Health Care

Republicans on the ACA: Wrong, but Rational

Courtesy of earloftaint.com
I find it strange," said Barack Obama on Thursday as he announced that the total of Americans getting private insurance through the exchanges has now exceeded 8 million, "that the Republican position on this law is still stuck in the same place that it has always been. They still can't bring themselves to admit that the Affordable Care Act is working." But it really isn't so strange. The Republicans' continued refusal to grant that anything good could possibly come from a law they've fought so bitterly for five years, even as encouraging news continues to roll in, is quite understandable. What's more, it's perfectly rational, even when all the predictions they made about its inevitable self-destruction fail to come true. Therein lies one of the paradoxes of our politics: At times, the most rational politician is the one who appears to be acting like a fool. Let's say that you're a Republican running for Senate. Perhaps you're whichever congressman will out-crazy his primary opponents...

Would You Let a Robot Give You a Sponge Bath?

Getting ready for their shift on the pediatric ward. (Kai Schreiber/Wikimedia Commons)
Imagine it's 50 years from now, and you've checked into the hospital for a minor surgery that will require you to spend a couple of nights there. There's a nurses' station down the hall, but you know that the nurses are also caring for lots of other patients and may not be able to come quickly when you have a need, particularly if it isn't an emergency, like getting a hand walking to the bathroom, or having someone pick up the TV remote you dropped, or maybe getting a foot rub just because that would be nice. Upon checking in, the clerk says to you, "I see that your insurance provides for a robotic aide while you're here. Is that something you'd like?" What are you going to say? According to a survey the Pew Research Center did on people's feelings about future technologies, most people would say "No thanks"—or at least they think so now. The survey is fascinating in part because many of the results seem (to me anyway) to be ridiculous. For instance, 39 percent of respondents think...

The Abortion Restriction That’s Too Extreme for Most Pro-Lifers

AP Images/The Columbus Dispatch/Brooke LaValley
E arlier this month, lawmakers in Kansas ended this session’s debate over abortion on a surprisingly low-key note. The Republican leadership shepherded two minor tweaks to existing abortion policies through the legislature, while staving off a far more contentious measure: a bill that would criminalize abortion after a fetal heartbeat can be detected, as early as six weeks into a pregnancy. The bill’s advocates say they are confident it would have passed, had it reached the floor; Kansas has strong anti-abortion majorities in both houses of the legislature and pro-life crusader Sam Brownback in the governor’s mansion. But the Republican leadership, prompted by the state’s most powerful pro-life group, Kansans for Life, used a legislative loophole to keep their more radical colleagues from attaching the fetal heartbeat proposal. Why, in a state where nearly every strain of anti-abortion restriction has taken root with ease, are advocates of the fetal heartbeat ban facing such stiff...

The Most Expensive Health Care In the World

The high-grade stuff.
As a reader of this web site, you are informed and aware, so you no doubt saw the stories that came out yesterday about the data trove the government just released on what individual doctors bill Medicare. The shocking news was that some have managed to charge the government millions of dollars, including one ophthalmologist, Salomon Melgen, who billed Medicare an incredible $21 million in 2012 alone, and who just happens to be caught up in an investigation of influence peddling with a Democratic senator. But before this story disappears with some head-shaking about scandal and fraud, we should take note of what it teaches us about why we have the most expensive health care system in the world. A lot of people had the same reaction to that detail about the Florida ophthalmologist: How on Earth is it possible for one doctor to bill $21 million to Medicare in one year? The good doctor's answer is that he has a large practice, but the biggest reason comes down to one word: Lucentis. It's...

Fetal Abnormalities: The Next Minefield in the Abortion Wars?

AP Images/Steve Helber
I n January, two legislators in Virginia’s House of Delegates introduced a bill that should have been uncontroversial. The bulk of HB 612 created new rules for genetic counselors practicing in the state, who had been unregulated and unlicensed. The roughly 95 genetic counselors already working in the state, screening pregnant women and adults for serious inheritable conditions, favored the law, which they saw as an extra layer of patient protection. The bill was so innocuous that by the time it passed in the House in late February, no one seemed to have noticed that it contained a conscience clause so sweeping that could allow counselors to refuse to provide fetal test results for conditions like Down Syndrome or Tay-Sachs Disease—the information patients came to them for in the first place—if they believed it could cause a woman to terminate her pregnancy. Originally, the bill had only created a loophole for genetic counselors who want to refrain from offering information about...

How Barack Obama Trapped the GOP On Health Care

It was all downhill from here.
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy. By now you're well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as "guaranteed issue"), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use...

Laying It All Out On Medicare

Flickr/Donkey Hotey
The release of a new Paul Ryan budget plan is always the occasion for a lot of ridicule from liberals, for a whole bunch of reasons, and this year's will be no different. Ryan's budgets always manage to combine a remarkable cruelty toward poor people with a sunny optimism that draconian cuts to social services will result in a veritable explosion of economic growth, allowing us to balance the budget without taking anything away from the truly important priorities (like military spending) or, heaven forbid, forcing wealthy people to pay more in taxes. I'm sure there are other people preparing detailed critiques of the Ryan budget, but I want to focus on one thing this brings up: the question of how we talk about Medicare. As he has before in his budgets, Ryan proposes to repeal the benefits of the Affordable Care Act, like subsidies for middle-class people to buy insurance and the expansion of Medicaid, but he'd keep the tax increases and Medicare cuts that the bill included in order...

Sunday Show Becomes 10 Percent Less Awful

Look! People who know what they're talking about!
A week and a half ago, I wrote a post over at the Plum Line with a couple of suggestions for how the Sunday shows could become less terrible. Some commenters pointed out that the real audience for these programs isn't actual people, but those within the Washington bubble for whom status and influence are everything. So my suggestion that the shows should never again interview a White House communication director or a "party strategist" of any kind—in other words, people who are there solely for the purpose of spinning—was unlikely to get much of a hearing. And my suggestion to drastically scale back on interviews with elected officials, who are also exceedingly unlikely to say anything interesting, would likewise fall on deaf ears. Which is perfectly true, and it hasn't stopped me from complaining about this topic before. But lo and behold, on yesterday's Meet the Press, something remarkable happened: They booked Jonathan Cohn of The New Republic and Avik Roy of Forbes to talk about...

Is the "Mend It" Period of the Affordable Care Act's Evolution Beginning?

All of a sudden, people in Washington seem to want to fix the Affordable Care Act. And regardless of their motivations, that should be—well, maybe "celebrated" is too strong a word, but we can see it as a necessary and positive development. Is it possible that the arguments about whether the ACA was a good idea or should have been passed in the first place are actually going to fade away, and we can get down to the businesses of strengthening the parts of it that are working and fixing the parts that aren't? It might be so. Sure, cretinous congressional candidates will continue to display their seriousness by pumping paper copies of the law with bullets , probably for years to come. But with this year's open enrollment period coming to an end in a few days, a particular reality is starting to set in, namely that, however you feel about the law, millions of Americans have now gotten health insurance because of it. Repealing it would mean taking that insurance away. So let's look at...

Hobby Lobby and the Return of the "Negro Travelers' Green Book"

Jalopnik
V ictor Green loved to travel. Being a mail carrier in the mid-20th century was a good, solid job, and the heyday of the American automobile was just beginning. Americans felt more mobile than ever before, especially once Eisenhower's interstate highway system expanded like a web through the country. The freedom of the open road beckoned. But Victor did not feel particularly free. As an African American, much of the nation was closed off to him and his family. Hotels rented rooms only to whites; restaurants wouldn't take his money; shops and markets kept their doors shut. Jim Crow was everywhere. So he wrote the first travel guide for African Americans, listing restaurants, hotels, gas stations, and even private homes that would aid the “Negro Traveler.” Known as The Green Book, it was an essential part of African American life for more than 20 years. By 1952, it had expanded its listings to include barbershops, bars, and nightclubs. Such a guide was essential, since each particular...

The Strange Bedfellows of the Anti-Contraception Alliance

AP Images/Patrick Semansky
AP Images/Patrick Semansky O n March 25, lawyers representing the owners of a large purveyor of craft supplies and a much smaller cabinetry business will appear before the Supreme Court in what has become the cornerstone case for opponents of the Affordable Care Act’s “contraception mandate.” Under the mandate, all employers—with the exception of religious organizations like churches—must include free birth control under their insurance plans. Catholic schools, hospitals, and social service agencies immediately raised a ruckus. Dozens of Catholic nonprofits filed lawsuits against the government, arguing that because their tradition forbids them from using birth control, paying for it—even indirectly through insurance—would violate their religious liberty. The cases that will appear before the highest court deal with a different question: whether the owners of corporations can claim religious liberty exemptions. But there’s a stranger and less remarked-upon twist. The owners of both...

News Flash: An Abortion Provider Wins in Kansas

AP Photo/John Hanna
AP Photo/John Hanna Dr. Ann Kristin Neuhaus observes a State Board of Healing Arts meeting flanked by her attorneys, Kelly Kauffman, left, and Bob Eye in Topeka, Kansas. S ince the death of George Tiller, the third-trimester abortion provider who was killed in Wichita in 2009, former abortion doctor Ann Kristin Neuhaus has been fighting Operation Rescue—one of the country’s most radical anti-choice groups—alone. As part of their effort to oust “Tiller the Killer,” Operation Rescue lodged frequent accusations of medical misconduct with the Board of Healing Arts, the state medical licensing board, against Tiller and his colleagues. After his murder, Operation Rescue turned the full force of its ire on Neuhaus, who had worked on and off as a consultant for Tiller in the early 2000s. Appeals to the Board of Healing Arts hadn’t worked in the past, but the 2010 elections swept in Sam Brownback, a virulent opponent of abortion, as governor. Brownback had the power to select new members for...

This Is Your Camry On Drugs

The change in the social perception of drunk driving is one of the great public health success stories of the last half-century. It went from being perceived as an amusing bit of recklessness to something truly despicable, and today drunk driving deaths are half of what they were a few decades ago. And now that recreational marijuana is legal in Washington and Colorado, almost surely to be followed by other states, there's a renewed need to discourage driving while high. The key to the success of the drunk driving campaign was creating a new social norm, one in which people would discourage each other from driving drunk. It also gave people a means to avoid it, by popularizing the idea of the designated driver. Washington state is starting a campaign to discourage driving while high with three PSAs soon to be airing in the state. No frying eggs here: OK, so that's kind of funny. But I'm a little skeptical about whether it will have a dramatic impact. The ad does include the idea of...

The Last Rural Abortion Clinics in Texas Just Shut Down

AP Images/Pat Sullivan
S ince November, the last abortion clinics in East Texas and the Rio Grande Valley, some of the poorest and most remote parts of the state, have been hanging on by their fingernails. The two clinics, both outposts of a network of abortion providers called Whole Woman’s Health, stayed open with slimmed-down staffs while their owner, Amy Hagstrom Miller, struggled to comply with the first chunk of HB2—the voluminous anti-choice law passed by the Texas legislature last summer—which requires abortion doctors to obtain admitting privileges at a local hospital. Today, after weeks of failed negotiations with nearby hospitals, Hagstrom Miller announced that both clinics are closing their doors. The clinics in Beaumont, about an hour east of Houston, and McAllen, just north of the Mexico border in the Rio Grande Valley, were the last rural abortion providers left in Texas. Between July, when HB2 passed, and November, when the admitting privileges requirement went into effect, nearly half of...

Hey Bert, Is This Thing Loaded?

Click inside for more charts!
Since the Newtown shootings, liberal commentators have been paying greater attention to all kinds of firearm-related issues, including accidental shootings. Josh Marshall in particular often tweets the accidental shooting of the day—" Georgia Man Accidentally Shot Cousin to Death When Gun Fell From Lap " was today's, following on " Ohio Boy Fatally Shoots Brother With Handgun He Thought Was a BB Gun ." Which got me wondering, how many of these incidents are there? What interests me for the moment aren't homicides, but accidental shootings. How do they compare to other causes of accidental death and injury? We all know that vivid individual cases, no matter how vivid, don't necessarily give an accurate impression what's happening overall. So let's delve into the statistics, shall we? The first thing to understand is that accidental shootings make up a relatively small proportion of all the different ways Americans find to stumble, metaphorically speaking (though sometimes not) to their...

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