Health Care

A Quiet Blockbuster

(AP Photo/J. David Ake) A s we near the end of this Supreme Court term, a number of cases of substantial interest to politically-aware people who aren't court specialists remain to be decided. Landmark rulings involving the constitutionality of affirmative action, crucial provisions of the Voting Rights Act, and laws discriminating against gays and lesbians are still up in the air. People without access to the physical opinions handed out at the Supreme Court building used to have to wait for media reports about the outcome of cases to trickle out. Today, opinions are released almost instantaneously in PDF form, transforming late-term opinion days into a minor event. According to Kali Borkoski of the indispensable SCOTUSBlog , more than 60,000 readers have viewed its live-blogging of yesterday's opinions, with more than 12,000 simultaneous viewers a little after 10 a.m, when the decisions are announced. However, the vast majority of these onlookers did not get rulings in the cases...

What Will Republicans Do if Obamacare Turns Out OK?

Flickr/Fibonacci Blue
Ramesh Ponnuru has a long piece at National Review imploring conservatives to come up with a health-care plan they can swiftly put in place when Obamacare inevitably collapses under the weight of its disastrous big-government delusions. Though I disagree with almost every point Ponnuru makes along the way, from his analysis of what will happen with Obamacare to his recommendations of what a conservative health-insurance system should look like (the fact that anyone, even a free-market dogmatist, thinks catastrophic coverage plus high-risk pools would work out great is just incredible), I'll give him credit for trying to get his ideological brethren to come up with a proposal to solve what they themselves keep saying is a terrible problem. But alas, his effort is doomed to fail. Why? Because when it comes to health care, conservatives just don't care . I'll elaborate in a moment, but here's the crux of Ponnuru's argument: Opponents of Obamacare should plan instead for the likelihood...

Our Bodies, Their Cells?

AP Images/Axel Heimkin
AP Images/Axel Heimkin Editor's note: On June 13, 2013, the Supreme Court, delivered its long-anticipated ruling in Association for Molecular Pathology v. Myriad Genetics. In a victory for the American Civil Liberties Union, the Court ruled that genes cannot be patented. The ruling invalidated Myriad’s key ownership claims over BRCA1 and BRCA2, two of the most important (and often deadly) players in hereditary breast cancer, and effectively overturned 30 years of patent practice. “A naturally occurring DNA segment is a product of nature and not patent eligible merely because it has been isolated,” wrote Justice Clarence Thomas in the unanimous decision. “It is undisputed that Myriad did not create or alter any of the genetic information encoded in the BRCA1 and BRCA2 genes." L ately I have been thinking a lot about breasts. Well, not exactly breasts, but about two of the handful of genes that influence whether breasts develop cancer. These genes are called BRCA1 and BRCA2, and among...

Washington, Colorado, and the Headaches of a Legal High

AP Photo/Damian Dovarganes
When Colorado and Washington State passed ballot measures legalizing marijuana last November, they weren’t just the first states in the country to do so—they were the first governments in the world to do so. While other nations and states, most notably the Netherlands and California, have decriminalized marijuana possession, the drug is still technically illegal. That means that while it’s tolerated by law enforcement, the government need not concern itself with a full-scale system for regulation and taxation. But there are advantages to legalizing the drug; Washington and Colorado can have a hand in making the product safer while they benefit from tax revenues. Both states are in the early stages of creating systems for taxation and regulation; the Washington State Liquor Control Board released a set of standards earlier this month, while Colorado’s state legislature has passed a series of recommendations from a task force. The differences between the two states' approaches will...

Bad Faith and Budget Politics

Obama has to do business with people who cannot be trusted to own up to their side of a deal.

AP Images/Jacquelyn Martin
Compromise is often an unhappily revealing art. “Ideals may tell us something important about what we would like to be. But compromises tell us who we are,” the philosopher Avishai Margalit writes. In finding compromises with Republicans on the federal budget, Democrats need to remember not only who they are but who the voters depend on them to be. From that standpoint, the start of the budget battle in early April did not go well. Acceding to Republican demands for cuts in Social Security and Medicare, the president’s budget left his party open to a cynical but predictable response. Without the least acknowledgment of a contradiction, the chairman of the House Republicans’ campaign arm, Representative Greg Walden, immediately went on television to denounce Barack Obama’s “shocking attack on seniors.” We’ve seen it before. Many of the House Republicans who voted in 2008 for the bank bailouts called for by the Bush administration denounced the bailouts in the 2010 election as if they...

Face It: You're Crazy (But So Is Everyone Else)

Flickr/Mark Turnauckas, Carling Hale
Flickr/Mark Turnauckas C ommonly referred to as "the DSM," the Diagnostic and Statistical Manual of Mental Disorders is often referred to as psychiatry's "Bible." If that's the case, imagine the outcry if an overzealous publisher merged the Gospels of Luke and Mark, and you have a pretty good idea of the controversy surrounding the release of the manual's fifth edition. After a six-year revision process—and nearly 20 years since the last edition—the American Psychiatric Association (APA) released the DSM-5 at its annual meeting this weekend, the product of 13 working groups and input from more than 1,500 professionals. Any effort to draw a line between the normal and the abnormal is sure to ignite debate, and it's no surprise that doctors and patients who rely on official diagnoses for health-insurance coverage have scrutinized the new DSM's every word. Among the most controversial changes : Grief following a loved one's death is now classified as a form of major depression;...

The Military's Suicide Scandal

AP Images/Charles Dharapak
What a drag it’s been these past few weeks to watch the military brass—those kings of accountability, at least when it comes to other people ’s behavior—huffing and bluffing and outright lying about what they knew and when they knew it. First we had to endure the sight of them gaping over the news that the sexual-violence crisis they’ve done nothing to squelch since the assault of 83 women and seven men at the Tailhook Air Force convention in 1991 has worsened. Now those same Pentagon officials are shocked, simply shocked, by the military’s spiking suicide rates, despite the fact that those numbers, which have been rising steadily for the past 12 years, come from their own reporting system (and some claim are still an undercount). The only thing worse than the Pentagon’s faux surprise has been the complicity of news organizations willing to echo its talking points. Shame on The New York Times for last week’s “Baffling Rise in Suicides Plagues the U.S. Military.” Disturbing, yes. But...

A Few Words about Angelina Jolie's Breasts

AP Photo/Alastair Grant
Angelina Jolie—a woman with some of the world’s most famous breasts—has explained in a thoughtful New York Times op-ed this week why she's had them prophylactically removed and replaced. Jolie’s mother died young, after a decade living with ovarian cancer; when Jolie herself got genetically tested, she learned that she had a BRCA1 genetic mutation that gave her an 87 percent chance of getting breast cancer. To protect her children from losing their mother too young, she opted for surgery, which she describes in some detail. That unexpected mash-up—glamorous Hollywood superstar, global ambassador for celebrity humanitarianism, and the sober Gray Lady, the brainstem of the establishment—has sent the issue viral. And so we have discovered that Angelina Jolie’s breasts are a Rorschach test. Women have written about their own experiences with breast cancer or its specter , and have been variously grateful to or angry at her for announcing her course of action, or hating or loving the way...

Eight Months Until the End of Job Lock

Flickr/walknboston
For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was "job lock"—if you have insurance at your job, particularly if you or someone in your family has health issues, then you're going to be hesitant to leave that job. You won't start your own business, or join somebody else's struggling startup (unless they provide insurance), and this constrains people's opportunities and dampens the country's entrepreneurial spirit. That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there's an article in that pro-Democrat hippie rag The Wall Street Journal entitled "Will Health-Care Law Beget Entrepreneurs?" Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John's guy...

How Low Can Part-Timers' Hours Go?

AP Images/Adam Richard
flick/ Carol Green S ay you’re an employer with an employee who works 30 hours a week. If you have 50 employees or more come next year, you’ll be required either to provide her with health-care coverage, which the Affordable Care Act will by then mandate for all employees who work at least 30 hours a week, or you’ll have to pay a $2,000 penalty for failing to cover her. Or, you could just cut her weekly hours to 29. That way, you won’t have to pay a dime, in either insurance costs or penalties. This thought, not surprisingly, has crossed the minds of quite a number of employers. Right now, the average number of hours an employee in a retail establishment works each week is 31.4 . And a whole lot of Americans work in retail—just slightly over 15 million, according to the latest employment report , out Friday, from the Bureau of Labor Statistics (BLS). Not all of them work hours that hover just over 30, of course, but the UC Berkeley Labor Center has calculated that 10.6 percent of...

Why the Fight over Obamacare May Never End

Since the Affordable Care Act was passed in early 2010, I've held more than one opinion on just how the American public will feel about it as time goes by. Initially, perhaps influenced by the momentousness of the Act's passage, I wrote that once it was implemented, it would be much harder for Republicans to attack. They would no longer be able to frighten people with phantoms of death panels, and instead would have to talk about reality. Since people would have their own experience with the law to judge from as opposed to some hypothetical future, the attacks would lose their potency, Republicans would back off, and the law would rise or fall in public esteem on its own merits. Then I began to have second thoughts. One of the biggest problems, which I wrote about a few months later, is that Obamacare isn't a single program like Medicare that people can come to love. It's a whole bunch of pilot programs and new regulations, many of which involve private insurance or existing programs...

The Unending War on Obamacare

Flickr/Fibonacci Blue
I'm not a historian, so maybe there's something I don't know, but it seems to me that there may never have been a piece of legislation that has inspired such partisan venom as the Affordable Care Act. Sure, Republicans hated Medicare. And yes, their rhetoric at the time, particularly Ronald Reagan's famous warning that if it passed, "We are going to spend our sunset years telling our children and our children's children, what it once was like in America when men were free," was very similar to what they now say about Obamacare. But once it passed, their attempts to undermine it ran more to the occasional raid than the ongoing siege. I bring this up because Kevin Drum makes an unsettling point today about the future of Obamacare: No, my biggest concern is what happens after 2014. No big law is ever perfect. But what normally happens is that it gets tweaked over time. Sometimes this is done via agency rules, other times via minor amendments in Congress. It's routine. But Obamacare has...

Obamacare's Delicious Ironies

We don't have health insurance, suckers! (Flickr/Elvert Barnes)
As the various "gangs" in the House and Senate were writing their immigration proposals, it became clear that to win the support of Republicans, the provisional legal status undocumented immigrants were going to get had to be punitive. No coddling those law-breakers; if they're going to get on a path to citizenship, it had better be an unpleasant path. It had to last for a long time—ten years, in the end. And there had to be a requirement that during that time, you couldn't get any federal benefits like food stamps or welfare. But this has produced a rather amusing irony. Republicans insist that one of the benefits those with provisional status must be barred from receiving is the subsidies that people of moderate incomes will get through Obamacare to buy insurance. As you'll recall, Republicans also believe that Obamacare's individual mandate is the most oppressive, liberty-destroying policy in the history of the republic; for instance, Wisconsin senator and Ayn Rand acoloyte Ron...

The Gosnell Case and the Two Kinds of Media Criticism

Fox is on it.
As you might have heard, conservatives are up in arms that the trial of Kermit Gosnell, the Philadelphia abortion doctor charged with multiple murder counts, hasn't gotten more coverage. They claim that the media have ignored the story because of their pro-choice bias. You should read Scott Lemieux's five lessons of the case, but a lot of liberals have been shaking their heads over conservatives' complaints, because the right's argument about the case is wrong in almost every one of its particulars. The truth is that though there hasn't been a lot of coverage in the mainstream media until now, many feminist writers have written about the case at length. And what allowed this horror to happen is exactly what conservatives want more of: a system where there are few (or no) legitimate abortion providers, sending poor women with few options to the back alleys, where they can be preyed upon by people like Gosnell. But I want to talk about the media angle to all this. As Kevin Drum points...

Five Lessons from the Gosnell Abortion-Clinic Controversy

WikiMedia Commons
The hot conservative story of late last week, starting with a USA Today op-ed by Kristen Powers, was the failure of the mainstream media to cover the horrifying case of Kermit Gosnell, a Philadelphia doctor accused of committing infanticide, and maiming and, in some cases, killing his patients (most of them poor women) in an unsanitary abortion clinic. Perhaps the story does deserve more coverage than it has received, but the lessons to be drawn from it are different from the conclusions conservatives are making. Here are five points currently being overlooked in the coverage of the controversy. Feminists Were on It Whether the mainstream national media has given adequate attention to the Gosnell case is a matter of judgment, although claims that it's been entirely ignored are incorrect. (Consider, for example, Sabrina Tavernise's lengthy New York Times story from 2011.) But it should be remembered who hasn't been ignoring the story: feminist writers . Many prominent feminists, for...

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