For more than a decade, the Affordable Care Act has been saving lives. Now we know that it’s also helped save taxpayers trillions of dollars that would have raised the deficit. That’s what change looks like. https://t.co/YfxfimIDAn
— Barack Obama (@BarackObama) September 6, 2023
Super good news here. And another reason the Affordable Care Act is such a success: its wonkiest policies on payment reform generated huge savings https://t.co/AYzYztIQGe
— Neera Tanden?? (@neeratanden) September 5, 2023
Despite the potentially aggravating FTFNYTimes-house-style headline, it’s not a bad article. [Unpaywalled gift link]:
… Something strange has been happening in this giant federal program. Instead of growing and growing, as it always had before, spending per Medicare beneficiary has nearly leveled off over more than a decade.
The trend can be a little hard to see because, as baby boomers have aged, the number of people using Medicare has grown. But it has had enormous consequences for federal spending. Budget news often sounds apocalyptic, but the Medicare trend has been unexpectedly good for federal spending, saving taxpayers a huge amount relative to projections…
Some of the reductions are easy to explain. Congress changed Medicare policy. The biggest such shift came with the Affordable Care Act in 2010, which reduced Medicare’s payments to hospitals and to health insurers that offered private Medicare Advantage plans. Congress also cut Medicare payments as part of a budget deal in 2011.
But most of the savings can’t be attributed to any obvious policy shift. In a recent letter to the Senate Budget Committee, economists at the Congressional Budget Office described the huge reductions in its Medicare forecasts between 2010 and 2020. Most of those reductions came from a category the budget office calls “technical adjustments,” which it uses to describe changes to public health and the practice of medicine itself.
Older Americans appear to be having fewer heart attacks and strokes, the likely result of effective cholesterol and blood pressure medicines that became cheap and widely used in recent years, according to research from Professor Cutler and colleagues. And drug makers and surgeons haven’t developed as many new blockbuster treatments recently — there has been no new Prozac or angioplasty to drive up spending. (Medicare is currently barred by statute from covering the new class of expensive anti-obesity drugs.)
Parts of the health system appear to have become more efficient, as medical providers have been more cautious about adopting new therapies without much evidence, and more care has shifted outside hospitals into cheaper settings…
SCOOP — The FDA plans to green light updated versions of the Covid booster as early as Friday, according to four people familiar with the agency’s plans.https://t.co/i8inNpOtUl by @BerkeleyJr @albamonica
— Amanda Terkel (@aterkel) September 6, 2023
ICYMI — previously the first approval was expected next Tuesday, Sept. 12th:
The Food and Drug Administration plans to greenlight updated versions of the Covid boosters as early as Friday, according to four people familiar with the agency’s plans.
The latest shots are designed to target the XBB.1.5 omicron subvariant. Though that strain is no longer dominant, the boosters should still protect against current circulating subvariants, which are closely related, the drugmakers and experts say.
The Friday timeline for authorization is not firm, and it could slide into early next week, two of the sources said…
Two sources indicated the FDA is exploring the possibility of granting the boosters a full approval license instead of an emergency use authorization, a departure from the approach used for previous Covid vaccine authorizations. However, it remains uncertain whether that is still the intended course of action.
After the FDA’s signoff, the Centers for Disease Control and Prevention and its advisory committee will issue their own recommendations about who should get the shots and how they should be used. The agency’s Advisory Committee on Immunization Practices is expected to vote at a scheduled meeting Tuesday. The CDC’s director, Dr. Mandy Cohen, could sign off on the boosters shortly after the meeting, allowing vaccinations to begin…
Most people with private and public health insurance should continue to pay nothing out of pocket for the vaccines, Kates said. If a person gets the vaccine out of network, however, it could carry a cost.
Some people without insurance may be able to get boosters free from safety net providers, such as community health centers, but others may have to pay the full cost. The Biden administration has also announced a “bridge” program that will offer uninsured people access to free boosters at least through the end of 2024.
Novavax’s vaccine, which has not been granted full FDA approval yet but instead is available through emergency use authorization, will continue to be covered, Kates said.
This AM from @MollyJongFast: “This weekend I was shocked to see no reporting about prescription drug negotiations …president after president have tried [to do this]…Pharma is so mad. The swamp is losing…this will change lives and instead we’re reading about Ron DeSantis…” pic.twitter.com/psiMrCYc21
— TJ Ducklo (@TDucklo) September 6, 2023
The media will never change their negative coverage of the Democrats, so we need to do what we always do. Change minds and whip votes one door knock at a time. Run our own race.
— Pamela Parkington ?? (@BigDogMom3) September 6, 2023
On The Road – Dagaetch – World Tour Part 5C – New Zealand
OzarkHillbilly
Still a Big Fucking Deal.
bbleh
All praise to the ACA, once again! Tens of millions of people have affordable healthcare coverage who otherwise would not. And that’s good not just for their health but for the knock-on effects, eg the ability to leave a job and move on to other, more productive things.
And while we’re at it, a few other things I’d like to see happen:
— “Medicare for all.” Make it available to anyone who wants to buy in. We hear a lot about how The Free Market™ in health insurance helps keep costs down by spurring innovation, avoiding unnecessary costs, yada yada. Fine, let them put up with a little free-market competition.
— And while we’re at it, increase regulation of the healthcare insurance industry. Start treating them more like a regulated utility than an unregulated profit-making business. Move toward the German/Swiss model.
— Lean HARD on state legislatures and licensing agencies to permit more of, and more treatment by, qualified non-physicians such as CRNPs. There’s no reason the first stop, or even the last, for someone with a routine sniffle or a sore throat needs to be an MD.
— Lean in on the AMA and others who are restricting the supply of physicians by limiting residencies and med-school admissions. Yes it’s true that creating significant barriers to entry helps ensure quality, but the present practice goes too far in that direction, and it’s motivated basically by greed.
— Restore the informal-but-effective ban on prescription drug advertising to consumers that existed prior to the Reagan administration.
And as to:
This! I’ve said the same thing several times, but it bears repeating a thousand times more.
Chief Oshkosh
Potentially?!? Sorry to be so negative and violent first thing in the morning, but I would love it if that headline writer stepped on a rake
ETA: Yes, it is still a big fucking deal.
rikyrah
Good Morning Everyone 😊😊😊
Chief Oshkosh
@rikyrah: Mornin’! :)
rikyrah
Obamacare was a game changer. Is it perfect? Of course, not. Could it have been designed better? Yes. But look at the large number of bad actors that 44 and Speaker PELOSI and Senator Reid had to deal with…..🤬🤬🤬
Baud
@rikyrah:
Good morning.
Suzanne
Obama may be the greatest president I will ever see in my lifetime, for the ACA (not just that, but that alone could put him over the top). Working with my clients both before and after, it’s hard to convey how afraid they were. There were years of fear about capital investments. But it’s worked. And psychiatric health care access has increased dramatically.
Fun fact: the ACA requires mental health care services to be covered in ACA plans. There’s been a significant increase in the number of behavioral hospital beds because of it. This never gets reported, but never forget that Obama and the Democrats are the reason we have psychiatric care in this country outside of expensive rehabs for celebrities, and shitty county hospitals that you get sent to by court order.
Baud
This quote is apt, but I’m curious what @MollyJongFast talks about. We have a lot of alternative media out there, and while they can’t substitute for traditional media, they can help pick up the slack.
Serious question, by the way, not a criticism in the form of a question. I don’t consume much political media these days so I don’t know what’s out there.
Kay
Wait until all the low income kids that Democrats covered with Medicaid start showing up.
We have covered tens of millions of children over the last 30 years. Republicans opposed ALL OF IT.
That will pay off big. Talk to low income middle aged and older people. MANY of them, MOST of them, never got any medical care at all coming up. I have heard “the last time I went to a dcotor was for my sports physical at school” from 60 year old men more than I can count.
We’re going to have an entire cohort who had lifetime basic health care entering Medicare for the first time. 100% due to Democrats. I have no problem paying for good investments like that and I think most Americans won’t either.
Baud
@Suzanne:
Five to ten years from now we’ll be saying the same thing about a lot of the bills Biden and the Dems have passed.
Our side claims to be thoughtful, but oftentimes too many ignore things that don’t result in instant gratification.
Mousebumples
I work in healthcare, and I didn’t know that! Very cool. We just need more psychiatrists (and other mental health professionals). It’s been an under-addressed need in this country for too long, and I hear from friends and family about long waits to see a psych provider.
Thanks for the great links in the OP, too, AL. I’m grabbing the NYT link to share with a student since I think that would make a great Hot Topic for our meeting next week. And the covid shot FYI is also appreciated since my team will need to make sure these are covered when they’re approved.
Kay
If national Democrats did nothing else covering all those millions of children over thirty years would make a worthwhile political Party. Republicans have nothing that even comes close.
rikyrah
@Kay:
This is so true. So true.
Baud
@Kay:
I hope we get credit. IIRC, we got no political mileage out of CHIPS.
I’m actually not sure we’ve gotten that much mileage out of any health reform. You can say that reforms kept some people in the tent who might have left, but we sure don’t seem to have produced passionate advocates, at least as far as I have seen.
Mousebumples
Also re Pharma being mad about drug negotiations, my husband tried to ask me a related news/trivia question. “Which pharmaceutical manufacturer is suing the federal government over Medicare price negotiations?”
My answer, while not technically accurate was right in spirit. “All of them.” They all hate the precedent this sets. Even if their drugs aren’t on the first list… Maybe next year. Or the year after. Or the year after. Etc.
bbleh
@Mousebumples: and it’s important not only for people with serious disorders but people with more run-of-the-mill issues who don’t need intensive psychiatric treatment but rather some informed and experienced counseling and maybe a recommendation to an MD for a short course of medication. The net benefit to society of easing widespread not-crippling-but-still-debilitating disorders is / would be enormous and worth many times the necessary investment.
Baud
I am saddened that state Republicans haven’t paid a price for refusing to expand Medicaid.
Matt McIrvin
A few days ago one of my favorite Mastodon posters, @[email protected], had an interesting theory about Biden’s media profile: she thinks he should stop personally distancing himself (in public rhetoric) from the prosecution of Trump. That he’ll be accused of a political vendetta regardless, so he might as well own it and look active and vigorous, since the Trump story already dominates media coverage at his expense.
The problem I can see with this is that it might legally jeopardize the prosecution and I think winning this is very important to Biden, more than scoring points. But the point about leveraging media attention is interesting.
bbleh
@Baud: oh but Medicaid is for THOSE people. See Davis X. Machina on sparrows, curtain rods, etc.
M31
and while the worst were GOP, of course, there was a way-too-high number of Dems in the bad actor group
every time I look at the Dem senate that Obama had to deal with I get really mad, but also so impressed that the ACA passed with so many good features
Fuck Joe Liebermann, that rancid piece of shit
Kay
@Baud:
I agree. It’s not politically beneficial. People don’t even remember that insurance used to be capped before the ACA. I once went thru bills with a lady – her insurance wouldn’t pay past 1 million and her 16 year old son had died of blood cancer after failed stem cell treatment. I stopped adding at 2 million and sent her next door for a bankruptcy. If they stop paying it shows up on their credit report and it’s a tidy, comprehensive list. I told her to throw out her huge bag o bills.
Medicaid is even worse. They don’t even realize they’re on a government program, let alone connect it to Democrats.
narya
@Baud: She does a three-segment podcast, with a different guest each segment. I don’t listen to every podcast–basically, I scan the guest list and see whether it’s someone I want to hear. It really is “fast” politics (the name of the podcast), and I personally tend to prefer more in-the-weeds discussions, but it’s not terrible.
@rikyrah: Totally agree it was a game-changer–I’m SO grateful that he just made it priority and worked with everyone to get it DONE.
I read this article yesterday (don’t judge me), and it was hard to tell whether they really don’t know what’s causing the gap or whether they really don’t want to give the ACA as much credit as it deserves. I think it’s some of both, tbh. As noted, it was, and is, a huge game-changer, and I think that there are a ton of little things that aren’t going to be captured easily.
BellyCat
THIS. The Feds need to step in as the AMA will NEVER change this. The current method violates the basic rules of capitalism for supply and demand and manipulates markets to disadvantage consumers. It is, arguably, illegal.
OzarkHillbilly
@Baud: Here in Misery the voting public expanded it via ballot issue because the state GOP refused to. And “we” rewarded them all with another term in office.
Over at OTB Steven Taylor talks about how most voters just vote for their team, no matter their policies or actions. Certainly is true in this state.
Kristine
I get a number of newsletters, and in one (iirc STAT), a pharma rep downplayed the negotiations, saying not much money would be saved and those saving won’t kick in for a couple of years anyway.
They also added that it would interfere with the doctor-patient relationship and, an oldie but a goodie, take money away from product development/R&D (read: less money for stock buybacks).
To bbleh’s list, I would add the end of stock buybacks. Pharma loves stock buybacks. I’ve said it before–it’s nothing but legal market manipulation. If a company wants to add value, they should do it the old-fashioned way, by product/process improvement and development of effective new products.
Betty Cracker
@Baud: Me too, and their refusal dented how much credit Dems get for healthcare support (which was the point of Repubs’ rejecting the money, of course). Pandemic-era expansion of Medicaid is ending, and I’ve seen ads targeting people who are affected, urging them to check out healthcare.gov. They won’t get much help thanks to the FL GOP, so most will probably become uninsured again.
I don’t know if there has been any effort to put Medicaid expansion on the ballot here. It passed in South Dakota, so there’s no reason to think it couldn’t in FL, though you need a 60% majority.
narya
That is so much horseshit, as you note. When I worked for a biotech, we did small clinical trials. They were trials that should have been part of Phase I development, but the big pharmas with which we worked didn’t have money at that stage–the marketing teams, OTOH, had piles of it. (Our studies were very expensive, relatively speaking.
ETA: point being, they HAD the funds, they just wanted to spend the money on selling their product, not on finding out if it worked early enough to make decisions about it.
Kay
Remember how the really stupid “fiscal conservative” Andrew Sullivan opposed the ACA?
Everyone understands he’s only famous because he has an english accent, right? That only ninnies and dopes think he’s smart?
He has been on the wrong side of every major US policy decision since the UK foisted him off on us. He’s bad for America.
Baud
@OzarkHillbilly:
They can vote for their team in the primary. That’s how we do it when am incumbent goes off the rails or loses the plot.
Baud
@Kay:
He supported gay rights when it was still acceptable that they not be treated as equals, and he enforced Obama. Other than those two things, a miserable failure.
Matt McIrvin
@Betty Cracker: People get very upset about losing something they had, not so upset about not gaining something they never had. And when they do gain, it’s an unknown often initially regarded with suspicion. That’s why the early coverage of the ACA was so negative– people who did think they were losing something howled.
OzarkHillbilly
@Baud: Oh yeah, and the state has yet to do it because the Misery state lege refuses to appropriate the money.
Betty Cracker
@Matt McIrvin: Biden’s instinct to be hands-off WRT the Trump prosecution seems wise to me.
Kay
@BellyCat:
Expanded licensure has solved a lot of that problem- PAs and nurse practioners. I see a nurse practioner as a primary. She recently referred me to a specialistfor osteoperosis. It works well. She provides ordinary care and is also the gate to specialized care of you need it. I’m really happy with her, but I know her and our kids went to school together and my husband represented her son …small town. Anyway! The article mentions it. Jerry Brown can take credit for that. California pioneered it, I believe.
Betty Cracker
@Baud: In 2009, Sullivan front-paged an original illustration I did of Sarah Palin and excerpted the post I wrote, so THREE things. ;-)
Mai Naem mobile >
I know Obama’s trying to be humble but he needs to embrace the term “Obamacare.” I always remember talking to a woman around the time O-Care was passed who thought Medicare was passed by Ronald Reagan. It’s all about marketing.
bbleh
@Kay: and not only does it reduce the need for more physicians, it also saves money, and it makes care available to patients who otherwise might have to travel long distances or wait a long time.
But it varies sharply by state. Some state boards are very “conservative” (for which read captured) about expanding licensure. The good news is, it’s becoming more of a winning issue from what I know, but there’s still a way to go.
Baud
@Matt McIrvin:
Chasing media attention on the media’s terms is idiotic. It would be like Biden deciding to ramble on like Grandpa Simpson talking about how old he is.
The only way for a Dem to garner positive media attention is to create a sensation among the public outside of the media. Think the Obama 2008 campaign. That’s really hard to do.
Geminid
@Baud: In 2017, Virginia Republicans finally paid a price for not expanding Medicaid. Ralph Northam and House Delegates made it an issue, and Northam won by 7 points and Democrats gained 14 seats in the House of Delegates. After that, the Republican House Speaker and 9 other Delegates voted for expansion, and 3 Republican Senators did also.
Medicaid expansion saved a lot of lives, and was probably the most consequential legislation passed by the General Assembly this century. By the time the Covid pandemic hit, 400,000 Virginians had been added to the state’s Medicaid rolls.
Wag
@Kay: Does Andrew Sullivan still exist? He fell off my radar screen years ago.
Kay
@Baud:
He supported gay rights exclusively because doing so was self interested. He’s a fucking blatant misogynist and it pains me that idiot media people don’t see it.
He spent 6 months basically stalking Sara Palin – just fucking disgusting behavior. He was basically taking the brain pan calipers he uses for his moronic 19th century race science to her belly. His argument was she was a “bad mom” because she took a flight while pregnant. I can’t stand Sara Palin but her pregnancy and the size of her belly at any point therein is none of his business. He would never have treated a man that way.
Kristine
@narya: Waaay back when I first started working at last day job (yup, Big Pharma), I read an article by one exec who felt that the age of the blockbuster was drawing to a close and companies would instead concentrate on specific indications and families of smaller volume products to treat them. I don’t believe the industry went that way—Wall Street still wants blockbusters and increases in quarterly profits and big fish swallow little fish in order to develop their potential big sellers. Product tweaks to extend patents. Paying off companies to delay generics entering the market. It may be a rich industry, but it’s not a healthy one.
Betty Cracker
@Kay: True — his Trig Truther shtick was sexist AF in addition to being just plain weird.
Kay
@Wag:
He’s in the thriving anti cancel culture grift. He spends his days opining that Yale Law students aren’t deferential enough to Right wing judges. He’s one of the ninnies who think the Oberlin student council “wokeness” is an existantial threat. Because of course he is. That gang is full of over promoted lazy thinkers.
Baud
@Kay:
If nothing else, I’ll always take pride in aging gracefully.
Baud
@Wag:
If he didn’t, they’d have to create him.
Kay
@Betty Cracker:
It was SO priggish and intrusive. Like a horrible, vicious gossip. First I laughed because look at this fucking clown collecting photos of the scarves Palin wears but then he showed his hand – she’s a BAD MOM because she kept working. I felt it personally because I don’t show a lot pregnant. As you know it’s different for all women. It’s partly the clothes I wore- like Palin I did the scarf thing – I also love a nice scarf but anyway.
Andrew Sullivan is the neighbor you have in Texas who turns you in to the pregnancy police. His entire phony “libertarian” pose dropped the moment he had to police a woman.
Mai Naem mobile >
@Baud: Sully supported gay rights because he himself is gay. He supported Obama because he’s HIV+ and needed the rules changed for him to gain US citizenship and that was not going to happen under a president McCain.
Baud
@Mai Naem mobile >:
They were good things, regardless of the underlying motivation.
narya
IMHO, it’s precisely because they focus on the things you mention, rather than on the research that leads to lots of failure but sometimes leads to a whole new way of thinking about, and addressing, an issue [waves at mRNA technology that saved us from Covid].
Soprano2
@OzarkHillbilly: No, they have implemented it because they lost in court over the issue of not funding it. I believe the money was in the budget this year. You’re right that they certainly didn’t want to fund it, but when they see that it’s a money saver in a few years they’ll all be claiming they were always for it.
Baud
@Kay:
That’s too harsh. He’d probably just sue you for the bounty.
bbleh
@narya: the whole advertising thing is a really pernicious problem. DTC (“direct-to-consumer”) advertising WORKS: patients are captivated by the gauzy imagery and they ask — or pester — doctors about products, and if it’s a medically acceptable course of action, sometimes an MD will go along, not least because a happy patient is likely to be more compliant in using the med.
Also, it’s useful in building brand visibility at launch, which is really important to pharmacos. First, they want to get as much of a jump on the competition as they can, and if you’re first to market, the bigger share you can capture, the bigger the share you’re likely to maintain even when competitors emerge. And second, regardless of when you come to market, you want to build your safety database, especially if — as is the case with many drugs today — you’re planning on launching in additional indications as soon as you can get approval.
The real problem comes when you’re head-to-head with one or two competitors, because then it’s basically an arms race. You can’t NOT advertise because then you lose share. OTOH your advertising is probably doing nothing more than maintaining the share you would have anyway. In other words, it’s money wasted. And in lucrative markets, that can mean as much or more as it cost to develop the drug in the first place (!!).
And it’s the last of those where I think there would be not so much pushback as a huge sigh of relief from the industry if DTC advertising were effectively banned again. They know it’s money wasted — a LOT of money.
The question is how all these things would trade off. I suspect — but I don’t know for sure — that a decade or two ago, pharmacos would have traded relief on the arms race for the brand-building advantages. Now, I’m less sure, but I bet it’d still be close, so the squealing would be muted, and of course the benefits to society as a whole would be substantial.
Maybe wait ’til the Medicare-negotiation fuss dies down. That’s a more important step forward anyway.
Betty Cracker
Flamingo update: Peaches is still recovering at the Seaside Seabird Sanctuary:
Looking good, Peaches!
Also, according to my rare birds alert from yesterday, there are flamingo sightings all over the Gulf Coast of Florida. The solitary flamingo who’s been hanging out in the Panhandle since Hurricane Michael in 2018 now has four other flamingos as company!
Dorothy A. Winsor
@Betty Cracker: Also principled.
Betty
@bbleh: I would add that efforts to reduce the cost of becoming a doctor ,such as grants for those willing to become internists to work in under-served areas, would also bring down the high cost of seeing a doctor.
MomSense
I worked my ass off to pass health care reform. 20 plus hours every week as a volunteer. Made lifelong friends in the process and heard more horror stories about what being without health care did to people. Our goal was to get the best possible version through the Senate Finance Committee because we knew that would be the version that would become law. I talked to Olympia Snowe and got some key intel about Max Baucus who had stopped talking. Yes, Snowe was trying to keep it alive when Baucus was being an asshole. It was an incredible experience and I count it as one of the best things I’ve ever done. I’ll never forget the morning after it passed. President Obama got on a conference call with us to thank us and he said the right to health care is now enshrined in law. His voice was hoarse and full of emotion.
bbleh
@Kristine: other things have changed too, notably that a lot of the relatively easy problems — ones that produced blockbusters almost out of the gate — have been solved. Eg, run-of-the-mill hypertension drugs are cheap as dirt and work well, so there’s not much money in pursuing yet another mechanism of action because it likely won’t yield much of an improvement over the standard of care. The problems being chased now are considerably more complex, eg metabolic disorders (eg the new generation of “weight-loss drugs”) and cancer (customized tweaking of certain immune-system components), which take a lot longer and a lot more money and which don’t necessarily produce the big improvements in overall patient health that the drugs of a generation or two ago did and do.
Pharma stocks were a gold mine for a while. They aren’t so much anymore.
RevRick
@Mousebumples: It’s not just Medicare that Pharma is fearful of, but private insurance,too, because private insurers usually cut a deal that is Medicare + a %. And private insurers won’t tolerate having to pay an enormous premium for the same drugs. They know that Medicare isn’t just negotiating for Medicare, but also Aetna.
narya
@Betty: This already exists–the National Health Service Corps pays back the loans of docs, nurses, midlevels, dentists, and behavioral health providers in return for them working in underserved areas. Federally qualified health centers (and, I think, other entities) work through NHSC to have their locations qualified to have these folks, and then folks apply for those positions. It’s a little cumbersome, but it works, and I saw expansions in the program before I left my job. (IIRC, the doc on Northern Exposure was part of the program.)
cmorenc
@bbleh:
Expanding the number of students admitted to medical school / residencies requires much more than surmounting resistance from the AMA – it also requires huge investments in creating or expanding the clinical resources where key hands-on training of new physicians occurs. You can’t just crank out a new medical school the way e.g. a new law school can be established with some classroom space + collecting enough burned-out veteran lawyers to teach class. 3rd and 4th year of medical school and residency require students to be immersed in clinical settings, exposed to enough numbers and varieties of patient conditions to get good at diagnosis and treatment methods, as well as current medical technologies. You’d need the expansion to not come with the cost of dilution of clinical training experience, which requires expansion of clinical resources.
Don’t misunderstand the above as arguing in opposition to expanding numbers of medical students – rather understand correctly that there are formidable resource factors beyond just AMA resistance that must be surmounted for that to happen.
Betty Cracker
@RevRick: Excellent point.
@Dorothy A. Winsor: Yes. That’s the most important thing, really. You don’t want to become the thing you oppose — even a little bit.
Betty
@Betty Cracker: That tail wag is just too cute! Peaches is a lovely bird.
bbleh
@cmorenc: all true, which is why I think expanded licensure is equally important (I think I put it first). And IIRC at this point only a minority fraction of MDs are AMA, so they’re not just not the only problem but a decreasing one, but they tend to be older, senior MDs, and they still have a lot of clout.
And the last thing we want is either “diploma mills” or a generation of less-than-qualified MDs flooding in. But we “import” a lot of MDs who were educated abroad, in part because we just don’t produce enough at home
@Betty: you bet! You think college debt is a problem, try med school debt! In some cases, dealing with the debt becomes career-limiting, even for an MD! We did (do?) something similar for college graduates who did some other form of public service; seems like there would be a fair way to do something similar for new MDs.
Chief Oshkosh
@Kay:
Maybe the Democrats should take a page from state- and municipality-level politicians.
On the label: “Price of this drug is 90% lower because of Democrats.”
On all Medicaid/Medicare documents: “This healthcare provided by Democrats.”
On every single Social Security check: “This retirement system and this check you are holding exist because of Democrats.”
At least they’re starting to do something like this with infrastructure, but they’re associating the work with the American Rescue Plan, leaving it up to the user to connect the ARP with Democrats. Instead, we should just flat-out place permanent signs:
“This bridge exists because of Democrats.” Literally engrave it in stone.
“This protected land exists because of Democrats” at the entrance to every National Park or Forest.
“This airport exists because of Democrats.” Fuck it. If Republicans can just hang a sign out front of Washington National to rename it “Reagan National” when that pig fucking shitheel set ATC and FAA back a generation, then surely we can boldly take credit for the good that we actually do.
Kay
@Mai Naem mobile >:
Oh, great. So happy that liberals made it possible for him to remain in this country. Labor unions call people like Andrew Sullivan “free riders”, I mean, they call them worse things but publicly he’s a free rider.
Democrats amaze me sometimes and not in a good way. Sullivan smeared the Clintons for years. He lied and hired liars to oppose health care for years. He’s a freakish “race scientist” and misogynist and he lost his fucking mind after 9/11 and went after Muslims and supported Iraq. But he supported Obama so we’re all pals?
I don’t want him on my side. Obama is a hugely talented person. He didn’t need Andrew Sullivan.
OzarkHillbilly
@Soprano2: I missed that, very happy to hear this. Thanx.
Kay
@Chief Oshkosh:
We laugh, but I think Social Security should have kept sending out the paper statements. People bring things to small town lawyers. They bring us papers. They would bring me the statement and ask me 1. if it was real and 2. if it would be there when they reached age. It was one of the few nice “what does this document mean” encounters I had. Usually I was like “that’s a judgment” or “that’s a 3 day eviction notice”.
It’s important to tell people.
Suzanne
@Mousebumples:
Oh yes. I have experienced this personally with Spawn the Elder. Trying to find behavioral health providers is…. very difficult. Many are not taking new patients. The shortage is significant.
I will also note that the cost of medical education is also part of the reason we have a shortage of doctors. I noted a couple of days ago that it is really financially difficult to take on an expensive degree, then have a few low-earning years before making more. (Common trajectory for doctors but also lots of other professionals.) During those low-earning years, the interest blows up, even if you are paying on those loans. Even if we just made student loans zero interest, that would go a long way to solving these problems.
NotMax
‘Tis the season.
Seeing/hearing the first ads for pumpkin flavored items of a comestible bent.
And BTW, gremlins are real. Head scratching ensued when fired up the ol’ PC after it being shut down for two weeks while was away. One of the dual monitors and the external speakers not functioning. Inspection at the rear discovered both of them had somehow, some way, become unplugged from the tower. Not plugs come loose, mind you, rather no longer inserted where they had been.
Spooky. ;)
Ben Cisco
@Kay: They still send them, just got one recently.
Kay
@Betty Cracker:
Speaking of gossip, did yu see that Murdaugh may have an actual issue for retrial?
That “low country” is nuts. I say that but in 2007 they marched our clerk of courts out in handcuffs because she was stealing.
Lawyers are insanely gossipy and NOT ONE of us knew ahead of time. We were outraged! Not thst she was a thief but that we didn’t know FIRST :)
Matt McIrvin
@Kay: Sullivan is super racist too; aside from the Bell Curve business there’s his horror that London is full of brown people now.
OzarkHillbilly
Heh: Pencils with teeth: meet the tiny cookiecutter shark that attacked a catamaran off Cairns
RevRick
Monday, Tuesday and Wednesday, I had my own interactions with the health care system. I had developed a head cold last week ( yes, I tested twice for Covid— negative), when it turned into a nasty cough on Sunday.
Monday morning I went out, watered the lawn, and went for my usual 6000 steps. That afternoon I had a bad coughing fit, felt a twinge in my left hip, went to the bathroom, and as I tried to get up off the can, agonizingly sharp pain made it impossible for me to stand or move. I sank, first to my hands and knees, and then flat on my face. I was immobilized with the pain. My wife called 911, the city ambulance arrived, two burly guys lifted me into a chair seat, got me down the stairs, to the ER, where I was seen by a CRNP, given a muscle relaxant, a lidocaine patch, a referral to the spine center, scrips, and sent home. Sciatica is a bitch. But within hours I was able to hobble around again, albeit with the assistance of my walker. Tuesday night another coughing fit triggered another sciatic episode, and a call to 911 at 4am. This time, two burly guys got me downstairs and seated on the loveseat, since another trip to the ER was pointless. I had a 10 am appointment with the spine center, and they said if I needed assistance to get in the car, to call 911, and they would send a couple of burly guys to help (this is a city-funded FD/EMT).
At 6, I realized I needed to get moving, if only to get upstairs to go to the bathroom, and with the assistance of my walker, got up and started walking— painfully shuffling at first. I then recalled the stretching, strength building exercises I did for my hip replacement surgeries, and was able to negotiate the stairs, toilet and getting in the car, and to the spine center.
There I was seen by Doogie Howser’s somewhat older brother, who, in the course of my examination, mentioned how they’ve seen a tremendous upsurge in COVID-related spinal arthritis, which can be triggered by cold-like viral infections! I then recalled, I had a mild case of COVID post-Christmas 2021, and my symptoms were achy torso and back. He prescribed a new prescription and PT sessions, beginning Friday.
NotMax
@OzarkHillbilly
Leaving behind holes in the shape of a silhouette of a Christmas tree a dead giveaway.
:)
rikyrah
@Baud:
Because their voters would rather cling to Whiteness than get medical care
CaseyL
@NotMax: I have some ideas about that:
House settling, creating just enough movement to joggle things loose/fall out?
Armies of ants coming in the night to see what food might be hiding behind those weird snakes, so they remove the snakes to have a look? – or because it’s warm?
Someone in your household unplugged everything on the way out, thinking that would be protection against surges?
Poltergeists! (Always a popular explanation. They’re constantly hiding things and moving things in my house. And I always say “thank you!” when the lost thing shows up again.)
rikyrah
@M31:
Everytime I think about how Medicare would already be lowered to 55, and how it would have been in place and the norm for a DECADE..
and how many lives that would have helped and change?
Yeah, PHUCK JOE LIEBERMAN
lowtechcyclist
@Kristine:
I’ve never understood how this isn’t a huge violation of antitrust laws. It’s the functional equivalent of price-fixing.
Kristine
@lowtechcyclist: IIRC, some companies have been penalized for it but I believe some still slip under the radar.
narya
@rikyrah: I want Those People–assholes like Lieberman and the
Rs who restrict healthcare–to have to live under the conditions that they force on poor and middle class folks. Two years, minimum. What are you gonna pay for today? Rent? Food? The doctor? Gas for the car so you can get to work? Cause you can’t pay for all of them.
Soprano2
@MomSense: Thank you for all that hard work. Passing the ACA is one of the most important things the government has done in my lifetime, and they couldn’t have done it without people like you.
CaseyL
@M31: Not just that worthless, corrupt ninny. It was Baucus who as Chair sat on the legislation for 6 months after the House passed it, so the momentum could dissipate.
rikyrah
A reminder.
Obamacare is the only expansion of the American Social Safety Net that DID NOT have – in its original design – the EXCLUSION of a huge swath of the American populace.
It took the Roberts Court to do that with that Medicaid bullshyt.
Baud
@rikyrah:
The ACA is a great achievement, but I’m not sure who was excluded from the original design of Medicare or Medicaid. (Unless you count young people and non-poor people).
rikyrah
@narya:
This is true. Have a cousin who is a dentist. She spent 5 years in a Texas Border town , and walked away with all her loans forgiven.
rikyrah
@MomSense:
Thank you :)
Omnes Omnibus
@Matt McIrvin: I think that fundamentally misunderstands Biden’s take on the governance in general and the DOJ in particular. He will not interfere in the administration of justice. He isn’t accepting the idea that, because Trump broke every norm, that those norms are gone. For better or worse, we elected someone who is going to try to do the right thing in the right way. I think it’s a good thing.
rikyrah
@Suzanne:
Absolutely.
Suzanne
@rikyrah: Joe Lieberman is a complete piece of shit.
He makes me understand why people who are inclined to agree with us stay the fuck home and don’t bother voting and throw up their hands and say that both parties are the same.
I will note that I don’t do that myself…. but I’m able to wrap my head around it.
Citizen Alan
@Baud: I’m not saddened so much as disgusted and enraged . Because the Venn diagram of politicians who insist on draconian anti abortion laws because they are “pro-life” and the politicians who refuse to expand medicard because it’s government overreach, tax and spend liberalusm blah blah blah is a perfect circle.
I’m looking at you, Mississippi Speaker of the House Phil Gunn!
Kay
@Matt McIrvin:
I figured he would be an immigrant opposed to immigrants. Of course he is.
I think we should have deported him when he got caught smoking pot in a national park just because that’s such a lame crime. How did he even get caught for that? Did he go find a ranger and blow smoke in his face? He’s a moron. I need to borrow his caliper set and measure his head.
narya
@rikyrah: It is really an awesome program! Everybody wins! And I think it also helps at least some folks understand the challenges that poor folks face w/r/t health care (some providers already know, but I suspect some do not).
narya
@Citizen Alan: And, as the FTNYT is reporting, OB/GYN providers are just leaving those states, meaning that ALL people who are pregnant are suffering from lack of available care. And it’s only going to get worse.
Mousebumples
Not defending him, but I remember getting scolded by a Park Ranger for using a portable grill in a (unbeknownst to us) National Park.
Tailgating before a Packers – Rams game in St Louis. Thought we were across the street from the Gateway Arch National Park. Nope. Still in the park, just across a street. 😂
We moved the grill across another street up be in front of a hotel and just ate our brats in the park, lol. (and the Packers won, but this was like a decade ago)
rikyrah
This is going to be an issue. For all those women in Southern Red States, this is going to be an alternative.
The Associated Press (@AP) tweeted at 3:16 PM on Wed, Sep 06, 2023:
BREAKING: Mexico’s Supreme Court decriminalized abortion nationwide Wednesday, two years after ruling that abortion was not a crime in one northern state. https://t.co/mPMaOHJ0gE
(https://twitter.com/AP/status/1699516912713990603?s=02)
UncleEbeneezer
@Matt McIrvin: How we he do this though? Trump is being prosecuted by Manhattan, The state of GA and DOJ. The only thing Biden did was on the last and that was: 1.) appoint Garland and 2.) refuse to assert Executive Privilege to protect evidence that Trump and his people wanted kept out of the hands of DOJ. Otherwise Biden hasn’t really done anything, which is a GOOD THING! Maybe he can make a general claim about the fact that DOJ is now using its’ power to protect civil rights, abortion rights, LGBTQ rights, prosecute hate crimes etc., instead of attacking peaceful protestors, but I don’t really see how he can make any realistic claims of involvement in the prosecution of Trump. And even if he wanted to, it would necessarily involve standing proudly behind Garland, who has been sullied by an extensive campaign of smearing by pundits, Twitterbots and cynical blog commenters. Biden can generally point to the fact that Justice is now moving in the right direction, and I think that is accurate, but I don’t think going into any greater detail would do him any good. And he still has to give people the presumption of innocence. Because that’s what Dem voters (and true Americans) actually believe in, and is the cornerstone of our Justice system.
rikyrah
@narya:
Not just leaving, but, don’t even want to apply for residency in those states. This is a problem that’s going to get serious very quickly, if you have all these residency spots open and unfulfilled in Red States.
John S.
@bbleh:
The US is pretty much the only country on the planet that even allows DTC advertising by pharmaceutical companies. It’s one of those weird things that non-Americans notice once they spend some time here.
schrodingers_cat
@Kay: He was pro-immigration until he got his green card now he is a raging anti-immigrant bigot. I gave up on him more than a decade ago. You are right about the British accent.
We colonials hear that accent and click our heels and say yes sir. I have noticed this phenomena in India too.
Jim, Foolish Literalist
@CaseyL: Yeah, when the O’Bros started their podcast they would occasionally make references to Lieberman single-handedly killing the Medicare buy-in, then later they said, yeah, he was just the one willing, eager, to be the public face of opposition.
I always say: Nobody remembers Byron Dorgan and Kent Conrad, and most people didn’t know they were there when they were there. And Mrs Dorgan and Mrs Conrad probably needed name tags to tell them apart.
Max Baucus came back from the grave (prove me wrong) last year to endorse his good friend and fellow walking corpse and Mega-MAGA trumpist Grassley.
VeniceRiley
Andrew Sullivan gave me the one STFU line to use on our left dem friends in regards to gay marriage. They were always spouting anti marriage messages at me back in the day. You cannot rufuse something that isn’t even offered to you as an option. Full stop.
And I think his case for marriage helped change minds in the “intellectual conservative” crowd.
His other hobby horses can ride off into the sunset.
Now that I have paid a lifetime of Medicare tax, I’m not in the USA to take advantage of it. And, as a non- citizen in the UK, I PAY for NHS. What I’d like is something like tax treaties for healthcare. I think it would be a financial boon for the govermenment. People would be free to retire overseas on less expensive countries… Yes, I know I’m dreaming.
I wonder when we’ll get new vaccines here? It’s like Covid isn’t a thing in the news at all.
Nelle
@bbleh: I knocked on 10-12 doors yesterday. Took a long time, as almost all wanted to chat. Twice invited in to admire the women’s recent paintings. Another 25 to go for November’s local elections.
Citizen Alan
@Kay: I thought it was even Worse than that. Didn’t the Sullivan have some bizarre conspiracy theory that Bristol palin’s out of wedlock child was actually sarah’s instead? Or maybe vice versa? That was around the time I stopped following him because I thought he was nuts.
Kay
@rikyrah:
I hope women are getting how little thought the anti abortion movement put into this. How absolutely cavalier and reckless they were regarding womens lives. Fanatics on a mission who have now put hundreds of thousands of women at risk.
They don’t care if women live or die. No one can or should trust them. The single best predictor of voting anti abortion is not gender or religion. It’s a negative view of women – women are liars or immoral or scheming. That’s the anit abortion movement.
CaseyL
@rikyrah:
Oh, those slots will be filled – just, not by qualified medical students but by graduates of quackery institutions.
If Liberty University doesn’t have a medical program, it can start one. They already churn out “lawyers,” don’t they?
RWer donors can easily set up “medical schools” that simply exclude such things as germ theory and epidemiology, instead offering “folk medicine” versions of those plus OB/GYN.
It’ll be snake oil and faith healer time again in the Red States.
UncleEbeneezer
@Betty Cracker: Especially coming on the heels of the DOJ/AG being overtly politicized by Barr, Sessions, and before them, Gonzalez and the US Attorneys scandal. Using DOJ to persecute political rivals, spying on protestors, firing everyone to have only your loyalists working there etc., is exactly the opposite of what Liberals/Progressives should want for an American Justice Dept. We want a Justice that is truly blind to politics. This is one of the biggest reasons we needed to elect (and need to re-elect) Biden.
Kelly
@CaseyL: How much oil do they get out of a snake? Those critters always look kinda lean.
Chief Oshkosh
@rikyrah:
And not just OB/GYN residencies – all residency programs in those states are being affected, though probably to a lesser extent than OB/GYN. As I’ve noted here before, I know of several offers that were dropped because young professionals starting families simply are not willing to deal with red state bullshit. The effects won’t be like a tsunami, but the icky water is rising..
ETA: CaseyL is probably correct, that the slots will be filled by wackos, at first, but this will fairly quickly lead to a residency program having slots taken away by the Big Money Boys as they get hit by lawsuit after lawsuit caused by said wackos.
montanareddog
@Kay: Am I a bad person? I am and I confess to snickering when I recently read that Sully, the vociferous champion of same-sex marriage, and outspoken Catholic, had just gotten divorced.
smith
@Matt McIrvin: Biden needs to stay well above any involvement in ongoing DOJ cases for the simple reason that having a Dem president doing this normalizes it for all future presidents. As the GQP is now, if they had someone in the WH that person would absolutely do what the Right imagines Biden doing: throwing political opponents in jail and prosecuting them on bogus charges. It might happen anyway, but it’s a very bad idea to give them any justification for it.
Ken
Also used during passage of the ACA. I was a bit young in 1965, but I imagine it was used against Medicare.
I think the first time I noticed the word “Medicare” must have been in a Gilligan’s Island episode, where Mrs. Howell said of someone, “You must be one of those silly doctors who voted for Medicare.” (Mr. and Mrs. Howell, for those not familiar with the great classics of American culture, were the stereotypical rich couple.)
Barbara
@Wag: Andrew Sullivan still exists. Somehow I am still on his email list but I never read his daily or weekly “dish” as he calls it. On the plus side, he really liked Obama in the lead up to 2008, and he also repeatedly called out George Allen for his “makaka” comments that led to his defeat for the 2006 VA Senate election, by pushing it into the mainstream media, and for that he deserves credit. I mean, he saved us from the possibility of President George Allen, so, you know.
His existential problem is that he wants the pieces of the liberal world view that personally protect him but twists himself into a pretzel to justify why no one else deserves what he should have. I have never figured out why he feels this way, but he has gotten increasingly tedious as the years go by.
Omnes Omnibus
@UncleEbeneezer: Unfortunately, there are more than a few people who want a mirror image Trump. Belief in democracy isn’t automatic. It’s hard work to do it right, and a dictator makes things so easy.
UncleEbeneezer
@Omnes Omnibus: Exactly! Biden (and Garland) actually believe in maintaining the strict separation between the President and the AG. As do, most DOJ employees, according to several former DOJ/USAttorneys/FBI people I follow. There really is a culture of “do the job” and “follow the evidence” and “nobody is above the law” that they believe in, regardless of who they vote for. People like Jeffrey Clark and the FBI guy who thwarted some of the early attempts to investigate Trump, sound like they really are the outliers and not representative of DOJ or even FBI, according to people like Peter Strzok and Andrew McCabe who note that they worked with lots of Republicans who put Justice and their job duties before any political considerations. The common smear that the FBI is “full of Republicans” isn’t the proof of widespread, political corruption that many take it to be.
Baud
Baud! 20XX!: Making Things So Easy!
schrodingers_cat
I haven’t read anything that limey cretin, Sullivan has written since 2009.
Citizen Alan
@Omnes Omnibus:
I believe I mentioned a few weeks back that back in 2016, I watched the green party debate on YouTube for laughs only to come away horrified that the green party as an institution apparently wants America to be a left-wing absolute dictatorship. All of the green candidates were of the firm belief that as President they could, for example, completely abolish private gun ownership with an executive order in the first 100 days after taking office.
Kay
@montanareddog:
It would be suprising if he wasn’t a hypocrite about that.
It used to kill me how patient his readers were with him. Like it’s their job to educate him. It isn’t actually the job of women with high risk pregnancies to open a vein and spill their guts to Andrew Sullivan. He can go do some work and read something. He’s this big fucking lump sitting there like “feed me!” and all these earnest liberals are explaining to him. Fuck him. It’s not my job to do his work for him. He doesn’t know anything about health care, including womens health care, and he’s too lazy and sloppy to learn.
He’s damn lucky he had that accent. Without that he’s just another conservative mediocrity.
schrodingers_cat
@rikyrah: Yeah and those states went after their immigrant doctors in the Orange Error regime, so only the really desperate or those with deep ties to these states will want to practice there.
Mr. Bemused Senior
This, and despicable as it is, it’s a single [though glaring] example of a common thread. “The cruelty is the point” doesn’t do it justice.
Consider the attempt to kill the ACA. There was no apparent thought given to the consequences.
These people seem to think it’s all just reality TV. Of course, to Trump, it is. I don’t understand how this attitude can be held by millions of people. Yet it seems to be so.
Soprano2
@Kay: I get a paper in the mail every year that tells me how much I will draw from SS depending on what age I start collecting. So they do still send out some stuff in the mail.
VeniceRiley
Andrew Sullivan gave me the one STFU line to use on our left dem friends in regards to gay marriage. They were always spouting anti marriage messages at me back in the day. You cannot rufuse something that isn’t even offered to you as an option. Full stop.
And I think his case for marriage helped change minds in the “intellectual conservative” crowd.
His other hobby horses can ride off into the sunset.
Now that I have paid a lifetime of Medicare tax, I’m not in the USA to take advantage of it. And, as a non- citizen in the UK, I PAY for NHS. What I’d like is something like tax treaties for healthcare. I think it would be a financial boon for the govermenment. People would be free to retire overseas on less expensive countries… Yes, I know I’m dreaming.
PHUK LEIBERMAN
I wonder when we’ll get new vaccines here? It’s like Covid isn’t a thing in the news at all.
Ruckus
@Kay:
When I was 1973 I had a doctor who told me that everything was changing in the medical field. It was no longer going to be family medicine where your family doctor set and casted minor breaks and did their own x rays, etc. Everything was going to change. He was right about all of it. It became a profit concept, no longer about the medicine, but only about the money. He was right about all of it. Does anyone get any healthcare without insurance? Are healthcare insurance companies going out of business other than by crappy management? I don’t think so. It’s big business as normal in the US in the healthcare business. It’s like a game in this country, who can make the most for the least cost. The wealthy get wealthier and the public gets less and less of their actual needs met.
smith
@Chief Oshkosh: The reluctance of medical residents to train in red states is only one aspect of the spiral in professional services those states are likely to face. Why would anyone with childbearing potential volunteer to live in such a risky situation if the risks are clear to them? It’s the educated populace that is starting to understand the real risks of living in rigidly anti-abortion states, and that understanding will only grow as more stories get out about what’s happening to women there.
In addition to the decline in access to medical care, the schools in red states will only continue to deteriorate as teachers bail on impossible working conditions. Faculty will leave universities that states like FL are trying to turn into bible colleges. The flight of children raised in those states after they have left for college will continue and probably accelerate.
Red states may continue to draw aging MAGAs who looking for low tax rates, but that will do little or nothing for the quality of life there. It’s always been a race to the bottom for the red states, but I predict they may not be prepared for what the bottom actually looks like.
OverTwistWillie
The last state to implement 1965 Medicaid was Arizona in 1982.
Only 28 states adopted the 1960 Kerr-Mills Act, the precursor to Medicare.
Mainlining Purity of Essence has always been big with political crackpots.
Betty Cracker
@Kay: I did see that! My guess is he’d have a much better chance of getting off if he’s tried again because he won’t repeatedly LIE about a key piece of evidence.
rikyrah
@Baud:
Medicare age policy was chosen because most Black people didn’t live long enough to get it.
And, I was thinking about Social Security – which excluded the professions that an overwhelming majority of Black people worked in because of Roosevelt compromising with Southerners who didn’t want Negros to be able to get the assistance. Their inability to pay into it for YEARS of course has an adverse affect on the amount of their eventual Social Security checks down the line.
narya
@Ruckus:
Yeah, up to a point. FQHCs serve everyone w/o regard for insurance status or ability to pay. If you’re eligible for something–e.g., Medicaid–they’ll sign you up, but if you’re not, they’ll see you anyway. There are also health center funds that specifically target migrant and agricultural workers–many places take the health care services to the workers, with mobile units. And the places I’ve worked serve folks who don’t have documentation w/o question.
Baud
@rikyrah:
Thanks. I was aware of the Social Security carve out. Didn’t realize about the Medicare age limit.
smith
@narya: Larger cities also have public hospitals, which do a booming business.
Suzanne
@Ruckus: County hospitals are the healthcare providers of last resort in most places. Which is why they’re often struggling financially.
EMTALA also requires emergency care or stabilization without regard for ability to pay. Active labor is considered an emergency.
Barbara
@rikyrah: In fairness, Nixon proposed expanding Medicare to cover a wider range of people and, yes, to his later deep regret, Senator Ted Kennedy opposed it by making the better the enemy of the best. Probably one of the most misguided short-term tactical steps taken by a politician in the post-WWII era. Brexit will never be exceeded as THE most misguided, stupidest tactical steps taken by a politician in the modern era.
I am not sure the age limit was racially motivated — it might very well have been — but 65 had become something of a demarcation line ever since Bismarck used 65 as the basis for retirement benefits in Prussia in the late 19th century. And yes, he very clearly chose it with the expectation that most people would be dead before that age.
Fake Irishman
@Kay:
this. All those kids getting coverage through Medicaid were based on reforms phased in during the 80s and 90s sponsored by the doggedness of Henry Waxman and his lead health policy staffer who sat down with each other and the beginning of each Congress starting in 1983 and asked themselves “So, what do we think we can get away with slipping in a reconciliation bill this term?” The cumulative answer between 1984 and 1991 was actually quite a bit.
Thanks to the ACA a lot more of their parents and childless uncles and aunts can get coverage too.
Fake Irishman
@Ken:
It was. Google operation coffee cup.
Fake Irishman
@narya:
Man, this thread is really getting into health policy weeds. Several folks are bringing Richard-Anderson-Dave-Mayhew levels of knowledge to the table here.
What Have The Romans Ever Done for Us?
@Kay: I think the general tone is that none of us are all pals with Sully. He’s a misogynist for sure. He’s got the same blind spot as most conservatives – he wants government intervention in the areas that benefit him personally but on all other issues conservative orthodoxy must reign.
And yeah, he knows nothing about anything policy related. He knows all about Edmund Burke and views every policy through a Burkeian lense which leads to stupidity. Except of course on the aforementioned issues that affect him personally.
I will say one other issue he was right on was torture during the “war on terror” but as they say a stopped clock is right twice a day. I haven’t read him or even really thought about him since he disappeared behind some paywall years and years ago because why would I pay to read the content he generates. He’s wrong pretty much as often as all those other intellectual conservatives. No better than Bobo Brooks, McCardlebargle and the rest. His accent indeed does a lot of heavy lifting for him. He has that like George Will has his bow tie and glasses. The thing about all those folks is the Trump movement has proven that the actual number of Republican voters who care what they think could fit in a bathtub. They have no influence over the movement they’re supposed to be the intellectual leaders of. Worse than useless.
Fake Irishman
@Baud:
Although it is interesting to note that Medicare also legally forced the desegregation of all health facilities. So that’s something. (A lot like the ACA banning gender differences in charges for health insurance, which is also a big deal)
UncleEbeneezer
@rikyrah: It’s starting to sound like there was almost a centuries-long practice of denying Black People access to any possibility of building Generational Wealth that persisted well into our lifetimes…
Do you per chance know any good sources that list all the policies that did this, throughout US history? I think it is one of the best ways to change peoples’ minds who oppose Reparations. I usually use examples of Redlining/Home Loans and The G.I. Bill as a couple examples I can use to illustrate how my Grand/Great-Grand Parents had access to programs that Black families did not, but a more exhaustive list would be really helpful in driving that point home.
rikyrah
@schrodingers_cat:
There are few things that I didn’t get until I found out the reason why behind them.
I didn’t get why all these rural White people were having such an issue with immigration. In my mind, they were in White, rural places with no immigrants. How could they be afraid and mad about folks that they had no contact with? Made no sense to me.
Until I realized that so many of the slots for doctors in rural America were being filled by immigrant doctors.
They were resentful that the people treating them and keeping them alive were immigrants. They were mad that the kids who grew up there and became doctors moved away never to come back, and they blamed the immigrants for being there.
As ridiculous as that sounds, that’s the clinging to the Whiteness. These foreign doctors and medical professionals , who are more educated than they ever will be, and yes, they resent it.
When I tell you finding out that fact that so many of these rural American hospital spots were filled by immigrant doctors…all of it made sense to me.
rmjohnston
It’s pretty clear that the ACA enjoys essentially the entire credit for this state of affairs, not just credit for it’s Medicare specific measures. It used to be that as older people with very expensive medical bills died and fell off the Medicare rolls, they were replaced by 65 year-olds with very expensive medical conditions they’d been waiting until they had access to good insurance, i.e., Medicare, to treat. Now they’re being replaced by 65 year-olds who took timely, less expensive care of their medical conditions due to having good insurance up to age 65 due to the ACA. Replacing your most expensive Medicare recipients members with your least expensive recipients is going to drive program costs way down compared to replacing them with your other most expensive recipients.
Barbara
@What Have The Romans Ever Done for Us?: At one point, it occurred to me that Sullivan is highly influenced by aesthetic considerations — he liked Obama, who was cerebral and low-key, and hated yokels like George Allen. He is truly in the political wilderness at this point along with a lot of his fellow travelers, like George Will, but he doesn’t have the soapbox sinecure that they do.
Barbara
@rmjohnston: This is a good point, and I agree that it is largely true, although it also has the less positive impact of pushing costs into the arena of required long term care arrangements as those “healthy” people age into circumstances where they cannot care for themselves.
lowtechcyclist
@Ruckus:
I knew you were old, but holy shit, I didn’t know you were the 2000 year old man! ;-)
rikyrah
@UncleEbeneezer:
You don’t want to go back to slavery? Then how about Jim Crow? Not just Tulsa, but the many other Black towns destroyed, burned or flooded (looking at you, Lake Lanier).
How about the ONE MILLION BLACK VETERANS WHO FOUGHT IN WWII and were DENIED THEIR GI BENEFITS? The compounding of the loss of Black wealth because of that.
How the foundation of the creation of the American Highway system usually has a destroyed Black community.
Some books:
When Affirmative Action Was White by Ira Katznelson
The Color of Law: A Forgotten History of How Our Government Segregated America
by Richard Rothstein
The Half Has Never Been Told: Slavery and the Making of American Capitalism
by Edward E Baptist
Jim, Foolish Literalist
Yeah, I think the only notable thing about Sullivan at this point is how quickly and completely he became irrelevant to The Discourse, like Dowd and Friedman (I don’t watch the Sunday shows, but MoDo never did many, but I haven’t seen Friedman quoted or clipped in forever. I think he still publishes at teh Times?)
I remember when his reaction to the first Obama-Romney debate (running through the streets, naked, screaming and smeared with beagle poop, in the words of one foul-mouthed and vituperative “blogger”) was rather breathlessly cited on the Today Show, because I remember thinking he had 100% name ID on that set, but the vast majority of people with the TV on while they got ready for work were thinking, “Who?”
Ben Cisco
Sullivan was ALWAYS a shite bag.
That Bell Curve nonsense SHOULD have been enough to dismiss him from relevance of any type.
UncleEbeneezer
@rikyrah: Thanks. I have most of these bookmarked already (especially Color of Law, which I have been meaning to read for a while now) but I was curious is there are any one-stop, Wikipedia-like page that just lists all the policies themselves with a sentence or two of how they denied Black People opportunities to build generational wealth. I’m surprised no one has put something like that together as it would be a great supplement to things like the 1619 Project. Maybe I will start to build one, when I have some time.
Omnes Omnibus
@Ben Cisco:
Exactly. I have never understood his appeal to people on our side.
Barbara
@Ben Cisco: Yes, true, nothing can ever excuse that. I used to read a lot more blogs in the heyday of blogging before gravitating like most people to just a few, though many went dormant. I never paid for anything Sullivan wrote. He was one of the stable of bloggers associated with the Atlantic Monthly for a while, along with Ta-Nehisi Coates, whose writing I really liked.
StringOnAStick
@Suzanne: Dentistry is another expensive education, and if they buy into a practice (a fading model) then they are making huge education payments plus buying in, so I’m their first years their hygiene staff are often taking home more. Then it gets lucrative, eventually. That office is the dentist’s retirement money when they sell it, but now it’s corporations buying them up and for a lot less because they dominate it now.
This model of buying into a practice and eventually buying out the retiring dentist is fading out though because they get out of dental school with so much debt; the more common avenue is to go work in “corporate dentistry”, where they are employees, often with incentive to do more procedures because they a cut. It’s turned the practice of dentistry into the same model as a car salesman, and that’s a bad, bad thing. The rise of corporate dentistry offices is a huge money maker for the people at the very top, which keeps the cost to the patient high.
schrodingers_cat
@rikyrah: I have a friend who practiced in rural ME. He is British by birth, and has Indian heritage. He has some stories to tell. They moved here so that their kids could go to college here. Their children were in high school and middle school when they immigrated. They decided to live in a university town instead of where he practiced. A one horse town near the Canadian border. I didn’t get it then, now I do.
About one third of American medical professionals are foreign born and educated and their immigration path is very difficult unless they have a immediate family connection (parent, sibling, spouse) who can sponsor them for a green card.
Did you watch the second season of Made in Heaven? I liked it, some critics have dinged it for being a tad too preachy
Suzanne
@StringOnAStick: Yeah, I have a friend from elementary/middle school who is a “corporate dentist”. We, uhhhhhh, do not have family wealth, so buying into a business is not a feasible thing. Private practices are kind of a dying breed in most of the medical specialties for the same reason. Physician-owned groups that own their own ambulatory surgery centers are a thing, tho.
rikyrah
@schrodingers_cat:
Halfway through it. I am really enjoying it.
Preachy?
Bringing up uncomfortable subjects? Why is that always designated as ‘ preachy’.
Ironcity
@Barbara: How long term care costs (individual and cumulative) is a good question. Looking from a longer view what is the likely demographic and health care picture (operations/financial/political) for the further out years when people who, say, entered the work force when the ACA started are 65 yo. Can the numbers be run out to 2070 or so?
schrodingers_cat
@rikyrah: It holds a mirror to India’s elite and what is reflected back at them doesn’t comport with their self image. Hence the criticism.
Mai Naem mobile >
@Baud: all I’m saying I’m not sure Sully would have supported Obama if it wasn’t in his self interest.
@MomSense: Max BucksRus is a POS. Bad enough the GOP senators let the ACA negotiations drag on but so did Baucus because he was trying to get as many healthcare related campaign donations as he could. Hindsight is 20/20 but other stuff like immigration might have been done if ACA negotiations had wrapped up earlier.
narya
@UncleEbeneezer: @rikyrah: There was a two-part PBS series, Driving While Black, that really dug into how the interstate system destroyed black communities, AND dug into how fraught mobility is for black folks in a society with the history of slavery.( Warning: there is body-cam footage of stops/murders.)
Chris T.
@Kristine:
“Don’t bother bargain-shopping. You won’t save more than $100 a day anyway!”
Anyway
@John S.:
I believe New Zealand is the only other country with DTC pharmaceutical advertising
sab
@Kay: I have always wondered how someone so intellectually incurious as Sullivan managed to get a first at Oxford. He didn’t just get a degree there. He did well.
Ruckus
@bbleh:
I was a mental health counselor a few decades ago and I had short and medium term clients. And the vast majority of all the clients at the mental health clinic I worked at were normal people with short term help needs that didn’t require a psychiatrist or a hospital.
Ruckus
@narya:
One of the things that I have to question is current health care, because I use the VA, like I am at this very moment, typing this in a waiting room, and while it may not be the very best, it is pretty good. One does have to learn a bit about how it works but that isn’t that difficult.