Tag Archives: healthcare

I Will Never Understand This

There are a lot of things I don’t understand. Bitcoin. How wireless internet works. Why anyone gives a rat’s patootie about Kardashian-type celebrities.  Lots more.

But on Thanksgiving–when I reflect on my good health and comfortable life and give thanks for my family– I am reminded that what I really, really don’t understand is why so many people oppose allowing government to insure other people’s health.

Don’t get me wrong: I certainly understand debating the how of healthcare, arguing for policy A rather than policy B or C. But I’m appalled by those who evidently consider health care an optional consumer good–and believe that people who can’t afford it shouldn’t have it.

What triggered this rant was a post from Dispatches from the Culture Wars. I’ve met Ed Brayton, who writes Dispatches. He is a delightful person, a steadfast proponent of reason, the rule of law, civil liberties and science.

He also has a pre-existing condition.

While Trump and virtually every Republican lies about not wanting to do away with the ACA’s protections for those who have preexisting medical conditions, the AARP has a new report out that says the result would be a massive increase in premiums for people like me, as high as $26,000 a year.

Brayton quotes from the AARP report:

The revised American Health Care Act (AHCA) threatens to do away with the Affordable Care Act’s (ACA) protections for people with preexisting health conditions. These protections prevent insurance companies from denying these individuals coverage or charging them higher rates based on their health.

Eliminating these protections could force millions of Americans to — once again — rely on state high-risk pools. State high-risk pools are supposed to provide access to health insurance for people who cannot get coverage in the individual health insurance market because of preexisting health conditions.

State high-risk pools may sound like a good idea but, in reality, they are fraught with problems. One of the biggest lessons learned from experience with state high-risk pools: They bring steep premiums that put coverage out of reach for millions. In the past, monthly premiums in state high-risk pools could be up to 200 percent higher than in the individual (nongroup) market. Consequently, only a small fraction of those with preexisting conditions could afford to buy a plan. Yet, these premiums — high as they were — only covered about half the amount needed to pay enrollee claims. Most states tried to close the financial gap through taxes on providers and government subsidies, but even those efforts proved insufficient. We project that if states return to pre-ACA high-risk pools in 2019, as proposed, high-risk pool premiums for people with preexisting conditions could be as high as $25,700 annually.

Brayton’s reaction paints the picture in very personal terms:

High-risk pools are a disaster. They make insurance completely unaffordable for the overwhelming majority of people. As I’ve said many times, if the Republicans succeed in repealing Obamacare, I’m dead. Probably within a year. There’s no way I could afford the premiums in a high-risk pool and my medication costs run into thousands of dollars a month, and that doesn’t count all the specialists and tests and stays in the hospitals.

The United States health industry (as a student once explained to me, we don’t have a ‘system’) costs twice as much per person as in the next most expensive country, and our outcomes are far worse. (We not only aren’t “number one,” the last time I looked, we were number 37.) Private health insurance companies have average overhead costs of 23-25% (costs that include bloated management salaries and corporate jets, along with marketing costs and personnel hired solely to decide that you don’t really need that medicine).

Medicare’s overhead is 3%.

Americans pay much more for much less, all because we don’t want to subsidize medical care for the Ed Braytons of the world–or for the children of poor families, or people who don’t look like us.

The day America joins the rest of the civilized world by guaranteeing universal access to basic medical care will really be Thanksgiving.



By George…He’s Right

George Lakoff is probably best known for his book, Don’t Think of An Elephant, but he has produced a steady stream of significant articles and books throughout his academic career. ( He was the   Richard and Rhoda Goldman Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley from 1972 until he retired a few years ago. He currently serves as Director of the Center for the Neural Mind and Society.)

Lakoff’s abiding interest has been identification of the cognitive differences between Progressives and Conservatives, and his blog frequently applies the results of his research to contemporary political puzzles. A recent post considered two questions about Donald Trump and Republicans that Lakoff says tend to stump Progressives.

1) Why don’t Trump supporters turn against Trump even though he is doing things that hurt them? (like taking away their healthcare)

2) Why do Republicans hate the Affordable Care Act, and why are they so transparently acting to give wealthy people a tax break funded by making healthcare unaffordable?

The short answer? Voters don’t vote their interests. They vote their values.

The longer answer? According to Lakoff,

Most thought (as much as 98% by some accounts) is unconscious. It is carried out by neural circuitry in our brains. We have no conscious access to this circuitry, but it’s there. This is basic neuroscience.

When it comes to politics, progressives and conservatives essentially have different brains. The unconscious beliefs conditioned in their brains are nearly exact opposites.

Lakoff describes conservative morality as a “Strict Father” worldview, and progressive morality as a “nurturant parent” paradigm.

Conservative moral values arise from what I call the Strict Father Family.

In this family model, father knows best. He decides right and wrong. He has the ultimate authority to make sure his children and his spouse do what he says, because what he says is right. Many conservative spouses accept this worldview, uphold the father’s authority, and are strict in those realms of family life that they control.

In this moral worldview, it is his moral duty to punish his children painfully when they disobey. Harsh punishment is necessary to ensure that they will obey him (do what is right) and not just do what feels good. Through physical discipline they are supposed to become disciplined, internally strong, and able to prosper in the external world.

What if they don’t prosper? That means they are not disciplined, and therefore cannot be moral, and so deserve their poverty. In this conservative view, the poor are seen as lazy and undeserving while the rich deserve their wealth. Responsibility is thus taken to be personal responsibility, not social responsibility. What you become is only up to you, not society. You are responsible for yourself, not for others.

Lakoff then outlines the conservative “moral hierarchy.”

• God above Man
• Man above Nature
• The Disciplined (Strong) above the Undisciplined (Weak)
• The Rich above the Poor
• Employers above Employees
• Adults above Children
• Western culture above other cultures
• America above other countries
• Men above Women
• Whites above Nonwhites
• Christians above non-Christians
• Straights above Gays

You can almost hear Mike Pence talking about how he is a Christian first….

Lakoff wants us to understand the differences in worldviews, so that we can better understand the genesis of conservative Republican policy prescriptions.

Understanding is well and good, but what Lakoff doesn’t tell us is whether it is possible to reason with–or failing that, neuter– Dear Old Strict Dad.

Making America Sick Again

With the introduction of its proposed budget, the Trump Administration has continued its effort to cut the ground out from under all but the wealthiest Americans–and especially from under the people who voted for Trump.

Fortunately, that budget displays the stunning ineptitude that is a hallmark of this Administration (Hey–what’s a two trillion dollar math mistake among friends..?) and is unlikely to pass.

We often hear exhortations to “follow the money,” or to “put your money where your mouth is.” Those phrases reflect an undeniable truth of human behavior: whatever our rhetoric, where we commit our resources shows our real priorities.  Trump’s budget not only makes his priorities painfully clear; it reflects his callous disregard for struggling Americans, including those who voted for him.

Time Magazine has detailed the consequences of the savage Medicaid cuts proposed by the Trump budget. Nearly one in four Americans–and 42 percent of Trump voters– rely on Medicaid. The budget assumes passage of the deeply unpopular Obamacare replacement passed by the House and currently pending in the Senate; that measure–which the CBO calculates would cost 23 million Americans their health insurance– cuts Medicaid funding by $839 billion over the next decade. The budget proposal reduces Medicaid by an additional $610 billion.

Those cuts endanger medical access for 74 million Americans.

Medicaid reaches far beyond able-bodied adults out of work, despite the proposal’s rhetoric. The elderly and disabled account for around 60% of Medicaid’s expenditures, with the disabled, including the mentally ill, accounting for a full 42% of spending.

The program is the country’s largest funder of long-term care expenses, covering 40% of the costs, as well as more than 60% of all nursing home residents. For Baby Boomers nearing or past retirement age, these funds are crucial: As MONEY has previously reported, nursing homes for the elderly cost an average of $80,000 annually, and those expenditures aren’t covered under Medicare, the health program for seniors over 65. In fact, because Medicaid absorbs high healthcare costs of people with expensive conditions like dementia, it has kept private insurance around 7% lower than they would be.

Slashing funds also disproportionately affects women and children: one-half of births in the U.S. are covered by Medicaid (that varies widely by state—in Louisiana, 65% of births are covered by Medicaid, according to the Kaiser Family Foundation). The Children’s Health Insurance Program, which covered more than 8.4 million children in 2015, would also see its budget significantly reduced, according to Joan Alker, Executive Director of the Georgetown Center for Children and Families. Medicaid also provides essential health coverage for low income women, particularly women (and children) of color.

And of course, the budget continues the Republican war on women and women’s health by defunding Planned Parenthood–effectively eliminating preventive care (pap tests, breast cancer screenings) for most poor women.

Pointing to the cruelty of this proposal is unlikely to move lawmakers for whom tax cuts for rich people are the highest priority, but you would think they might realize that such a wholesale assault on access to preventive care would wildly increase overall medical costs. (The old adage “penny wise, pound foolish, comes to mind.) Trump’s budget would throw people back to the tender mercies of the emergency room, return us to the days when medical costs and nursing home fees bankrupted families, and ensconce a system in which healthcare is simply a consumer good, available to those who can afford it and too bad for the rest of you.

Destroying Obamacare and slashing Medicaid aren’t even the end of the story: the proposed budget also “severely cuts funding for science and public health agencies, including a $1 billion cut to the National Cancer Institute.”

Notably, the National Institute of Health’s budget would be slashed from $31.8 billion to $26 billion. The Center for Disease Control and Prevention would face cuts of more than $1 billion, including a $222 million decrease in funding to the chronic disease prevention programs, which help people with conditions like diabetes, heart disease, and obesity.The National Science Foundation would face a decrease of $776 million.

Welcome to dystopia.

We’re Number One! NOT.

This is my week for borrowing. But when someone says something so much more eloquently than I could, it’s hard to resist.

This time, it is a former student.

I keep in touch with a number of my former students via Facebook. I enjoy seeing their wedding photos, pictures of their children as they grow, and following their career paths. Most of them are truly admirable human beings, and I take a sort of motherly pride in reading their social and political commentaries.

In the wake of the House healthcare vote, one of those former students, –now a government employee who is for that reason understandably reluctant to “go public” with his critique–posted the following diatribe.

The United States has more citizens in prison than any country in the world. Even more than China, which has four times as many people. Republican legislators chose to focus on eroding healthcare protections.

The United States has a public education system ranked lower than Russia. Republican legislators chose to focus on eroding healthcare protections.

The United States has average Internet speeds three times slower than Romania. Republican legislators chose to focus on eroding healthcare protections.

The United States has infant mortality rates nearly twice as high as Belarus. Republican legislators chose to focus on eroding healthcare protections.

The United States has 2.5 million citizens without access to improved drinking water. Republican legislators chose to focus on eroding healthcare protections.

The United States has a youth unemployment rate of 13.4%. Republican legislators chose to focus on eroding healthcare protections.

The United States has 50 million citizens living below the poverty line. Republican legislators chose to focus on eroding healthcare protections.

The United States has greater income inequality than Morocco, Jordan, Tanzania, Niger, Kyrgyzstan, East Timor, and 95 other countries. Republican legislators chose to focus on eroding healthcare protections.

The United States is responsible for nearly twice as much CO2 emissions as the entire European Union. Republican legislators chose to focus on eroding healthcare protections.

The United States has more railways than any country on Earth, by more than 100,000 kilometers, but has virtually no long-range public transportation system. Republican legislators chose to focus on eroding healthcare protections.

The United States spends more on national defense than every other nation on Earth COMBINED, yet seems to be in perpetual warfare and has a barely functioning veteran-support system. Republican legislators chose to focus on eroding healthcare protections.

Next Election Day, please don’t forget this. And don’t ever let them forget it.

I’ve said it before and I’ll say it again: I’d turn this country over to my students in a heartbeat.

Speaking of “turnover”…as a direct result of the health-care vote, the well-respected Cook Report downgraded the 2018 prospects of twenty Republican House members. As the Washington Post’s Plum Line reports

Today, House Republicans are waking up to a big set of brutal ratings changes from the Cook Political Report. In the wake of the vote, Cook has shifted 20 GOP-held seats toward Democrats. Yes, 20. ..Cook analyst David Wasserman writes.. that the GOP passage of a bill this unpopular “is consistent with past scenarios that have generated a midterm wave.”

Meanwhile, Nate Silver takes stock of the abysmal unpopularity of the bill and concludes that the vote for it could prove “a job-killer for GOP incumbents.” And Nate Cohn draws a comparison between yesterday’s vote and the 2010 vote for the Affordable Care Act that helped cost Democrats dozens of House seats and their majority. As Cohn notes, if that history is any guide, it’s possible that those Republicans who voted for the GOP bill could lose substantial support in the next election.

Finally, let me add my voice to those of Hoosier Democrats who are trying to convince Christina Hale to run against Susan Brooks in Indiana’s Fifth Congressional District. Hale would be a formidable candidate; as she displayed during her run for Lt. Governor and her prior tenure at the Indiana Statehouse, she has energy, intellect, eloquence and integrity–and she’s a strong voice for women and girls. I hereby volunteer for her campaign!

And if the Cook Report is right, 2018 will be a very good year….

When The Emperor Has No Clothes…

Yesterday, the Republicans’ much-hyped replacement of the Affordable Care Act went down in flames.

There are multiple lessons to be drawn from the legislative fiasco we’ve just witnessed, although I am doubtful the people who most need to learn those lessons are capable of doing so.

The first–and most obvious–is that Donald Trump presides (in the words of David Gergen, who has served both Republican and Democratic Presidents) over an incompetent and delusional Administration. “I actually think this may be the worst hundred days we’ve ever seen in a president.”

As one wag commented, William Henry Harrison had a better second month.

Political commentators have repeatedly catalogued the myriad ways in which Trump is unsuited for the Presidency–including but not limited to his emotional and mental instability, lack of intellectual curiosity and ignorance of the structures and operations of government. Those deficits translate into an inability to understand that Presidents–unlike CEOs of closely-held corporations–cannot simply issue orders to Congress, a co-equal branch of government, and expect compliance.

The art of a legislative “deal” is distinctly different than the art of developing a parcel of real estate. A successful Presidency requires skills that Trump neither possesses nor understands.

Then there is Paul Ryan, who has long been lauded as the Republicans’ policy wonk. The lesson here is that in a group of midgets, even a short guy looks tall. Ryan has had seven years to craft a replacement for Obamacare; clearly, he spent none of that time considering what such a replacement should look like. Ryan has been “defrocked”–shown to be all political posturing and no policy chops. The bill he tried to peddle to his fractious caucus was an abysmal piece of legislation–a “steaming pile of excrement” in the words of one Republican lawmaker.

Even if Ryan had possessed the skills credulous pundits have attributed to him, however, it probably would not have been possible to bridge the deep divides within the GOP. The aptly-named “lunatic caucus” wants nothing less than a government retreat from any participation in healthcare, including Medicaid and Medicare. The moderates–mostly elected from more competitive districts– understand that such a retreat is neither possible nor desirable, and wanted legislation that they could have described as improving upon the ACA.

The only thing the two factions agreed upon was that they were being asked by a President with a 37% approval rating to vote for a measure supported by 17% of voters.

Congressional Republicans are hopelessly divided between the radical ideologues produced by 2011’s extreme gerrymandering (who don’t give a rat’s patootie what their party’s leadership wants) and the GOPs (somewhat) more traditional representatives.

The third lesson, then, is that It will only get worse.

The Party of No is no longer capable of getting to yes.