticut, America is finally having a conversation about gun control. For the many who want to decrease access to firearms in the wake of several mass shootings, new laws being proposed around the country to limit and regulate guns and ammunition represent a momentous first step. But running through the gun-control debate is a more delicate conversation: how to handle mental-health treatment in America. Among both Democrats and Republicans, in both the pro-gun and anti-gun lobbies, there’s a widespread belief that mental-health treatment and monitoring is key to decreasing gun violence. Shining more light on the needs and struggles of the mentally ill would normally be a positive change; mental-health programs and services have been cut year after year in the name of austerity. But in the context of gun violence, those with mental illness have become easy scapegoats...

A Contraception Compromise

Stacy Lynn Baum / Flickr
Last year, as part of implementation for the Affordable Care Act, the Obama administration rolled out a rule on contraception that inspired a huge backlash from religious conservatives and began the “war on women” fight that extended through the presidential campaign. In short, Health and Human Services required all employers to include contraception in health insurance plans, without extra charge. Religious institutions could receive an exemption as long as they met particular requirements: Said organizations had to be nonprofits who mainly employed co-religionists, and had “the inculcation of religious values” as their primary purpose. This definition precluded exemptions for certain religious charities—like Catholic hospitals—which prompted a variety of lawsuits, as well as a huge political spectacle that tarnished Republicans for the rest of the year. But the Obama administration listened to complaints, and has adopted a new definition of “religious organization” that’s a little...

Mississippi's Last Abortion Provider

Flickr/kbrookes
T welve years ago, Dr. Willie Parker was at home listening to Martin Luther King, Jr.’s “I’ve been to the mountaintop” sermon. Parker had heard the words many times before. But this time, he found himself focusing on King’s interpretation of the Bible story of the “good Samaritan,” who stopped to help a man who had been left for dead by robbers. Though others had passed the man by, the Samaritan stopped, King explained, because he didn’t think about the harm that might befall him if he did. Instead, he asked what might happen to the dying man if he did not. Parker, an ob-gyn who had been practicing for 12 years at the time, suddenly felt that King’s words held meaning for his own work. Having grown up in a religious family that was active in the Baptist church (Parker was “born again” and preaching the gospel at 15), he had been brought up to believe that abortion was wrong. Up to that point, he had never provided one. He’d refer women to other providers, but was too conflicted about...

The Demographics of Abortion: It's Not What You Think

Why does the ’70s-era image of the white, middle-class teenager as the typical abortion patient persist?

AP Photo
In the 40 years since Roe v. Wade , quite a bit has changed about the abortion debate. Evangelicals have taken the helm of the anti-choice movement, once dominated by Catholics. The movement has shifted strategies repeatedly—from stoking moral outrage and blocking abortion clinics to feigning concern for women’s health and, most recently, passing innocuous-sounding building regulations aimed at eliminating access to abortion. For its part, the pro-choice movement has mellowed since the days radical feminists crash ed town halls into a professionalized juggernaut of lobbyists and lawyers with a mighty service arm known as Planned Parenthood. But one thing that hasn’t changed since 1973 is the public image of what a typical abortion patient looks like: A middle-class, white high-school or college student with no children whose bright future could be derailed by motherhood. Hollywood portrayals of abortion patients are few and far between, but largely reinforce this understanding; Juno...

Looking Back at Pro-Choice's Battles

AP Photo/Nick Ut
(AP Photo/Doug Mills, file) In this April 5, 1992 file photo, pro-choice demonstrators gather on the Ellipse near the White House in Washington. For many abortion-rights activists, the debate over health care reform has been frustrating, even disheartening, as they see their political allies on the defensive over the issue and their anti-abortion rivals on the attack. It's been 40 years since the Supreme Court's landmark decision over a woman's right to choose in Roe v. Wade . How has the landscape over the issue of abortion and the politics of reproductive health changed since? Here's a round-up of our best coverage over the past decade on the changing climate, both in public opinion and in legislatures inside the Beltway and out, over abortion. 2012's War on Women , E.J. Graff "For the ladies, the year’s sound track could have been a strangled gasp, followed by snorting and laughing out loud. The attacks on women’s health, on contraception, on abortion, on the definition of rape—it...

What's Left of Roe

Barack Obama's re-election might make the landmark decision safe for now, but its meaning has eroded over the years.

(AP Photo/Pablo Martinez Monsivais, file)
Since the ruling was handed down 40 years ago today, Roe v. Wade— which held that the constitutionally guaranteed right to privacy included a woman's right to choose to have an abortion—has been subject to an ongoing legal and political assault. This assault has not succeeded in getting the decision overturned. But it has caused the scope of the opinion to become narrower in ways that have disproportionately affected the rights of women of color, poor women, and women in isolated, rural areas. The re-election of Barack Obama might make Roe safe for the time being, but it is worth taking stock of how its meaning is being eroded and what the future battles would be. The first major conservative victory in the struggle to narrow Roe v. Wade was the Hyde Amendment, which prohibited Medicaid funds from being used to provide abortion services. The Hyde Amendment split the pro- Roe v. Wade coalition on the Supreme Court, and was ultimately upheld in a 1980 5-4 decision . Three of the...

The Great and Terrible News about American Health Care

This is how much people elsewhere love their health systems. (AP Photo/Jae C. Hong)
If you've been paying attention to debates on health care over the last few years, you're probably aware of how poorly the American system performs compared to other similar countries. We're the only advanced industrialized democracy that doesn't provide universal health coverage to our citizens, and though there are many variations in those systems ranging from the completely socialized (as in Great Britain) to the largely private but heavily, heavily regulated (as in Switzerland), they all do better than we do on almost every important measure you could come up with. That's the big picture. But a new report from the National Research Council and the Institute of Medicine compared the United States to 16 similar countries (mostly in Europe but including Canada, Australia, and Japan) on a range of health measures has some fascinating details. Unsurprisingly, the United States comes out at or near the bottom on most measures of health. We have the highest infant mortality, the highest...

Just What Workers Need: More Labor Civil War

AP Photo/Corpus Christi Caller-Times, Rachel Denny Clow
As a rule, most merger or affiliation announcements between two organizations tend to the celebratory: Each group brings a proud history and now have joined together to create an even prouder future, yadda yadda. But not last Thursday’s press release from the California Nurses Association/National Nurses United (CNA), which proclaimed its affiliation with the National Union of Healthcare Workers (NUHW) in an announcement largely devoted to attacking the presumed perfidy of the Service Employees International Union, with which NUHW has been engaged in a prolonged blood feud that puts the Hatfields and McCoys to shame. Broadly speaking, SEIU and CNA are the nation’s two pre-eminent health-care worker unions, with CNA the leading organization of registered nurses and SEIU representing close to one million hospital orderlies and nursing home attendants. In 2009, after the two groups had waged a number of bitter organizing campaigns against each other for the right to represent the same...

New Year, New Abortion Restrictions

Flickr/NARAL Pro-Choice Virginia
Virginia Governor Bob McDonnell obviously wasn't looking for any attention when he certified a set of new regulations last week that could shutter many abortion clinics in the his state. The Republican certified the new requirements on the Friday between Christmas and New Years, and chose to forgo a public announcement about his decision. But low-profile or not, the decision is an scary one for the state's 20 abortion clinics, which now must get to work to comply the 2010 building code for hospitals. That means a lot of very costly changes that have no bearing on the work these clinics do, like widening hallways and doorways and installing hands-free sinks (the kind that automatically turn on when you put your hands underneath the faucet). Advocates for reproductive rights say many of the state's 20 abortion facilities could be forced to close—which is, of course, the whole idea. But McDonnell's decision to make the move as quietly as possible indicates a significant change in the...

A Cleared Bill of Health

Flickr/Robert F. W. Whitlock
Flickr/Robert F. W. Whitlock T here have been few more consequential years in the history of health care in America than 2012. This year saw disasters averted, new problems identified, and hope triumphing over despair. The biggest health-care news in 2012 was the dramatic and surprising decision by the Supreme Court in late June to uphold (for the most part) the Affordable Care Act (ACA). Chief Justice John Roberts shocked his Republican admirers by siding with the liberals on the Court to affirm the constitutionality of the law's individual mandate as a tax, though he also gave Republicans a way to fight back by saying the federal government couldn't force states to accept what is arguably the law's most significant feature: its dramatic expansion of Medicaid. So, as the ACA began moving toward full implementation in January 2014, governors and legislators in Republican-dominated states did whatever they could to undermine its future success, or at the very least not contaminate...

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