Health Care

Rebuffing the Zones?

Outside Planned Parenthood’s clinic in downtown Boston, a painted yellow line swoops across the sidewalk and into the well-trafficked street, marking a 35-foot half-circle around the entrance. Most days, anti-abortion demonstrators gather on the edge of the line, holding signs and rosaries, and clutching bundles of pamphlets. As women approach the half-circle, the demonstrators spring into action. The goal is getting the women to pause and talk to them before they cross into the “buffer zone” on the other side of the line, which Massachusetts law declares a protest-free space.

The Supreme Court will hear oral arguments about the constitutionality of these buffer zones tomorrow, in McCullen v. Coakley. The arguments won’t tackle the polemical question of whether abortion should be available; instead, the justices will be asked to consider whether the buffer zones violate anti-abortion demonstrators’ First Amendment rights.

New York’s Pot Legalization Is Still Kinda Square

Just days after the first state-regulated marijuana shops opened in Colorado—to the delight of everyone who loves a good pot pun in their morning newspaper—reports began to circulate that New York’s Democratic governor, Andrew Cuomo, was poised to bring his state into line with the twenty others that have legalized marijuana for medical use. This week, according to the New York Times, Cuomo will announce an executive action allowing twenty New York hospitals to prescribe marijuana to patients with glaucoma, cancer, and a handful of other chronic diseases, to be determined by the Department of Health. The governor is skirting the state legislature, where four medical marijuana bills, including one that passed the House last spring, perished in the Republican-controlled Senate. The legislative proposals would have allowed patients with a dozen illnesses, including epilepsy, post-traumatic stress, diabetes, and arthritis, to possess two and a half ounces of cannabis, and set up a system for licensed marijuana distributors.

Why Medicaid Patients Using the ER More Isn't a Bad Thing

Flickr/Rob Nguyen

As they argued that we needed to get coverage for the millions of Americans without health insurance, one of the problems advocates pointed to was the fact that many of the uninsured ended up showing up at the emergency room with relatively minor ailments, because they don't have regular doctors they can see and they know the hospital will have to treat them regardless of whether they'll be able to pay. This leads to crowded ERs and lots of uncompensated care, which is bad for everybody. So what happens when you give a bunch of formerly uninsured people Medicaid? According to a new study from the Oregon Health Insurance Experiment, a unique data set around a randomized experiment made possible a few years back when the state of Oregon distributed new Medicaid enrollments by lottery, people went to the ER more once they got on Medicaid.

Liberals might find this disheartening. But not only is it not all that surprising, it doesn't undermine the case for Medicaid expansion at all.

No, Obamacare Wasn't a "Republican" Proposal

flickr/Ralf Heß

The filmmaker Michael Moore has, through his fine documentary Sicko and other public arguments, done a great deal to bring attention to the deficiencies of the American health-care system. His New York Times op-ed on the occasion of the first day of the Affordable Care Act's exchanges repeats some of these important points. However, his essay also repeats a pernicious lie: the idea that the Affordable Care Act is essentially a Republican plan based on a Heritage Foundation blueprint. This argument is very wrong. It is both unfair to the ACA and far too fair to American conservatives.

Before explaining why a central premise of Moore's argument is wrong, let me emphasize our points of agreement. It is true that the health-care system established by the ACA remains inequitable and extremely inefficient compared to the health-care systems of every other comparable liberal democracy. Moore, unlike some critics of the ACA from the left, is also careful to note that the ACA is a substantial improvement on the status quo ante: if it's "awful" compared to the French or Canadian or British models, it's a "godsend" for many Americans. Moore also has some sensible suggestions for improving the ACA in the short term—most notably, a public option and state-level experiments in more public health care where it's politically viable.

Health Reform's Next Test

AP Photo/Jim Mone

Failure, flop, fiasco—however you describe it, the Obama administration’s rollout of Healthcare.gov will go down as one of the most embarrassing episodes of public mismanagement in recent history. In principle, the defects of the website have nothing to do with the merits of the Affordable Care Act. As a practical matter, however, the two have become intertwined, and the big question is how much damage the flawed rollout will do to the political survival of the ACA as well as those in Congress who voted for it.

Say Thanks to a Republican Idea Day

Don't be afraid. (Flickr/House GOP Leader)

When John McCain ran for president in 2008, he offered up a health reform plan. Nobody paid all that much attention to it, because it was pretty clear that health care was an issue McCain didn't care about at all, and much like the "patient's bill of rights" George W. Bush had touted when he ran for president eight years earlier, it would be forgotten as soon as he took office. Four years later, Mitt Romney had something resembling a health care plan too, but once again, nobody paid much attention to what it contained, because any time health care came up, the only question was how Romney could square his stated position that the Affordable Care Act was a poisonous hairball of misery coughed up by the Prince of Darkness himself, while the plan it was modeled after, often referred to as "Romneycare," was a wonderful thing that everyone in the state where it was implemented seems to like.

Both McCain's and Romney's plans were mostly an amalgam of ineffectual half-measures and truly terrible ideas, but mixed in there were a few proposals that might actually be beneficial. And now that we're just days away from the full implementation of the ACA, some conservatives will be offering up similar reform proposals again (here's one).. The problem they face is that once millions of people have been enrolled in new insurance plans, you can no longer just propose to repeal the law, because that would mean kicking them off the insurance they have. "Repeal it!" only works as a battle cry when you can pretend no one would be harmed. So they have two choices: stop talking about health care entirely, or have some kind of plan you can claim you're proposing to put in its place. And Democrats can respond by actually agreeing to one or two of the Republicans' ideas. It sounds crazy, I know. But hear me out.

The Year in Preview: Pot's Uncertain Future

After the triumphs of marijuana reform in 2012—culminating in two successful ballot initiatives which made Washington and Colorado the first places in the world legalize the possession and sale of small amounts of weed—it was almost inevitable that 2013 would be a let-down. It wasn’t an unproductive twelve months for supporters of more lenient marijuana politics: New Hampshire and Illinois legalized pot for medical use, and Vermont decriminalized the possession of small amounts of marijuana. The residents of cities in Maine and Michigan also cast (mostly symbolic) votes in favor of pot legalization. But a third state has yet to join the two earliest adopters in sanctioning the possession and sale of pot, which remains illegal under federal law.

Out of Birth Control—At Least the Long-Term Kind

Press Association via AP Images

Beleaguered fans of the Affordable Care Act (ACA) got some encouraging news on Wednesday morning: The contraceptive mandate is working. A study released by the Guttmacher Institute, a think tank that supports abortion rights, revealed that the number of privately insured women who paid nothing out of pocket for birth-control pills nearly tripled since the fall of 2012, from 15 percent to 40 percent. More women are also getting the vaginal ring at no cost.

The Year in Preview: Taking the Offensive on Reproductive Rights

(AP Photo/Pablo Martinez Monsivais

The four horsemen haven’t appeared on the horizon yet, nor has the sea turned to blood, but you’d be forgiven for thinking that when it comes to reproductive justice in the United States. End times are just around the corner.

In 2013 alone, states enacted gobs of restrictions on early access to abortion. From Texas to Ohio to Iowa, dozens of clinics shut their doors. The courts are abortion-rights advocates’ best hope for stemming the tide of regressive legislation, but as Scott Lemieux has extensively documented here at the Prospect, their judgments have been decidedly mixed.

In this ever-growing maelstrom of incursions on abortion rights, pro-choice politicians have stayed on the defensive, clinging to the standards established by Roe v. Wade even as conservatives whack relentlessly at their foundations. Given the apocalyptic tenor of the times, supporters are routinely lauded as martyrs for the cause. Wendy Davis’s doomed filibuster against a restrictive abortion bill on the floor of the Texas Senate was undoubtedly the high point for the pro-choice movement this year, even though it was clear that the law—which is now wreaking havoc on the state’s abortion providers—would pass anyway. But the victories are almost always pyrrhic, a trickle of small symbolic triumphs amid an avalanche of defeats.

Americans Suddenly Discovering How Insurance Works

Flickr/Eric Allix Rogers

It's been said to the point of becoming cliche that once Democrats passed significant health care reform, they'd "own" everything about the American health care system for good or ill. For some time to come, people will blame Barack Obama for health care problems he had absolutely nothing to do with. But there's a corollary to that truism we're seeing play out now, which is that what used to be just "a sucky thing that happened to me" or "something about the way insurance works that I don't particularly like"—things that have existed forever—are now changing into issues, matters that become worthy of media attention and are attributed to policy choices, accurately or not. Before now, millions of Americans had health insurance horror stories. But they didn't have an organizing narrative around them, particularly one the news media would use as a reason to tell them.

The latest has to do with the provider networks that insurance companies put together. This is something insurance companies have done for a long time, because it enables them to limit costs. If an insurer has a lot of customers in an area, it can say to doctors, "We'll put you in our provider network, giving you access to all our customers. But we only pay $50 for an office visit. Take it or leave it." An individual doctor might think that it's less than she'd like to be paid, but she needs those patients, so she'll say yes. Or she might decide that she has enough loyal patients to keep her business running, and she wants to charge $100 for an office visit, so she'll say no.

So every year, doctors move in and out of those private provider networks, and the insurers adjust what they pay for various visits and procedures, and inevitably some people find that their old doctor is no longer in their network. Or they change jobs and find the same thing when they get new insurance. And that can be a hassle.

But now they have someone new to blame: not the insurance company that established the network, and not the doctor that chose not to be a part of it, but Barack Obama. It's not just my hassle, it's a national issue.

Bishops May Not Be the Crooks This Time

AP Images/Luca Zennaro

Tamesha Means was only 18 weeks pregnant on the morning of December 10, 2010 when her water broke. In a haze of pain, she called a friend for a ride to the only hospital in her central Michigan county. She had no idea that the hospital, Mercy Health Partners, was part of a Catholic health system. She just knew she needed help.

$2,229.11 for Three Stitches? Behold the Wonder of the Free Market.

Eight stitches? That'll be $4,000. (Flickr/Sarah Korf)

Twenty years ago I had my first knee surgery, after tearing some cartilage while skying for a thunderous dunk on the basketball court (or it might have been just falling backward while getting faked out on defense—who remembers the details?). Although I had insurance, I was responsible for a substantial copay, and I vividly recall the one item that stood out among the dozens on the bill. For the two steri-strips that covered an incision—tiny pieces of tape that even today cost about 20 cents retail, and which hospitals buy in bulk so surely cost them just a couple of pennies—I and my insurance company were charged $11, or $5.50 per strip. A miniscule amount in a five-figure bill, but it struck me as the most absurd, since it represented a markup of approximately 10,000 percent, if not more. More recently, I was getting some physical therapy for the same knee, and in what turned out to be a session that wasn't covered by my insurance, a therapist put a piece of kinesio tape around my kneecap. The retail price for that length of tape is around 40 cents (though again, they buy it in bulk so it's probably a quarter of that); and there was the therapist's time to retrieve, cut, and apply the tape, which took about sixty seconds all told. Total tape charge: $75.

My experience is not at all uncommon, as an excellent piece in today's New York Times explains.

Pot Shots Fired: Recreational vs. Medicinal in Washington State

AP Images/Elaine Thompson

As Washington begins to accept applications for the state’s first regulated recreational pot shops, cries of protest about the state’s plans for medical marijuana are coming from unexpected quarters: the left. A year after voters put their state on track to become one of the only places in the world where marijuana can be legally owned and sold for purely recreational use, the state legislature still has to decide what to do with its rickety fifteen-year-old medical marijuana system. With the Department of Justice’s hawkish eyes trained on the state, determined to ensure that the drug, which is still illegal under federal law, remains under strict control, some bureaucrats and lawmakers are afraid that Washington’s unregulated medical marijuana system could doom the whole experiment.

The Death Panels Are Coming

Now that healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of "death panels."

They never really went away.

The Media Need to Do More to Help People Navigate Obamacare

Thanks, Fox Business Channel!

Yesterday, Tim Noah made a point in an MSNBC appearance that I think deserves a lot more attention. Media outlets have been doing lots of reporting on the problems of the Affordable Care Act rollout, but what they haven't done is provided their audiences with practical information that could help them navigate the new system. Of course, most Americans don't have to do anything, since they have employer-provided insurance. But for all the attention we've been paying to the individual market, media outlets haven't done much to be of service. "The New York Times has published the URL for the New York exchange exactly twice," Noah said, "both before October first."

My experience in talking to journalists about the publication of this kind of thing—unsexy yet useful information, whether it's how to navigate a new health law or understanding where candidates stand on issues—is that they often think that addressing it once is enough. When you ask them about it, they'll say, "We did a piece on that three months ago." The problem is that for it to be effective, they have to do it repeatedly or people won't get it. What we have seen is that this information can be found somewhere on news outlets' web sites (here's an example), but it isn't on the evening news broadcast or in the print edition of the paper.

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