Category Archives: Health Care

Paul Krugman is wrong about Medicaid

Paul Krugman suggests in his New York Times column today that continuing the expansion of Medicaid is the answer to the outlandish cost of health care in the United States. He’s wrong. Medicaid is a lifeline for the impoverished, but the program would have to be reformed to the point that it would no longer be recognizable as Medicaid to be satisfactory for most Americans.

The reason Krugman likes Medicaid is the program’s success at controlling costs. He says that of all the health care delivery systems in the country, Medicaid is the one most like those in Europe, which have much lower costs than ours. If that’s true, it’s only because most of the rest of our fragmented system is completely fucked up.

Among the primary aims of European systems is health care equity — providing everybody with the same access to high-quality health care regardless of income or station. Medicaid does not come close to doing that. Krugman says that care from Medicaid providers is good and that lack of access is greatly exaggerated. In my experience the former is sometimes true and the latter, never.
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I drink because I’m worried, people; I don’t drink because I’m dry

Updated 11.22.2013

I know that there are millions of Americans who are content with their health care coverage — they like their plan and, most importantly, they value their relationship with their doctor. They trust you. And that means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. (Applause.) If you like your health care plan, you’ll be able to keep your health care plan, period. (Applause.) No one will take it away, no matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.”

          — Barack Obama

I’ve seen a number of Obamacare supporters arguing that the President’s promises about keeping plans and doctors carried a silent qualifier to the effect of “if they’re compliant with the new regimen.” Somewhat less frequent but still common are remarks to the effect that people whose plans have been cancelled should have known better, or that they’re stupid to want to keep their crappy plans. Probably they should have known (although Obama supporters who are ordinarily incensed with people who don’t take the President at his word are now incensed with people who did). Maybe they are stupid. Regardless, we wouldn’t be having this discussion if the President hadn’t lied — and it was a lie — repeatedly. Supporters of the legislation thought that the illusion of choice was critical to the success of the effort. The promises were an epic bait-and-switch, rivalled only by the disappearance of the vaunted “public option.”

In the excerpt from Obama’s 2009 address to the American Medical Association, the line about keeping one’s health care plan, period, is, I suppose naturally, subordinate to the line about keeping one’s doctor, period. Can you spot the silent qualifier in that clause? Yeah, me neither. And with the furor over the cancelled plans on temporary hiatus, awaiting the verdict on the state of the federal exchange in nine days and the verdict of insurers and regulators on extending the plans, the problem of losing one’s doctor is about to take center stage.

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I don’t find this stuff amusing anymore

Updated 11.20.2013

“I think we probably underestimated the complexities of building out a website that needed to work the way it should,” [President Obama] told the annual meeting of the Wall Street Journal CEO Council.

The [security] experts said the site needed to be completely rebuilt to run more efficiently, making it easier to protect. They said runs on 500 million lines of code, or 25 times the size of Facebook, one of the world’s busiest sites.

One of the most important repairs remaining deals with the information pages that the system provides to insurers about coverage applicants. These so-called “834s” have been riddled with erroneous information and, despite weeks of repairs, they continue to spit out incorrect data.

The enrollment, to give you a general sense of what’s happening, for a health plan that might have to sign-up 100,000 people in order to get their share of the 7 million Obama administration’s national enrollment objective, has grown from perhaps 10-15 enrollments a day a few weeks ago to 40-50 a day now … Backroom error rates being committed by, when enrollment data are transmitted to the health plans, are still far too high to transition to high volume processing without serious customer service issues.

The last quote is from an insurance industry insider, so take that into account in whatever fashion you think appropriate. I was too lazy to google the security experts cited in the bit about that aspect of the site, but 500 million lines of code? Holy crap. Can that be true?
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We can do better than this

Below the fold you’ll find the first in a series of “Medicare for All” graphics I’m developing. At the moment they’re just to look at, but they’ll include a call to action as soon as The Search Committee finds an appropriate one.

The ongoing Obamacare drama presents an opportunity to raise the visibility of single-payer and to draw new adherents to it from a variety of positions. Everybody everywhere likes them some Medicare, except the people whose profits are diminished by it. Nobody likes insurance companies, except the people whose profits depend on them. This is one of those rare moments when just about everybody is talking about health care and 90% of the people who are talking about it are saying “lord god this is fucked up.”
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All across America, insurance company executives and insurance commissioners are doing spit takes

(Updated 11/14/2013)

Obamacare: despise it or hate it, it’s now the law of the land and we all need to accept it and make it … wait, what’s that? The President just changed the law? Okay then.

As you know, people and Republicans have been making a big noise, first about the continuing web site enrollment woes, and then about insurance company customers who are getting cancellation notices for their insurance policies after the President emphatically said for three years that “if you like your plan, you can keep your plan.” (You most likely couldn’t keep your plan but in fairness to the President, he probably thought nobody would want to.) In response to this less than joyful noise, the administration has come up with an administrative fix that they think will put the screws to the insurance companies they blame for the mess, but is almost certain to backfire: they’re allowing insurers to reinstate the cancelled plans if the various state insurance commissioners permit it.
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Shared sacrifice: In which both sides agree to throw some old folks and some poor into the volcano

For whatever reason, the occasion of tax and spending cut negotiations has inspired tough-minded liberal thinkers to suggest that there’s virtue to be found in beating up poor people and Medicare-bound older folk. Full disclosure: I benefit from Supplemental Security Income (SSI), the program Nick Kristof hopes will be cut during the negotiations, and I’m close to Medicare age, although I won’t be as close to it in a month or two as I am now if Jon Chait and Matt Yglesias get their ways.

Kristof, the New York Times columnist whose heart bleeds, is taking some grief for his most recent column suggesting, based on no evidence whatever other than what the only people in Appalachia whose accents he could understand told him, that SSI ruins kids through the vehicle of their greedy parents. It’s an astonishingly faithful recreation of the Reagan-era welfare queen style of assault on poor people, and it wasn’t well-received. Comments on the Times site were much in the “Kristoff is monstrously clueless” vein; elsewhere, the response was often more harsh than that.

Kristof makes many risible claims, including whining that poor people avoid military service when he clearly believes they exist to be cannon fodder, but for some reason, this quote really summed it up for me:

Antipoverty programs also discourage marriage: In a means-tested program like S.S.I., a woman raising a child may receive a bigger check if she refrains from marrying that hard-working guy she likes.

As with Mitt Romney suggesting women could single-handedly stop crime by marrying “someone”, this glimpse of how the Wanker Class imagines sex, love, and marriage for everyone else. For Romney and Kristof, of course, you marry for love. But for working class people, they prescribe a system where women exchange sexual release and laundry-doing for sharing household resources with hard-working men, who are also assumed to be able to provide discipline for children women are always mysteriously unable to provide. Love and romance go unmentioned, assumed to be a luxury for the well-off, instead of a desire shared across classes. Kristof can’t even bring himself to admit that working class women might actually be capable of a lofty emotion like love, imagining the best they can do is like someone.

Elsewhere, some people who actually know something about the program and about poverty, a subject about which Kristoff acknowledges he knows little, and about the history of clueless aggravated assaults on anti-poverty programs like SSI by people like Kristoff, had this to say.

Citing anecdotal evidence from a sample of one person living there as well as the testimony of a long-standing critic of Supplemental Security who has proposed block granting it, Kristof sensationally claims that parents are “profiting from children’s illiteracy” and pulling their kids out of literacy classes in order to keep them disabled and eligible for Supplemental Security.

[T]here is a venerable traditional of mainstream journalists spreading folkloric urban (and now rural) myths about Supplemental Security. The cycle is well-established—first, mainstream journalists claim that parents are “coaching their children” to appear disabled (prominent in the 1990s) or that parents are medicating their children to make them seem disabled (the most recent scare pre-Kristof), then investigators at [Government Accountability Office], [Social security Administration], and other places study the issue empirically rather than just relying on a few anecdotal tales and find that the claims are unfounded. So, for example, with the most recent medication scare, GAO found that children who took medication were actually less likely to qualify for SSI than those who did not. Meanwhile, resources and attention are diverted from focusing on the real-world ways we could make programs like Supplemental Security even more effective for disabled kids and their parents. And so it goes.

Journalistic myth-making about Supplemental Security takes particular aim at parents caring for kids with severe mental impairments. For some reason, there is incredible denial about the reality of mental impairments in 21st century America. Kristof demonstrates this denial when he downgrades the seriousness of mental impairments by calling them “fuzzy.” This might be called the optical definition of child disability. if you look like one of Jerry’s kids, you’re really disabled; if not, well we really can’t be sure, can we?

As a bonus idiocy, Kristof mentions that poor people in America often have air-conditioners and microwaves, the implication of course being that they’re luxuriating in poverty, and he annunciates a wholly delusional hope that at a moment when a good two thirds of the people who appropriate money are eager to cut social program funds, they’ll “take money from SSI and invest it in early childhood initiatives.” That’s not going to happen, of course; if they take money from SSI, they’ll take money from SSI. And when people are willing to take money from desperately poor, disabled children, they’re willing to take money from any constituency that can’t punish them for doing so.

Throw Mama from the train, and then make her pay retail for the hospital bills

Possibly that makes Jon Chait and Matt Yglesias slightly less monstrous than Kristof, since the people they want to punish for the sin of being alive at a time when liberals want to appease homicidal Republicans have slightly more clout than disabled children of impoverished parents — that would be adults approaching the Medicare eligibility age, which Chait and Yglesias would like to see raised to 67 years from the current 65.

Like Kristof’s, this is a really bad idea. Unlike Kristof’s, it would probably kill some people outright. Richard Eskow identifies and refutes the rationales for raising the eligibility age for people whose health care needs are increasing and whose access to affordable and useful health insurance is decreasing or vanishing altogether. None of Chait’s arguments stand up to even the slightest scrutiny, but his first one is downright brutal.

“When the question comes to what concessions the Democrats are going to have to accept,” Chait writes, ” … raising the Medicare age seems like a sensible bone to throw the right.” That’s the first bad reason to compromise. Raising the Medicare age would increase the number of uninsured Americans, and would do so for people who need substantially more care than the average person.

It would also cost more money than it saves. The Kaiser Family Foundation estimated that its $5.7 billion in projected Federal savings would lead to an additional $11.4 billion in health spending elsewhere in the economy.

More uninsured Americans? Higher healthcare costs? That’s not bone. It’s meat.

Eskow is being kind. That’s not meat, that’s murder.

Chait’s essay in sociopathy attracted a lot of negative attention. Eskow cites a particularly stringent response from David Dayen, which Yglesias complained of as “ritual scourging” in his own largely supportive tract. Here’s Dayen:

Let’s look at Chait’s reasoning. I would probably start with the fact that he’s not 64 or 65. My parents are, and until my dad reached Medicare in November, they were paying $2,500 a month on the private market for health insurance. So I’ll be happy to provide him with their phone number so he can tell them how it’s “tolerable” for them to spend two years more than they expected doing that.

The one thing we know will be a side effect of increasing the Medicare eligibility age is that insurance premiums will skyrocket. It will make Medicare more expensive because they lose relatively healthy 65 and 66 year-olds from their risk pool, and it will make private insurance more expensive because they add relatively sick 65 and 66 year-olds to their risk pool. Insurers hate the idea for just this reason. As a result, everyone’s premiums will rise, and cost-shifting will ensue from the government to its citizens … The idiocy on display here can hardly be believed.

But really, it’s standard-issue idiocy, and it arises at least in part from the fact that when these assholes talk about shared sacrifice, they’re doing so from the position of people who are going to perpetrate it, not participate in it.

As for Kristoff, the mentality that plaintively wonders why lower-class women won’t just cross their legs or marry their likable fellow and bemoans a state of affairs in which food stamps and welfare are more attractive than blowing up other impoverished people in far off lands, speaks for itself. Shrieks for itself.

Soon, my petition will be a real boy, plus: Canadians don’t want Canadians to know what they know about Tommy Douglas

My petition requesting the Obama administration to commission a National Intelligence Estimate on climate change is 19 signatures shy of achieving visibility on the White House petitions system, meaning that it’ll start showing up when people search for climate change-related petitions. It is also a mere 24,869 signatures shy of mandating an administration response. Please go sign, if you’ve not.

The government in Canada is approaching and possibly exceeding the US standard for keeping secrets for bad reasons, having won a court case allowing them to continue shielding files showing the degree to which they spied on former Saskatchewan premier Tommy Douglas for 50 years. Douglas was a socialist, and the creator of what became Canada’s national health care program (one of which we do not have here in the US) and, as an advocate for peace and social justice, could not be trusted. Hence my suggestion for the new Canadian national tourism motto: “Canada. We’re not nearly as nice as you think we are.”

Democrats agree to push for single-payer health care system if mandate falls

BTC News has learned that senior Congressional Democrats are quietly directing staff members to organize an effort to pass Medicare-for-all legislation in the event the Supreme Courts strikes down the individual mandate provision of the Affordable Care Act, also know as Obamacare.

The staff members are reaching out to leaders of key advocacy groups for support of the effort. Speaking on condition of anonymity, a Democratic Congressional Campaign Committee official told BTC News that the fight for universal health care in America will play a critical role in the reelection campaign of President Obama, and in the efforts of Democrats to regain control of the House and solidify control of the Senate.

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Alan Fucking Simpson! plus: SS v. ACA: comparing apples and a mouthful of tacks

Alan Fucking Simpson! is a former Senator from Wyoming. He hates Social Security and the “greedy geezers” who rely on it to sustain them in their later years, and he doesn’t understand why anybody who already gets Social Security cares about preserving the program for younger people when anyone can see that it’s none of their business. He is the co-chair of the current president’s completely gratuitous National Commission on Fiscal Responsibility and Reform, a name that translates to “the National Commission on Cannibalizing Social Insurance and Safety Net Programs.”

President Obama created the bipartisan commission when Congress, in an uncharacteristically sensible move involving some characteristically skeezy motives, decided not to. The prospective Congressional commission prefigured the late, unlamented Super Committee, which was designed to do the same thing—produce a list of proposals that Congress would either approve without amendment or disapprove. The president supported the plan, but most Senate Democrats opposed it and it went down when several Republicans who cosponsored the legislation voted against it on the grounds that the commission might somehow do something that could possibly redound to Obama’s benefit.

Good for them. Unfortunately, the president then appointed his own commission, but without the legislative imperative. He named Erskine Bowles, a conservative Democrat and wealthy investment banker, to represent liberals and the poor, and to hold down the cannibals’ corner he appointed the aforementioned cannibalistic Republican Alan Fucking Simpson!

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How the patience of the Greeks spells doom; plus, Crazed Doctors for Sanity

The European countries acting on behalf of Greece’s creditors are bullies. Americans are saps. And a group of sane doctors may get the right result for all the wrong reasons.

As is the bully’s practice, the more the Greeks concede, the more the bullies demand. To this point the bullying has worked (for the bullies) but now the country’s managers are in fear for their political lives, at least, so the country looks as likely to default on its debts as to accept the latest turn of the screw.

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