Health Care

Changing Primary Care's Colors

There’s a cheap, easy solution to the shortage of doctors in the field—nurse practitioners. But two-thirds of the states are standing in the way.

AP Images/Darron Cummings
AP Images/Darron Cummings Right now, as we’re stuck in a swamp of headlines about the failure of Obamacare’s rollout, it’s hard to imagine that there are bigger problems looming for the Affordable Care Act. But when the influx of newly insured Americans finally flounder their way through the health care website, there may not be enough doctors waiting on the other side. Organizations like the American Association of Medical Colleges (AAMC) predict that even if the federal government wasn’t trying to insure an additional 32 million people, the ageing U.S. population would quickly outpace the growth of the doctor pool. The scarcity is particularly acute in primary care—the physicians who preside over the mundane yet vital tasks of ordering routine blood tests, diagnosing strep throat, providing cancer screenings, and treating chronic illnesses— where the AAMC estimates there will be a shortfall of 45,000 doctors over the next decade. That means longer waits to see pediatricians, family...

Shocker: Health-Exchange Websites Can Be Done Right

That sure seems easy.
In the last few days, you might have seen a news story about something called Thehealthsherpa.com . The story usually goes like this: "The federal government may have screwed up when it tried to create the Obamacare website, despite spending hundreds of millions on contractors. That's why three tech geeks thought they could do a better job. And after just a week of coding, they did it." So have these guys solved all our problems? Is it now a piece of cake for everyone to find out what their insurance options are on the individual market? That would sure be a good thing, especially since nearly everyone complaining that their plans are being cancelled—the folks whose fate has suddenly become the most important moral and practical crisis facing America—seems to be taking their insurers at their word when they get those threatening letters instead of trying to find out what their choices actually are. The answer is ... sort of, maybe. Thehealthsherpa.com isn't actually the only site that...

The Supply-Side Economics of Abortion

AP Images/Rex C. Curry
AP Images/Rex C. Curry L ast June, Ohio Republicans quietly slipped a handful of abortion restrictions into the state’s budget, alongside provisions to invest in Ohio’s highway system and a new funding model for the state’s colleges and universities. Eight states, including Ohio, already require clinics that perform or induce abortion to have a “transfer agreement” with a local hospital so that patients can be transported quickly to a more sophisticated medical center in case of an emergency. The budget, which Republican Governor John Kasich signed into law with the abortion provisions intact, included an innovative new rule, making Ohio the first state to prohibit abortion clinics from entering into transfer agreements with public hospitals. Four months later, the new rule is already bearing fruit for its anti-choice architects. Ohio had 14 abortion providers at the beginning of the year; soon, it could be down to seven. Toledo’s two abortion clinics had their licenses revoked...

Why Isn't Everyone More Worried about Me?

Click to reassure me that my troubles outweigh the suffering of millions.
Apparently, there was a meeting of the editors at The New York Times op-ed page in which someone said, "You know how every time someone does a story about one of these Obamacare 'victims' whose insurance companies are cancelling their plans, it turns out they could do really well on the exchange, but no one bothers to check? We should get one of them to write an op-ed, but not bother to ask what options they'll have." And then someone else responded, "Right, don't bother with the fact-checking. But we need a new twist. What if we find someone who'll complain that the problem with Obamacare is that other people care too much about poor people and the uninsured, while what they ought to be doing is spending more time liking her Facebook post about her possibly increased premiums?" The editors looked at each other and said, "That's gold. Gold!" And this was the result. Written by Lori Gottlieb, a Los Angeles psychotherapist and author, it relates how she got a cancellation letter from...

Obamacare Expansion in the Offing?

Flick/urbanbohemian
Every few days, a new poster child for the horror of Obamacare comes along, the person who just loves their insurance plan but has been told it's being cancelled. Pretty much every time, their story turns out to be full of holes—the plan they're on is junk insurance, they'd be able to get better and cheaper coverage through the exchanges, and so on ( here's the latest). But without a doubt, this small group of people (and not, say, the millions who are getting free or low-cost coverage for the first time) have become the momentary face of the Affordable Care Act, at least in the mainstream news media's eyes. So now the administration is scrambling to deal with this political problem, and here's the latest twist : The most popular idea for a fix on the Hill is legislation that would entitle someone who purchases health insurance coverage through the end of this year to keep that coverage. Other legislative responses may include extending the health exchange enrollment deadline or or...

Disastrous Obamacare Rollout Leaves Opinions on Law Weirdly Unchanged

Don't they realize the hell this now-missing woman has been through?
If you had asked Republicans a few months ago what they hoped for from the first month of operation of the Affordable Care Act's insurance exchanges, they probably would have said, "It'd be great if the website doesn't work at all, and people get completely frustrated about it. And it'd be nice if the insurance companies chip in by sending people scary letters about policy cancellations. It'd be extra-great if the media then credulously reported on those letters without asking whether they're true, or saying much of anything about all the people who will benefit from the law. If that happens, Americans will surely turn against it en masse, and we'll be on our way to repealing it once and for all." If that's what they wanted, they got it—at least until we get to the part about Americans turning against the ACA en masse. Things could hardly have gone worse in this stage of the rollout, and guess what: Americans' opinions about the law are, by all indications, exactly what they were...

In Shocking Development, Health Insurance Companies Still Suck

The Affordable Care Act was designed to solve the big problem of health security—namely that nobody in America had it—and find a way to get coverage for the 50 million Americans who were uninsured. It also attempted to address lots of other problems, and this week it's a good time to remind ourselves that many of its provisions came about because, to put it bluntly, health-insurance companies are despicable scum who will literally kill people (more on this below) if it makes them more money. I bring this up because now, people in the news media are learning about a scam insurance companies are trying to pull on some of their customers, and are not only not portraying it as such, but are simply taking the insurance companies' word and blaming the whole thing on the Obama administration. I realize that part about "despicable scum" is a little intemperate, and without question there are employees of the insurers who are good people. But as a whole, outside of the tobacco companies or gun...

Things that Are Still True about Health Care

It isn't quite as bad as this, but there are still problems. (Flickr/Doug Kline)
It's been a pretty intense month on the health-care front, what with the beginning of open enrollment for the new exchanges giving rise to lots of disingenuous fulminating from Republicans, not to mention a whole lot of crappy journalism. Any time a story dominates the news for a couple of weeks, there's a temptation to believe that what's happening now will change everything. So I thought it might be a good idea to take a step back and remind ourselves about some things that are still true about the Affordable Care Act and still true about health care in America. Over the long term, the problems with Healthcare.gov won't have much of an effect on the success or failure of the law. Yes, it has been a huge screw-up, with both the administration and the contractors sharing responsibility. Yes, it has caused a lot of people trying to sign up for new insurance a lot of hassle. But it's the thing everybody's focused on now in part because it's the only thing happening with the law, until...

Oklahoma's Abortion Battle Goes National

AP Images/Peter Morrison
(AP Photo/J. David Ake) O n Tuesday, the Oklahoma Supreme Court handed down a ruling that will help determine how the U.S. Supreme Court handles its next big abortion case. But Cline v. Oklahoma Coalition for Reproductive Justice hasn’t been scheduled for oral arguments just yet. The law in question, which deals with abortion-inducing drugs, was messily written, leaving room for considerable doubt about whether the state of Oklahoma intended to require doctors to follow a particular set of dosage requirements (the state attorney’s argument)—or ban the use of the drugs for abortion entirely (the Oklahoma Coalition for Reproductive Justice’s argument). When it accepted the case, the U.S. Supreme Court sent it back to the Oklahoma court for clarification about the law’s original aim. After several months of deliberation, the Oklahoma justices decided that the law effectively bans all medication-induced abortions by prohibiting the use of one crucial drug. Now, the U.S. Supreme Court will...

Time to Investigate Those Insurance Company Letters

As a follow-up to this post , I want to talk about the thing that spawns some of these phony Obamacare victim stories: the letters that insurers are sending to people in the individual market. People all over the country are getting these letters, which say "We're cancelling your current policy because of the new health-care law. Here's another policy you can get for much more money." Reporters are doing stories about these people and their terrifying letters without bothering to check what other insurance options are available to them. There's something fishy going on here, not just from the reporters, but from the insurance companies. It's time somebody did a detailed investigation of these letters to find out just what they're telling their customers. Because they could have told them, "As a result of the new health-care law, your plan, StrawberryCare, has now been changed to include more benefits. The premium is going up, just as your premium has gone up every year since forever...

Another Phony Obamacare Victim Story

NBC News' Obamacare victim, who it turns out is not actually a victim.
In the last couple of decades, a particular technique of news-story construction has become so common that I'm sure you barely notice it as something distinctive. It's the use of a device sometimes referred to as the "exemplar," in which a policy issue is explained through the profile of one individual, whose tale usually begins and ends the story. It's ubiquitous on television news, but print reporters do it all the time as well. As the Affordable Care Act approaches full implementation, we're seeing a lot of exemplar stories, and I've been noticing one particular type: the story of the person who seems to be getting screwed. If it were true that most Americans were indeed being made worse off by the law, that would be a good thing; we'd learn their stories and get a sense of the human cost of the law. The trouble is that in the real world, there are many more people being helped by the law than hurt by it, and even those who claim to be hurt by it aren't being hurt at all. To see...

The Biggest Design Flaw in Healthcare.gov

The pathway to disaster.
In my column today , I argue that the Healthcare.gov disaster has its roots in the government-contracting system, where big projects that go past deadline and over budget is standard operating procedure. There is one particular design flaw, however, that I didn't get a chance to discuss there but is worth noting. My guess is that it wasn't given all that much thought, or at the very least, somebody had what sounded like a good reason at the time to do it the way they did. But the result was that the administration needlessly multiplied the headaches it would have with the rollout and made everyone's experience significantly worse, and it didn't have to be that way. Before I tell you what it is (the suspense is killing you, I know), let's stipulate that Healthcare.gov did indeed present an extremely complex challenge, much more so than just creating an ordinary website. That's because it isn't a closed loop, but rather needs to communicate in real time with a bunch of outside systems,...

Healthcare.gov 2: The Contractors' Search for More Money

AP Photo/John Amis, File
AP Photo/HHS E veryone agrees that the rollout of Healthcare.gov has been something between a fiasco and a disaster. One of the mysteries is how a famously tech-savvy administration, headed by a president whose campaigns broke new ground in using digital technology to accomplish their goals, could have presided over this kind of screw-up. The answer is nearly as complicated as the website itself, but as the administration has said, the problems are not insurmountable and the site will be fixed (hopefully sooner rather than later). The next important question is what we can learn from this episode. There are vital lessons to be absorbed about how our government functions—not the Obama administration in particular per se. Instead, we got a good peek at what happens when private companies adept at squeezing billions from the taxpayers are hired to build something big. There's plenty of blame to spread around, from the White House to the Department of Health and Human Services to the...

Mission Affordabled: Why Obama’s Website Problems Aren’t “His Iraq”

AP Photo/J. Scott Applewhite
AP Photo/Jacquelyn Martin, File Y es, the Affordable Care Act website rollout has been a fiasco. And, as always happens when political catastrophe strikes, the wave of bad analogies has rushed in its wake. One in particular is gaining ground: Healthcare.gov is for Barack Obama’s presidency what the invasion of Iraq was to George W. Bush’s administration, complete with outraged liberal reactions to it . Here’s the funny thing: it’s a bad analogy, which could turn out to be accurate … but probably won’t. To start with, the fact that people died in Iraq, as opposed to the inconvenience involved in a malfunctioning website, doesn’t make it a bad analogy. The analogy has to do with presidential decisions; it’s about process, not outcomes, and there’s nothing at all wrong with that. No, what makes it a bad analogy is that Iraq War was misconceived from the start, and the actual events of the war, to a large extent, made obvious what some saw from the beginning. With the exchanges, on the...

Terrible Republican Idea Exposed as Even More Terrible

Flickr/adwriter
Yesterday, the Congressional Budget Office came out with a report assessing the budgetary impact of something many conservatives have supported, raising the Medicare eligibility age from 65 to 67. What they found was that the change would save far less money than had previously been assumed: only $19 billion over the next decade. The main reason is that many of the people no longer eligible for Medicare would be eligible for either Medicaid or insurance subsidies through the health exchanges, so the net effect on the federal budget would be small. But more important than that, this is an opportunity to remind ourselves that when government is doing something worthwhile, doing less of it isn't a good idea even if it saved a lot of money. And if cutting back only saves a modest amount of money, it's a really bad idea. You know what else would save a lot of money? Eliminating the United States Navy. But I'm guessing that most conservatives think having a navy is a good thing. Medicare is...

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