Health Care

The Conversation: What’s the Best Way to Die?

AP Images/J PAT CARTER

What does it mean to have a good death? Few people long to spend their last hours with their bodies stuck full of tubes, listening to the hum of high-tech equipment under fluorescent lights. Yet every year, hundreds of thousands of Americans die in hospitals, where doctors’ aim is to cure at all costs, using expensive and often invasive treatments to prolong their patients’ lives by days, weeks, or months.

Life Takes Visa—Except If You Want to Buy Pot

AP Images/Marcio Jose Sanchez

Earlier this summer, Elliott Klug had a plumbing problem on his hands. There was a leak in the drainage line between his marijuana dispensary, Pink House Blooms in Denver, Colorado, and the street. It was a relatively simple fix, but when it came time to pay the plumber, things got more complicated. Because of federal regulations that restrict marijuana business owners’ access to financial services like banking, Klug had no choice but to hand the plumber an envelope with $25,000 in cash. When the plumber tried to deposit the payment, the cash was held in limbo until the bank could count all of the money and verify that it wasn’t laundered—standard operating procedure for such a large cash deposit. Klug says it’s just another daily hassle for marijuana dispensaries, which occupy a strange legal gray area. Under Colorado law, Pink House Blooms is just one more small business, but in the eyes of the federal government, Klug is illegally trafficking one of the most dangerous drugs around.

Can Republicans Buck the Tea Party?

AP Photo/Marc Levy

Since the Tea Party emerged following President Barack Obama’s victory in 2008, Republican governors have frequently been the faces of some of the most extreme policies in recent political memory. Even before her infamous “finger point” at the president, Arizona’s Jan Brewer was signing and defending her state’s racial-profiling bill, SB 1070. In Ohio, John Kasich championed a law—later repealed by voters—to strip public employees of bargaining rights. In Florida, Rick Scott has pushed a plethora of hard-right policies, from drug screening of welfare recipients and government employees to reductions in early voting. Michigan’s Rick Snyder, who has a moderate streak, went to the extreme last December when he approved “right to work” legislation in a state built largely by union labor.

Yet Brewer, Kasich, Snyder, and Scott are among the nine GOP governors who have staked considerable political capital on Medicaid expansion, a key piece of the Affordable Care Act.

The Conservative Plan for Medicaid Expansion

AP Photo/Osamu Honda

A number of policymakers on both sides of the aisle cheered when, in April, the Arkansas Legislature passed a law both expanding Medicaid and transforming it into a service available in a marketplace of insurance options, a move known as the “private option.” Similar cheers erupted in June when Iowa Governor Terry Branstad approved a similar measure. The legislation marked a major accomplishment—not because the policies are necessarily improvements over traditional Medicaid but because they establish politically palatable paths for conservatives who want to increase access to health care. In Pennsylvania, GOP Governor Tom Corbett—who was against Medicaid expansion and this week announced he is is tepidly for it—has pointed to the these new plans as a model he might consider (among other, more controversial changes.) The private option may be a way to make comprehensive health-care coverage viable in other Republican states—but that depends largely on what happens in Arkansas and Iowa over the next several months.

The Obamacare Is Falling! The Obamacare Is Falling!

AP Photo/Charles Dharapak

As we approach the full implementation of the Affordable Care Act at the end of the year, confusion still reigns. Most Americans don't understand what the ACA does or how it works, which is perhaps understandable. It is, after all, an exceedingly complex law, and from even before it passed there was an aggressive and well-funded campaign of misinformation meant to confuse and deceive Americans about it, a campaign that continues to this day and shows no sign of abating. To undo uncertainty and banish befuddlement, we offer answers to a few questions you might have about Obamacare.

Could Conservatives Help Obamacare Implementation Work?

She only wants to help, really. (Flickr/American Life League)

Supporters of the Affordable Care Act, up to and including President Obama, have been at pains to point out to anyone who'd listen that as with any large and complex piece of legislation, implementation is going to be imperfect. There are going to be hiccups. Hurdles. Stumbles. Stops and starts, ups and downs, potholes and roadblocks and detours. They've been saying it because it's true, because they want to prepare the media and the public, and because they know that conservatives will be squawking loudly every time it becomes apparent that some feature of the law needs to be adjusted, trying to convince everyone that even the most minor of difficulties is proof the law should never have been enacted in the first place.

But let me make a counter-intuitive suggestion: Perhaps all the inevitable overblown carping from the right will prove to be a good thing, actually making the law work better in the long run

The Sum of Its Parts

Flickr/Will O'Neill

We're just two weeks away from the start of open enrollment for the new state health care exchanges established as part of the Affordable Care Act, and it's safe to say that Republicans will not be able to repeal the law between now and then. It's equally safe to say that they won't be able to repeal it by January 1st, which is when the people who sign up for insurance through those exchanges start on their new plans. That's also the date when a whole bunch of other components of the law take effect. When that day comes, will Republicans have to abandon all hope of ever repealing it?

The ones who don't understand the law (and let's be honest, that's probably most of them) might answer yes. Once it goes into effect and begins destroying lives, sapping us of our precious bodily fluids, and generally turning America into a socialist hellhole where all hope has died and the flickering flame of freedom has been snuffed out, people will quickly realize what a disaster it is and support repeal. The problem is that come January, the ACA will be transformed. It will no longer be a big, abstract entity that would be possible to undo. Instead, it will be what it truly was all along: a large number of specific reforms and regulations that in practical terms are entirely separate from one another. What this means is that once it takes effect, "Obamacare" for all intents and purposes will cease to exist.

Anti-Choicers' New Mexico Experiment

The American Prospect/Chloe Hall; AP Photo

In early August, several dozen teenagers and a few adult supervisors descended on the Holocaust and Intolerance Museum in Albuquerque, New Mexico with a request: They wanted the curators to add an exhibit on abortion. When their demand was rebuffed, the teens—who were spending the week in the city as part of a pro-life training camp sponsored by Survivors of the Abortion Holocaust—unfurled a banner outside the building calling Albuquerque “America’s Auschwitz.”

The protest catapulted Albuquerque into the national media, but the demonstration is just one part of a larger experiment by the recent wave of pro-life activists flocking in from out of state: Can they transform New Mexico—a moderate state with liberal abortion laws—into another combat zone in the abortion wars? After a number of failed efforts to change policy in the legislature, abortion opponents have homed in on Albuquerque. Earlier this summer, they gathered enough signatures to put an ordinance banning abortion after 20 weeks before city voters in a special election. While similar bans have been passed in a dozen states, the proposed law would be the first to limit legal abortion at the local level. The immediate goal is to end the controversial practice of third-trimester abortion, but the campaign could also serve as a model for pro-life activists who are eager to spread red-state extremism into more moderate parts of the country.

The Republican Team Effort on Obamacare Obstruction

AP Photo/J. Scott Applewhite

When it comes to the Affordable Care Act, you have to give Republicans credit for sheer sticktoitiveness. They tried to defeat the law, but it passed. They tried to get the Supreme Court to declare it unconstitutional, but that didn't work. So now, as the open enrollment period for the exchanges approaches on October 1, they're thinking creatively to find new ways to sabotage the law. Sure, at this point that means screwing over people who need insurance, but sometimes there's unavoidable collateral damage when you're fighting a war.

Their latest target is the Obamacare "navigators." Because not just the law but the insurance market itself can be pretty complicated, the ACA included money to train and support people whose job it would be to help people get through this new system, answering consumers' questions and guiding them through the process. Grants have been given to hospitals, community groups, charities like the United Way, churches, and the like in the 34 states that are relying on the federal government to operate their exchanges in whole or in part. You can see the problem: If there are folks out there helping people get health coverage, that will mean that people will get health coverage. And that won't do.

What's Killing Poor White Women?

For most Americans, life expectancy continues to rise—but not for uneducated white women. They have lost five years, and no one knows why. 

AP Images/Lars Halbauer

On the night of May 23, 2012, which turned out to be the last of her life, Crystal Wilson baby-sat her infant granddaughter, Kelly. It was how she would have preferred to spend every night. Crystal had joined Facebook the previous year, and the picture of her daughter cradling the newborn in the hospital bed substituted for a picture of herself. Crystal’s entire wall was a catalog of visits from her nieces, nephews, cousins’ kids, and, more recently, the days she baby-sat Kelly. She was a mother hen, people said of Crystal. She’d wanted a house full of children, but she’d only had one.

The Law That Must Not Be Named

This is not actually a skit from "Portlandia."

Talking Points Memo has done a service and rounded up a bunch of the ads states will be airing to promote the health insurance exchanges created under the Affordable Care Act, and they provide an interesting window into how the exchanges in particular, and the ACA in general, is going to look to the public. The first thing you notice is that none of ads mentions the words "Affordable Care Act, let alone "Obamacare." A couple of them use words like "official" to denote that this is sponsored by the state, but others just make it seem like a consumer marketplace that might not have anything to do with government at all. And many of the spots look like they were produced by the state tourism board, with quick cuts between picturesque scenes from all around the state and poetic words about how our state is awesome and we're all terrific people. For instance, this one from Oregon barely mentions health care at all; it's just a friendly Portland hipster musician bounding around the state with his guitar singing "Long live Oregonians! We are Oregonians!" Take a look:

Total Eclipse of the Fetal Heart

AP Images/Rogelio V. Solis

By the end of July, it was clear opponents of abortion were going to have a banner year. In the first half of 2013, state legislatures across the country enacted dozens of restrictions on abortion clinics that will slim their hours or shutter them completely. States like Wisconsin and Indiana added requirements like ultrasounds and waiting periods for women seeking the procedure. After a high-profile debate, Texas passed a law that bars abortion after 20 weeks, bringing the total number of states with similar bans to 11.

The show’s far from over. Earlier this month, at a press conference that featured the Duggar family of 19 Kids and Counting fame, two Ohio state legislators announced they were restarting the fight for one of the most restrictive abortion laws in the country. House Bill 248, generally known as the “Fetal-Heartbeat Bill,” was introduced on August 22 in the House Committee on Health and Aging, chaired by the bill’s co-sponsor, state representative Lynn Wachtmann.

Why the Republican Obamacare Strategy Fell Apart

News flash: these guys never knew what they were doing. (Flickr/Speaker Boehner)

After President Obama signed the Affordable Care Act, conservative writer David Frum, who had been a speechwriter for George W. Bush, chided his compatriots for the strategy they had employed in opposing it. Had they worked with Obama on a compromise, he argued, the result could have been a more conservative version of the law; by simply opposing it in its entirety, they wound up with nothing once the law passed. For raising this criticism, Frum was declared a traitor and banished from the conservative movement; these days his (still conservative) ideas get a better hearing on the left than the right.

And what has been the Republican strategy on health care reform since the ACA's passage? Well, first they tried to kill it through the courts. That didn't work, though they won for Republican governors the right to refuse the Medicaid dollars that would enable them to offer insurance to their states' poor (congrats on that), though many of them are coming around to accept the money. In the one house of Congress they control, they've held dozens of symbolic repeal votes, so many that it's become a national joke. They're now threatening to shut down the government (very bad) or default on America's debts (even worse) unless Obama agrees to shut the law down, a plan even many within their own party realize is insane. So they've ended up looking like petulant children who don't know when they've lost, not to mention viciously cruel ideologues who would literally rather see people go without health insurance than allow them to get it through a system tainted in any way by contact with a law with Barack Obama's signature on it.

So once again, they're not getting what they want substantively, and they're losing politically as well

Washington's Weed Whackers

For most of Stephanie Kahn’s life, medical marijuana was a tempting remedy that remained just out of reach. Her father, who suffered from multiple sclerosis, was told by doctors as early as the 1970s that medical marijuana could alleviate his symptoms. At first, he was repelled by the idea of using an illegal drug. But as the pain and muscle spasms grew worse, he eventually tried marijuana and found that, as the doctors said, it provided almost-miraculous relief. Decades later, when her mother was undergoing chemotherapy for lung cancer, Kahn, a nurse, heard the same refrain. “She lost 45 pounds in a month and a half,” she recalls. “And the doctor kept saying, marijuana could help her handle the chemo, could help her get her appetite back.”

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