Tamesha Means was only 18 weeks pregnant on the morning of December 10, 2010 when her water broke. In a haze of pain, she called a friend for a ride to the only hospital in her central Michigan county. She had no idea that the hospital, Mercy Health Partners, was part of a Catholic health system. She just knew she needed help.
Eight stitches? That'll be $4,000. (Flickr/Sarah Korf)
Twenty years ago I had my first knee surgery, after tearing some cartilage while skying for a thunderous dunk on the basketball court (or it might have been just falling backward while getting faked out on defense—who remembers the details?). Although I had insurance, I was responsible for a substantial copay, and I vividly recall the one item that stood out among the dozens on the bill. For the two steri-strips that covered an incision—tiny pieces of tape that even today cost about 20 cents retail, and which hospitals buy in bulk so surely cost them just a couple of pennies—I and my insurance company were charged $11, or $5.50 per strip. A miniscule amount in a five-figure bill, but it struck me as the most absurd, since it represented a markup of approximately 10,000 percent, if not more. More recently, I was getting some physical therapy for the same knee, and in what turned out to be a session that wasn't covered by my insurance, a therapist put a piece of kinesio tape around my kneecap. The retail price for that length of tape is around 40 cents (though again, they buy it in bulk so it's probably a quarter of that); and there was the therapist's time to retrieve, cut, and apply the tape, which took about sixty seconds all told. Total tape charge: $75.
My experience is not at all uncommon, as an excellent piece in today's New York Times explains.
As Washington begins to accept applications for the state’s first regulated recreational pot shops, cries of protest about the state’s plans for medical marijuana are coming from unexpected quarters: the left. A year after voters put their state on track to become one of the only places in the world where marijuana can be legally owned and sold for purely recreational use, the state legislature still has to decide what to do with its rickety fifteen-year-old medical marijuana system. With the Department of Justice’s hawkish eyes trained on the state, determined to ensure that the drug, which is still illegal under federal law, remains under strict control, some bureaucrats and lawmakers are afraid that Washington’s unregulated medical marijuana system could doom the whole experiment.
Now that healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of "death panels."
Yesterday, Tim Noah made a point in an MSNBC appearance that I think deserves a lot more attention. Media outlets have been doing lots of reporting on the problems of the Affordable Care Act rollout, but what they haven't done is provided their audiences with practical information that could help them navigate the new system. Of course, most Americans don't have to do anything, since they have employer-provided insurance. But for all the attention we've been paying to the individual market, media outlets haven't done much to be of service. "The New York Times has published the URL for the New York exchange exactly twice," Noah said, "both before October first."
My experience in talking to journalists about the publication of this kind of thing—unsexy yet useful information, whether it's how to navigate a new health law or understanding where candidates stand on issues—is that they often think that addressing it once is enough. When you ask them about it, they'll say, "We did a piece on that three months ago." The problem is that for it to be effective, they have to do it repeatedly or people won't get it. What we have seen is that this information can be found somewhere on news outlets' web sites (here's an example), but it isn't on the evening news broadcast or in the print edition of the paper.
Earlier today, the Supreme Court announced that it would hear not one, but two challenges to the Obama administration’s contraception mandate; they’ll be heard together in an action-packed hour of oral arguments sometime in the spring. Both cases deal with conservatives’ ever-growing penchant for anthropomorphizing corporations—this time, the justices will decide whether companies can be exempted from the mandate to provide birth control at no cost to employees because of the owners’ religious beliefs.
This morning, I was listening to NPR—because yeah, I'm an effete pointy-headed liberal and that's how I roll—and I heard a story about people in California who got insurance cancellation notices, but then wound up getting better coverage and couldn't be happier about it. And the other day there was this story in the Washington Post about droves of poor people in rural Kentucky getting insurance for the first time in their lives—free, through Medicaid—because of the Affordable Care Act. In other words, after spending weeks telling the tales of people losing their health coverage (who in truth could get other health coverage), the media are finally putting at least some attention on the people who are benefiting from the ACA.
And encouraging news seems to be breaking out all over.
More than a few conservatives are of the opinion that should the Affordable Care Act fail to achieve its goals, it would make the adoption of single-payer health insurance in the United States more likely. The reasonable ones who believe this argue that their side hasn't done enough to come up with ideas to address the very real problems in the health care system, so if the ACA doesn't work, they don't have much to offer in response. If the question is, "Well now what?" and their response is, "How about making it impossible for you to sue your doctor if he cuts off the wrong leg? And can I interest you in a health savings account?", the American public may well turn to the big-government solution instead. I've spoken to conservatives who think that scenario is a real possibility. Carnival barkers like Rush Limbaugh, on the other hand, are telling the rank and file that the rocky rollout of the ACA was all part of the secret plan: things would go wrong, and then the socialist in the White House would be able to swoop in and implement single-payer before anyone realized what was happening.
And there are plenty of liberals who would say, "Sounds good to me!" Not that they're rooting for the ACA's problems to remain unsolved, but they are trying to make people understand that the difficulties are a result not of the ACA containing too much government, but of it not containing enough (this is a point I've made myself). But a belief that the ACA's failure would make single-payer more likely fundamentally misreads our political history.
It has been said many times over the last few years that now that Democrats successfully passed a comprehensive overhaul of American health insurance, they own the health-care system, for good or ill. Every problem anyone has with health care will be blamed on Barack Obama, whether his reform had anything to do with it or not. Your kid got strep throat? It's Obama's fault! Doctor left a sponge in your chest cavity? Stupid Obama! Grandma died after a long illness at the age of 97? Damn you, Obama!
OK, so maybe it won't be quite as bad as that, but pretty close. Here's an instructive case in exactly how this plays out
Like Napoleon forging into the Russian winter, anti-choice politicians are loath to give up on abortion restrictions, however minor, until the Supreme Court forces them to. On Wednesday, Arizona Attorney General Tom Horne asked the Supreme Court to reinstate a law that would strip Medicaid funding from doctors and clinics who perform abortions. Poor women already can’t use federal dollars to cover abortion procedures—that’s been illegal since the late 1970s. The law, which was struck down by the Ninth Circuit Court of Appeals in August, instead would prevent the state’s abortion providers from being reimbursed by Medicaid for providing any kind of care to low-income women, whether it’s breast exams, cervical cancer screenings, or contraceptive services.
The Organisation for Economic Cooperation and Development has released their latest health indicators report, and while you may not find 200 pages of charts and graphs on cross-national health comparisons as fascinating as weirdos like me do, let me just point to a couple of interesting things. Most of the findings will be pretty familiar to people who have followed the health care issue in the last few years, but there's at least one thing that surprised me, which I'll get to in a minute. First though, I have to point to this graph, which shows just what an outlier the United States is in terms of what we spend on health care and what we get. It shows the relationship between spending and life expectancy:
Over the course of the past day or so, you may have seen some alarming news: Long-term use of birth control pills, according to a study released at the Annual Meeting of the American Academy of Ophthalmology, may be linked to glaucoma, one of the leading causes of blindness in the US. If you happen to be one of the more than 80 percent of women who has used oral contraceptives during her life, you’d be forgiven for feeling a little nervous. Long-term contraception is pretty much unavoidable for sexually active women who would rather not get pregnant.
Last week, President Obama announced a "fix" to the problem of people in the individual health insurance market getting cancellation notices from their insurance companies: he'd allow the insurers to offer those substandard plans for another year. Does he want the fix to work? We can't read his mind, but depending on how you define "work," it would be better for the Affordable Care Act's ultimate success if it didn't. And as things have played out over the last few days, there are reasons that as a political problem this could fade.
As you may know, insurance markets are governed by officials in each state, and if a state's insurance commissioner doesn't want to allow the substandard plans to be sold, he or she can say no, no matter what the President might want. And a few of those insurance commissioners—from Vermont, Rhode Island, and Washington state—have already said they won't allow it. So what you have here are heavily Democratic states not supporting Obama. But here's the key to the story: those states also chose to run their own health exchanges, and all of them are working well.
We could end up with a situation in which the states that adopt Obama's fix are the ones most opposed to Obamacare, and the states that support Obamacare don't adopt it. And I wouldn't be surprised if that's just fine with Obama.
The argument for the national government administering things over the states has always been summed up, I thought, by an old James Carville joke: I’ll race you from Disneyland to DisneyWorld. I get to take the federal roads.
That joke, however, has been turned upside down by implementation of the Affordable Care Act (ACA). The whole sequence has been weird. After all, the law—as a concession to moderate Democrats who feared Republican attacks about a federal-government takeover—wound up asking the states, and not the federal government, to run the exchanges. But Republican-led states refused to do so. When the federal-run Healthcare.gov crashed, the odd result is that the current winners of the federalism battle—which is often waged, at least rhetorically, by Republicans dead set on keeping the feds out of their local government—are Democratic states such as California and New York where things are running reasonably smoothly. Or at least far better than the federally-run exchanges.