Health Care

The Citizens United of the Culture Wars

Flickr/Mark FIscher
Flickr/Mark FIscher E ven a broken clock is right twice a day. Heeding calls from gay-rights supporters, business groups, and Republicans like John McCain and former presidential candidate Mitt Romney, on Wednesday Arizona governor Jan Brewer vetoed a "religious liberty" bill that would have allowed for-profit businesses to refuse service to gays and lesbians so long as they were motivated by "sincerely held religious belief.” A nearly identical law failed to advance in Kansas last week. Now, in light of the blowback, anti-gay discrimination bills in conservative legislatures—including Mississippi, Georgia, and Oklahoma— have stalled , and even lawmakers who voted for such measures are stepping back their support. The failure of these anti-gay discrimination bills amounts to a stern rebuke to the religious right, which sees defeat on the horizon in the gay-marriage fight. Just in the past two months, judges have overturned bans on same-sex marriage in Oklahoma, Virginia, Texas, and...

The Political Failure Behind the Healthcare.gov Debacle

You haven't heard much about healthcare.gov lately, and that's because it's working pretty well. So this is a good moment to think back on both what went wrong and how it got fixed, which we get in a timely article from Steven Brill. The fixing story is an interesting one, but before it's too late, I want to do a little more blame-placing. It goes without saying that much of the responsibility lies with the contractors who did such a terrible job of creating the site. Another way to think about the problems is that there was a missing middle: you had people who understood the technology but didn't grasp the politics, and people whose job was politics who didn't understand the technological challenges. That's intuitively appealing, but I think it lets the political people off the hook. Their screw-up wasn't a result of their unfamiliarity with technology. It was a political failure, full stop. What I mean by that is that the people who are supposed to understand politics should have...

Should We Call the Midwife?

AP Images/Katie Collins
E arlier this month, a bill advanced in the Arizona state legislature that would ban the use of midwives in the state during births where the mother has had previous caesarean sections, is delivering multiples or might face breech birth. How best to give birth is, needless to say, a topic of perennial interest. What follows is a conversation between two Prospect staffers who stand on different sides of the midwife debate. Amelia Thomson-DeVeaux: So basically, last year, Arizona overhauled its licensing protocols for certified professional midwives, allowing them to perform high-risk births at home. Vaginal births after cesarean sections, breech births, twins, etc. And now Kelli Ward, an Arizona state senator, wants to ban midwives from attending high-risk births. She says it's a pro-life issue. Choice quote: “I see the mom and the baby as two separate entities,” Ward said. “I would love to preserve the choice of the mother for their home birth, but that child also needs to have a...

The ACA Can't Fix Our Mental Health Crisis

AP Images/Bob Wands
AP Images/Bob Wands A s more people sign up for insurance under the Affordable Care Act, the next few months will usher in a fundamental change in mental health care. Under the ACA, insurers are for the first time required to cover mental health and substance abuse treatment as one of ten “essential benefits.” This is good news for the millions of Americans who suffer from some form of mental illness but don’t seek treatment. The question now is whether the country’s mental health infrastructure is equipped to deal with an avalanche of new patients. The answer? Probably not. Mental health care is saddled with two problems: It’s expensive and inaccessible. A 2012 survey by the Substance Abuse and Mental Health Services Administration found that more than 18 percent of American adults suffered from some form of mental illness in the past year . Of the forty percent who sought treatment, more than one-third paid for it out-of-pocket. To put this in perspective, only about 16 percent of...

Arkansas's Medicaid Folly

AP Images/Brian Chilson
On Tuesday, the Arkansas state legislature failed to renew a bill authorizing its expanded-Medicaid plan, an innovative approach to Obamacare that allowed the state to use federal funds to purchase private insurance for the state's low-income residents. Arkansas's unique plan was a compromise between the state's Democratic governor, Mike Beebe, and the Republican-led legislature, and made the state one of the few ultra-conservative ones to bother expanding Medicaid. In the 25 states that didn't expand, many of the poor are still doing without insurance, because the federal subsidies weren't designed to kick in until people made above a certain threshold. If Arkansas doesn't renew its Medicaid program, more than 87,000 people who've gotten insurance this year will suddenly lose it again. Opponents are complaining that the plan is expensive. To begin with, the entire cost is paid for by the federal government until 2016, and after that the state will never chip in more than 10 percent...

Needling for Change

AP Images/Jae C. Hong
AP Images/Jae C. Hong F or the first few years Liz Evans worked at the Portland Hotel Society, a network of homeless shelters in central Vancouver, she would arrive at her job already exhausted. On her morning walk through Downtown Eastside—a neighborhood infamous as the poorest zip code in Canada—she stepped over drug addicts passed out in doorways and sidled around alleys where people would cook dope and shoot up in broad daylight. It was 1993, and Vancouver was in the throes of an HIV epidemic. Tens of thousands of impoverished injection drug users were crammed into a fifteen-block radius. The Portland Hotel Society was one of the few housing projects in the city that welcomed drug addicts, and working there felt like triage. Evans, a nurse, trained her staff to intervene when the residents overdosed. “It was such a painful time,” Evans says. “These weren’t people who were partying or using drugs to have fun. They were poor and sick and dying.” Desperate for a solution, city...

Why Don't We Have Viagra for Women Yet?

AP Images/Allen Breed
L ast week, a small drug company called Sprout Pharmaceuticals announced that its version of “female Viagra” —a medication designed to enhance women’s libidos—was going back for yet another battery of tests. The Food and Drug Administration (FDA) wants more data on how Sprout’s drug, the whimsically named “flibanserin,” affects driving ability. If this news sparked a little twinge of déjà vu, don’t be surprised. For more than a decade, pharmaceutical companies have trudged through round after round of clinical trials in pursuit of a drug that can alleviate some of the symptoms of female sexual dysfunction. Inevitably, a new set of tests makes headlines. Given Viagra’s blockbuster success since it was approved in 1998—in 2012, sales totaled more than $2 billion—there is a huge untapped market for a drug like flibanserin. More than 40 percent of women suffer from some form of sexual dysfunction in their lifetime. The most common complaint is hypoactive sexual desire disorder (HSDD), a...

Horrible Bosses

AP Images/John P. Johnson
AP Images/Warner Brothers D o you believe everything your boss tells you? The answer probably depends—if he tells you the Cubs are going to win next year's World Series then maybe not, but if he tells you your benefits are being cut and explains the reason why, you'll probably take him at his word. After all, he's in charge of the business, so he should know. But Tim Armstrong, the CEO of AOL (company motto: "More Than Just Your Grandmother's Email, Really!") must have thought his employees were pretty darn stupid when he told them last week that he was cutting their 401(k) contributions and blamed the change on the Affordable Care Act. He explained in an interview that the company had incurred $7 million in "Obamacare costs," whatever that's supposed to mean, and later complained that two employees who had "distressed babies" had cost the company $1 million each. It's been said many times that once he passed significant health care reform, Barack Obama came to "own" the health care...

Affordable Care Act Gives Workers Freedom; Republicans Enraged

No, they didn't take er jerbs.
Since I wrote about postal banking this morning, I've decided to continue the day's shameless, lowest-common-denominator clickbaiting by talking about a new Congressional Budget Office report and the Affordable Care Act. Hang on to your hats. With all the hype of a new Beyonce album, the CBO dropped its latest report on government finances and other related topics, which includes the news that the deficit has dropped to its lowest level since Barack Obama took office. This may prove inconvenient for Republicans still invested in fomenting deficit panic, but they'll be helped by the fact that most Americans actually believe the deficit has gone up in the Obama years. According to a new poll from the Huffington Post , not only do 54 percent of people think so, but 85 percent (!) of Republicans think so. In any case, the part of the CBO's report that's getting more attention is their projection that as a result of the ACA, the labor force will be reduced by 2 million in 2017, rising to 2...

Why Anti-Choicers Can’t Take Credit for the Falling Abortion Rate

On Monday, the Guttmacher Institute released a study that seemed, at first blush, to vindicate the anti-choice movement’s increasingly feverish attempts to end abortion through state-level restrictions on women and providers. Using survey data from 2011, the research organization—which leans pro-choice—found that abortion rates have plummeted to a 30-year low. Since 2008, the number of abortions performed in the U.S. fell 13 percent. Anti-abortion activists pounced to take credit, criticizing Guttmacher for “failing to acknowledge the impact of pro-life legislation” in its explanation for the sudden drop. The Guttmacher researchers point out, quite reasonably, that the most recent wave of anti-choice legislation began in earnest in the months after the 2010 midterm election, when abortion rates were already falling. If anything, abortion’s decline was in spite of anti-choice sentiment, not because of it. As the abortion rate was falling, so was the birth rate. Fewer women were seeking...

Remembering What Matters About the Affordable Care Act

Flickr/Laura Smith
On the Affordable Care Act front today, there's very good practical news, and not-so-good political news. That gives us an excellent opportunity to remind ourselves to keep in mind what's really important when we talk about health care. Let's start with the good news. First, as Marketplace reported this morning, a new report from PriceWaterhouseCoopers shows that the average health insurance premium on the exchanges is actually lower than the average premium in employer-sponsored plans. And it isn't because the coverage is inadequate; according to a spokesperson, "even when you factor in all the out-of-pocket costs, the average top tier gold and platinum plans are similar to employer ones." It's hard to overstate what a success this is. If you've ever bought health insurance on the individual market before now, you know that if you could get covered at all, you were likely to get a plan that was expensive but had lots of gaps and lots of cost-sharing. The whole point of the exchanges...

The Six Constituencies the State of the Union Actually Mattered To

AP Images/Charles Dharapak
AP Images/Charles Dharapak I t was a strange State of the Union Address—mixing emotional tugs on the heartstrings with anodyne rhetoric that made it seem like everyone from Barack Obama to the angriest Tea Party Republican was bored with the annual exercise. The speech had no over-arching theme save (yawn) America’s enduring greatness. There were hard-hitting sentences and paragraphs, but no dramatic policy proposals nor even bold, if unattainable, dreams. The State of the Union address was unlikely to anger anyone whether it was financial titans fearing economic Kristallnacht or Bashar al-Assad. For all of Obama’s rhetorical gifts, it was another speech that was mangled beyond recognition by the State of the Union sausage grinder. Before the speech, the agony of White House wordsmiths struggling with the State of the Union was memorably captured by Jeff Shesol, a Bill Clinton alum, who described the standard text as “written by a flash mob—a sudden aggregation, inside and around the...

GOP to Working Poor: Drop Dead

AP Images/Charles Dharapak
In one of the better lines in last night's State of the Union address , President Obama chided House Republicans for their endless series of votes to repeal the Affordable Care Act: "[L]et's not have another 40-something votes to repeal a law that's already helping millions of Americans ... The first 40 were plenty." He followed up by observing that "we all owe it to the American people to say what we're for, not just what we're against." As it happens, last week three Republican senators outlined a plan that can be fairly described as a Republican plan to replace Obamacare. (The basic features of the plan are clearly described by Sarah Kliff of Wonkblog here .) Because most of the Republican Party convinced themselves in 2009 that a tax penalty for people who don't carry health insurance was a grave threat to the American constitutional order, the plan does not include an individual mandate. But otherwise, in its general priorities the plan strongly resembles the Heritage Plan of the...

Vaccine Fear Mongers Are Wrong, But They're Not Ideological

President Obama possibly being injected with Kenyan socialist nanobots. (Flickr/ Rene Najera)
It's been true for some time that conservatives are far more likely that liberals to hold a number of false beliefs about the world, some of which were always political (e.g. Saddam had weapons of mass destruction, evolution is a myth) and some which became more political over time, particularly the belief that the planet is not warming and its subsidiary beliefs, which include the idea that there is a great deal of disagreement among climate scientists as to whether warming is occurring. Sometimes when this is brought up, someone will mention that liberals believe some demonstrably false things too, like the idea that childhood vaccines cause autism. The trouble is, there has never been anything other than anecdotal evidence for this contention. Yes, there may be a parent at your kid's organic vegan locally sourced small-batch co-op nursery school who thinks it's true, and dangerous lunatic Jenny McCarthy, the nation's most prominent propagator of this theory, is a Hollywood...

The GOP, Guardians of Health Security

Mitch McConnell chats with some folks about health care 'n stuff.
This morning, Greg Sargent calls our attention to this new ad for Mitch McConnell, in which a man who got cancer from his job at a uranium enrichment plant in Paducah. The man testifies that it was McConnell, fierce advocate of worker safety and health security, who made sure that workers got cancer screening and compensation: That'll never work, a liberal might say. McConnell is not only one of the nation's foremost opponents of any and all regulations to protect worker safety, but he wants to repeal the Affordable Care Act, which would take away the health coverage tens of thousands of Kentuckians just got. As you may know, Kentucky has been more aggressive in taking advantage of the ACA than probably any other conservative state. They set up their own exchange, and it has proven to be one of the best in the country; they also accepted the Medicaid expansion (these developments can be attributed mostly to the fact that the governor is a Democrat). According to this site tracking...

Pages