Come for the politics, stay for the snark.

“Look, it’s not against the rules anywhere, but a black woman with power was dating and there has to be something wrong with that.”

The arc of the moral universe doesn’t bend itself. it’s up to us.

The republican caucus is covering themselves with something, and it’s not glory.

Nikki Haley, who can’t acknowledge ‘slavery’, is a pathetic shill.

Anyone who bans teaching American history has no right to shape America’s future.

… pundit janitors mopping up after the gop

The worst democrat is better than the best republican.

T R E 4 5 O N

Someone should tell Republicans that violence is the last refuge of the incompetent, or possibly the first.

Black Jesus loves a paper trail.

Make the republican party small enough to drown in a bathtub.

Why is it so hard for them to condemn hate?

American History and Black History can not be separated.

“woke” is the new caravan.

Roe isn’t about choice, it’s about freedom.

We still have time to mess this up!

Can we lighten up on the doomsday scenarios?

We’ve had enough carrots to last a lifetime. break out the sticks.

When someone says they “love freedom”, rest assured they don’t mean yours.

No Justins, No Peace

Come on, media. you have one job. start doing it.

Too often we hand the biggest microphones to the cynics and the critics who delight in declaring failure.

Fani Willis claps back at Trump chihuahua, Jim Jordan.

There is no right way to do the wrong thing.

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World's Best Healthcare (If You Can Afford It)

Fallows, Redux: The GOP Health Care Plan–Worse Than The Chicken At Tresky’s

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Cole is right. Fallows is killing the ‘tubes these days.  Case in point:  this piece, in which Fallows in part channels  another excellent post by Merrill Goozner, carries this title: Undoing Medicare:  The Real ‘Death Tax.’

Here’s what Goozner said:

Seniors and the poor account for over half of health care spending. Within those groups, 5 percent of the population accounts for 50 percent of health care costs; and 20 percent of the population accounts for about 80 percent. These costs come for the most part at times when economic incentives have no influence at all on medical decision-making: in medical crises; in treating chronic conditions; and, for most Medicare patients, in the last six months of life.

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That’s why a voucher program for Medicare, which will shift an increasing share of those inevitable costs onto the elderly themselves, can fairly be categorized as a 100 percent estate tax or death tax. People under 55 need to know that if the plan crafted by Rep. Paul Ryan were passed, most of them will never have a cent to leave to their children. It will all go to the health care industry to support the American way of dying.

And here’s Fallows’ conclusion:

If one major goal is containing overall health spending, it is flat-out delusional to think that older people, in their role as patients or individual purchasers of insurance policies, can be more effective negotiators than Medicare in its entirety dealing with the health system as a whole.
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In short: the overall economic price tag for medical care is likely to go up under this plan; and the number of people who will have to live with worry about ruinous medical bills will be much greater. This is part of the reason why, until very recently, no “serious” person proposed getting rid of Medicare.

Exactly so.  Fallows has nailed it — and you should head over there to read the whole thing, if only for the update containing the analysis by one of Fallows’ readers who correctly nails an error in Fallows’ reasoning about the death tax the Republicans seek to impose on Americans.  It’s not as bad as argued above.  It’s worse.

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Image:  Francisco de Goya, In the Plague Hospital, 1808-1810.

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Wednesday Evening Open Thread

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For the fifth anniversary of Massachusetts’ version of the Affordable Healthcare Act, local ABC affiliate WCBV did a pretty good hour-long live panel program, which I hope will be posted online for further discussion eventually. As the host said several times, ‘the health care industry accounts for one in six jobs in Massachusetts‘, so a discussion including the heads of the three biggest local hospitals and of multiple insurance/hmo companies is more than a niche interest in these parts.

One particular surprise, for me, was that Dr. Timothy Johnson, former Medical Editor for ABC, said that ‘single-payer will be coming‘ to the US ‘within five to ten years‘… and none of the CEOs so much as flinched in disagreement. That’s a clip I’d certainly like to post.

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Dance for Us, Tiny Tim! Dance!

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We Americans are a generous and warm-hearted people, if only we’re presented with a nice, strong, easy-to-understand narrative. Thus, the Washington Post reports on an extremely specialized niche at health-care non-profits:

The call from the White House came late in the week. Rep. Paul Ryan was vowing to slash Medicaid in his 2012 budget proposal, the administration strategists explained, and they wanted to have a powerful response ready, complete with poignant stories of Americans who might lose their health coverage under the Republican plan.
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Within minutes, Elizabeth Prescott was on the case. The coordinator of a vast database of real-life stories maintained by the advocacy group Families USA, Prescott worked through the weekend poring over hundreds of files. Among them were heart-wrenching tales of hardship faced by people whose care is dependent on Medicaid, the joint federal-state health insurance program for the poor and disabled.
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By the next Monday morning, Prescott was ready to e-mail the White House the first batch of five people from five different states. But Prescott needed more, so she set to work calling smaller health-care advocacy and legal aid groups across the country in search of as many compelling cases as possible to counter the chairman of the House Budget Committee. […] __
Families USA is hardly the only group that specializes in finding individual cases. With the group’s encouragement, smaller, locally based allies are increasingly maintaining lists of their own. The White House has unique sources as well — drawing, for instance, on those people who have written President Obama directly.
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Still, for sheer scope and geographic reach, few can match the Families USA story bank. Begun about two decades ago in the lead-up to then-President Bill Clinton’s failed effort at health reform, it has expanded to include thousands of names in a detailed, confidential database that can be searched according to such fields as health issue, location, race and income. It even includes notes about how articulately the person describes their experience.
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As often as five times a day, Prescott consults the system in search of a case to match the latest request…

Gods bless the woman. If I had her job, I’d probably eat a gun barrel before the end of the week, possibly after an attempt to shoot up the executive offices of the nearest medicopharminsurance conglomerate. Because this is the kind of outside-the-box innovation America’s been reduced to: coming up with stories calibrated to the exact degree of ‘heartstring-tugging’ necessary for each political target of wallet-opening.

And those stories are a frustratingly renewable resource. Remote Area Medical just did its first free clinic weekend in Northern California:

By the time the free health clinic at the Oakland Coliseum opened Saturday at dawn, some 800 tickets had been handed out to people who waited in the cold all night for the chance to have a tooth extracted, get new glasses or to finally get prescription medications for arthritis or other painful conditions.
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Geneva Clay, 51, of San Leandro worked as a project manager and had health benefits before she was laid off in 2009. She had been waiting in line since 11 p.m. Friday and was number 282.
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“We are the middle class. We are in need of health care because of the lack of jobs,” she said, trying to keep warm until her number was called. “In this country, we shouldn’t have to fight for medical coverage, we shouldn’t have to fight to see a doctor. We can send money all over the world, but we can’t take care of our own.”
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The crowd included the newly and long-term unemployed, students and people who were homeless. Some of those who had recently lost their jobs had been given the opportunity to stay on their former employers’ coverage out of their own pocket, but couldn’t afford it.
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But many of the people seeking care had full- or part-time jobs that either did not come with health benefits or required them to contribute so much that they were priced out of coverage. Some had health care, but no dental or vision insurance. Those people typically earned too much to qualify for government health programs.
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“We need universal health care. People shouldn’t have to stand out here all night,” said Sharice Gastile, 28, of Oakland, a full-time college student and single mother who was 17th in line. She is one of many Californians who lost adult Medi-Cal dental benefits when the program was cut in 2009…

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Big Surprise: People Support Programs They Use

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I’ve written about dual eligibles and Medicaid before. I’m putting it up again (in an easier to read article) because I can predict, based on the riddled-with-outright-lies health care debate we had last time that this debate will also be fact-free.

This is where we spend Medicaid dollars:

Because of generally poorer health and greater needs for high-cost services, the country’s 8.8 million dual eligibles are the most expensive population within the Medicare and Medicaid programs and the most difficult to coordinate care for, according to a report issued Monday morning by the Center for American Progress and Community Catalyst.

According to the report, dual eligibles make up 18 percent of Medicaid enrollees but consume 46 percent of program spending. Meanwhile, they comprise 16 percent of Medicare enrollees but consume 25 percent of spending.

Old people and the disabled cost the most (there’s a shocker) and then there’s pregnant women and children.

Medicaid, while wildly unpopular among public intellectuals, Republican House members and media personalities, is (surprise!) actually popular with the public:

If you listen to the inside debate you would think Medicaid is America’s most unpopular program. Conservatives don’t like Medicaid on ideological grounds; it’s a government entitlement program. Providers complain about the program’s reimbursement rates. And liberals have long complained about the program’s limitations, especially the gaps in whom Medicaid covers and the large variations in coverage among states. With its joint federal-state financing and welfare-linked heritage, Medicaid is treated as fundamentally different than the two other big entitlement programs — Social Security and Medicare — and thought to have dramatically less public support.

It was against this background that one of our recent polls produced a real surprise. It turns out that the insider’s view of Medicaid is not the public’s view at all. While not viewed as favorably as Social Security or Medicare, Medicaid is actually surprisingly popular with the American people, and they resist the idea of making big cuts to the program.

When we asked in our poll which programs the public was willing to see cut by Congress to reduce the deficit, no surprise, only 8% were willing to see “major reductions” in Social Security or Medicare. But only 13% were willing to see major reductions in Medicaid, the same percentage as for public education. Sixty-four percent supported “no reductions” at all in Social Security as a way to reduce the deficit, 56% in Medicare, and 47% in Medicaid, hardly the mark of an unpopular program. Forty-six percent of independents and a little more than a third (35%) of Republicans said they would “not support any reductions at all” in Medicaid to reduce the deficit.

Paul Ryan is calling his proposal to gut Medicaid “welfare reform” because conservatives and media put a lot of time and energy into portraying Medicaid as a program that only “other people” rely on.

Medicaid is much broader than that, because it includes the elderly, the disabled, and children. I’m not surprised that most people support it. Many of them are relying on it.

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Vermont and Community Health Centers

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Vermont’s House passed legislation that is intended to lead to single-payer:

After a full day and evening of debate, the Vermont House gave preliminary approval to health care reform legislation that’s designed to put the state on the path toward a single payer system.

Here’s the original proposal:

Under Shumlin’s “single-payer” system, Vermont residents would receive health benefits paid for by the state, regardless of their employment status or income. The plan is designed to help stem rising health costs, which state officials say have become unsustainable.

“Health care costs are climbing at a rate of more than 12 times the growth of the Vermont economy, and we’re not getting the best value for our money,” Shumlin said in a prepared statement. “The time for change has come.”

It seems to me that Vermont is suited for single payer for several reasons, one of which is community health centers.

Here’s a brief description of community health centers:

Spread across 50 states and all U.S. territories, there are 1,250 Community Health Centers that provide vital primary care to 20 million Americans with limited financial resources. Directed by boards with majority consumer membership, health centers focus on meeting the basic health care needs of their individual communities. Health centers maintain an open-door policy, providing treatment regardless of an individual’s income or insurance coverage.

Vermont uses community health centers in a big way. They have a basic non-profit primary care delivery system in place, which I believe makes them a good candidate to put a public payment system in place.

Vermont has 625,741 people. In 2009, 107,691 Vermont residents received care through a community health center.(pdf)

Compare that with Ohio, where of 11,542,645 people, 475,000 were community health center patients in 2009.

The stimulus provided an extra 2 billion in funding for community health centers. The PPACA provides 11 billion (appropriated-there’s 34 billion authorized) in new funding over the next 5 years, and the estimate is that will mean 40 million people will be using a community health center by 2015.

As I have mentioned here before, I once relied on a community health center in Ohio for pregnancy care, on a sliding scale fee basis. It was a normal pregnancy, I was young and generally healthy, and the “team” approach to what I believe was called “wellness” was a good fit for me. It was a very positive experience during a difficult time. I saw a nurse, a social worker, a nutrition person and a physician. I went to the same crew for well baby care.

I now have health insurance and live in a rural community where I go to a private for-profit medical group. If I had a choice I would opt for the community health center model. I don’t have a choice. The for-profit medical group I use is the sole non-emergency provider for two counties, so I’d be traveling 40-some miles to go elsewhere. They have several locations in the two counties, but it’s all the same entity.

Here’s my question. If you have adequate health insurance would you be open to the idea of a non-profit community health center approach to primary care, personally? Would you go to a community health center for primary care, even if you have insurance coverage that covers for-profit, private health care delivery? Would you be open to changing not just the mechanism for payment, but your personal health care delivery, at the primary care level, voluntarily?

Understand this is not the Vermont plan, nor do I mean to imply exclusively non-profit delivery of primary care is the Vermont plan, or the eventual aim.

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Happy Birthday Healthcare Reform! Looks Like We Made It!

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We ain’t dead yet!

To commemorate the birthday of healthcare reform, Ron Johnson (Asshole-Wisconsin) wrote an op-ed in the Wall Street Journal that is so fraught with bullshit, it compelled me to use the word “fraught” in this very blog post.

To put it another way, it’s a crock. It’s a crock of shit with a shit demi-glacé; that’s what I’m sayin’, y’all.

Calling the Affordable Healthcare Act the “single greatest assault on our freedom in his lifetime,”1 Senator Johnson went on to spin some yarn about how his daughter who had a heart condition (she’s alive and well having been treated under her father’s private insurance) would have been murdered by Obama’s Death (Panel) Eaters, and how sad is that?

I don’t even want to think what might have happened if she had been born at a time and place where government defined the limits for most insurance policies and set precedents on what would be covered. Would the life-saving procedures that saved her have been deemed cost-effective by policy makers deciding where to spend increasingly scarce tax dollars?

Carey’s story sounds like a miracle, but America has always been a place where medical miracles happen.

Nice try, dipshit.  The ACA doesn’t set precedents on what will be covered; it sets minimum limits on what private insurers must cover.  I mean, if health insurance companies are going to take your money, shouldn’t they spend it on health care?  I know.  It’s crazy talk.  I must be out of my mind.

From Jonathan Chait over at The New Republic:

That’s the argument. Johnson implies that procedures like this don’t happen elsewhere. Does he have any data? No. Does he have any reason to believe that the Affordable Care Act would prevent private insurance from covering procedures like this? No. That doesn’t happen in countries like Switzerland that have systems like the Affordable Care Act, and it doesn’t happen in the socialist hell of Massachusetts.

Indeed, one of the reasons for the law is that private health insurance often contains lifetime caps on coverage, or arbitrarily throws people who develop expensive conditions off their plans, and therefore keeps people from getting procedures like the one Johnson’s daughter received. But asking someone like him to actually take into consideration the actual needs of the tens of millions of Americans without health insurance, as against the completely imaginary threat to his only family, is asking far too much of Johnson’s intellect or moral reasoning.

Pretty much.

But enough talk about Teabilly assholes.

It’s a celebration, bitches! Let’s look back on what Obama said one year ago today:

show full post on front page

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Vinson: ‘Stop Me Before I Rule Again’?

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IANAL, and therefore have no idea what Judge Vinson is up to here:

Judge Stays Own Ruling Against Health Care Law
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A federal judge in Florida on Thursday issued a stay of his own ruling against the Obama health care act, allowing the law to remain fully in effect while being appealed, eventually to the Supreme Court.
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The Florida case is one of two in which judges have found a central provision of the law unconstitutional. But it is the only case in which a judge struck down the entire law, and suggested that implementation should halt during an appellate process that could stretch for two years.
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Judge Roger Vinson of Federal District Court in Pensacola, who ruled on Jan. 31 that the entire law was invalid, issued the stay without a specific request from the Obama administration. The Justice Department, which represents the administration, had asked Judge Vinson to clarify his January ruling, which the judge had characterized as the “functional equivalent” of an injunction to suspend the law.
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The administration did not, however, cease implementation of the law. States took differing approaches, with some effectively ceasing all planning while others continued as if nothing had changed.
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Judge Vinson, his irritation evident, made it clear that he had meant for his ruling to stop the law in its tracks.
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“My order was as clear and unambiguous as it could be,” Judge Vinson wrote. The government, he added, had no right “to basically ignore” his ruling.
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The judge wrote that he had expected the Justice Department to immediately seek a stay of his ruling, and in the name of speeding the appellate process he then saved it the trouble of doing so now…

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