Health Care

Daddy's Home!

AP Images/Edmond Terakopian
AP Images/Edmond Terakopian M any mornings this year Matt Nuttall and his friend Ryan Faulkner met up in one of several neighborhood parks located between their houses in Pleasant Hill, California. While they changed diapers, dispensed snacks, and made sure their little ones didn’t fall off the playground equipment, the dads “talked to each other in adult,” as Nuttall puts it. Before too long, their children would begin to fade, and they’d head back to their respective houses to prepare lunch and oversee afternoon naps. “We didn’t do much, just sat around and kept the kids and ourselves from going crazy,” says Nuttall, who teaches ninth- and tenth-grade English at Sacred Heart Cathedral Preparatory in San Francisco. After his wife returned to her job, Nuttall took 12 weeks off from his. For half of that time, he received $945 a week through California’s Paid Family Leave program. The program, which has been in existence since 2004, offers workers up to six weeks off with maximum pay...

Obama's Opening Salvo In the War of Words

President Obama making a statement today.
Starting today, Americans are going to learn three things when they watch media coverage about the government shutdown. First, they'll see Republicans say that Obamacare totally sucks and everybody hates it, and also that President Obama is being super-mean by not giving them what they want. Second, they'll learn that their fellow citizens have a pox-on-both-their-houses view on this whole thing, because nothing says "journalism" like going out on the Mall or to the local diner and getting a few quotes from average folk saying, "They're all acting like children!" And third, they'll hear Barack Obama say that with their intransigence, Republicans are hurting regular Americans. And not just regular Americans generally, but actual, specific regular Americans. Many of these Americans will be seen standing patiently behind the President as he tells their stories. That's what he did today in his first post-shutdown statement, which combined a celebration of the opening of the health-care...

Have Too Many Cooks Spoiled Obamacare?

AP Images/J. Scott Applewhite
It's safe to say that if Americans don't understand the Affordable Care Act (ACA) by now—and they don't —they never will. The slightly better news is that consumers don't have to understand it in order to benefit from it, but even so, almost all the problems the ACA has encountered or will encounter are a result of the law's enormous complexity. That complexity grew out of early decisions made by Barack Obama, but along the way Congress added their own layers of complexity in order to pass it, then conservatives on the Supreme Court added some more. There were reasons, most of them perfectly good, for each of these decisions; everyone thought they were responding to reality or doing what was in the best interests of the country. But as full implementation of the law is upon us, we should acknowledge how much damage has been done by all this complexity. In a recent article in National Affairs , Johns Hopkins political scientist Steven Teles bemoans the rise of "Kludgeocracy." The term...

Senator Talks for Hours, While in Real World, Things Proceed According to Plan

Politics is, to a degree we don't often notice, mostly about talking. Politicians describe what they do in heroic, usually martial terms—they "fight" for things, they wage "battles," and so on—but what they actually do is talk, and talk, and talk some more. They talk on the floor of Congress, they talk in committees, they talk to constituents, they talk to each other. There are a few of them, oddly enough, who are not particularly good at talking. But the successful ones are almost all good talkers. So it isn't too surprising that Ted Cruz, the former debate champion who is known as an exceptionally good talker, is able to get up and talk about the satanic plot that is Obamacare for 18 hours straight. There's something fitting about this last stand. Let's recall that just a few days ago, Cruz was being branded a traitor by Tea Partiers simply for acknowledging that the defunding effort will fail in the Senate. So what better way to get back in their good graces than a grandiose,...

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

AP Images/J PAT CARTER
AP Images/J PAT CARTER W hat 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. For the past two decades, Sherwin Nuland, a surgeon and bioethicist at the Yale School of Medicine, has been advocating for a dramatic change in our attitudes toward death. In his 1994 book, How We Die: Reflections on Life’s Final Chapter , he argued for an approach to death that emphasizes dignity above treatment. How We Die spent months on the best-seller lists and won the National Book Award. But in the ensuing years, Americans’ zeal to stave off the inevitable seems to have grown rather than diminished, leaving too many caregivers and family members to...

Life Takes Visa—Except If You Want to Buy Pot

AP Images/Marcio Jose Sanchez
AP Images/Marcio Jose Sanchez E arlier 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...

Can Republicans Buck the Tea Party?

AP Photo/Marc Levy
AP Photo/Harry Hamburg S ince 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 Last of the Late-Term Abortion Providers

After Tiller A t one point early in After Tiller , a new documentary on third-trimester abortion, a counselor at a late-term abortion clinic asks a patient to explain why she wants to terminate her pregnancy just a few months before she gives birth. “My baby’s got a disease, and it’s fatal in a lot of ways,” the woman explains between sobs. The camera zooms in on her hands, clenched around a ball of tissue. “He could be stillborn. He would have a very short life, full of surgeries and seizures until he would pass. He’s not a viable child. The most loving thing I can do is let him go now.” Stories like this echo throughout After Tiller , directed by Martha Shane and Lana Wilson, which opens today in New York City. The film follows the lives and work of the only four doctors in the country who perform abortions in the last trimester of pregnancy. Three of the doctors portrayed in the film—Stacey Sella, Susan Robinson, and LeRoy Carhart—worked for George Tiller, the late-term abortion...

The Conservative Plan for Medicaid Expansion

AP Photo/Osamu Honda
AP Photo/The Columbus Dispatch, Chris Russell 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...

The Obamacare Is Falling! The Obamacare Is Falling!

AP Photo/Charles Dharapak
AP Photo/Steve Browne, Valley City Times-Record 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. What's happening when? The next important date is October 1, when open enrollment for insurance plans on the new exchanges begins. Those who sign up will begin their new insurance on January 1, when the rest of the high-profile components of the law take effect. The individual mandate, requiring everyone to carry insurance or pay a fine, takes effect, as does...

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, making the law work better in the long run. Not because the conservatives' motives aren't bad (they are), and separate from the...

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 1, 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...

Anti-Choicers' New Mexico Experiment

The American Prospect/Chloe Hall; AP Photo
AP Photo/ The Albuquerque Journal, Kitty Clark Fritz; homepage photo by Chloe Hall/The American Prospect Abortion-rights supporters and opponents demonstrate at the University of New Mexico in Albuquerque. I n 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 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 reproductive-rights battleground? After a number...

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...

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 healthcare at all; it's just a friendly Portland hipster musician bounding around the state...

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