Something Encouraging For a Change

In today’s news, Senator Turtle Face (formally known as Addison Mitchell McConnell, Jr., Republican of Kentucky) delayed the vote on the “Less Money for Health Insurance Equals More Money for Rich People” bill. Presumably, he didn’t have enough Yes votes to pass legislation that nobody (except him and a few rich people?) likes.

This will either give the Republicans a few days to find the necessary Yes votes, or it will give opponents of the bill (of which there are many) the chance to create more No votes. Since the Senate Majority Leader had planned a quick vote on a bill he tried to keep as secret as possible, the postponement appears on balance to be a welcome development.

Proving again that he is indeed the Master Negotiator, the President put on a show at the White House today with Republican Senators, at which he announced:

This will be great if we get it done. And if we don’t get it done, it’s just going to be something that we’re not going to like, and that’s OK, and I understand that very well.

As far as we know, the President has not yet demonstrated in a single case whatsoever that he has any understanding at all of the the American healthcare system, the Affordable Care Act, or the Republican effort to repeal or replace it. Clearly, he is a Big Picture guy.

Consistent with the possibility that this is not Hell, some observers think the Republicans’ struggles are a sign of better things to come. Paul Waldman of The Washington Post writes:

The Republican health-care bill is not dead yet, but it’s in rough shape. Whether it passes or not, it has been an utter debacle for the GOP, making the Affordable Care Act they’re trying to undo more popular than ever, energizing the Democratic base, complicating the relationship between President [DT] and Congress and sowing justified distrust of Republican motives among the broader public.

It has also done something else: moved the debate on health care in America to the left and made single payer much more likely.

Even if the Senate bill fails, Republicans give up and move on to tax reform, and the status quo remains in place, this debate will have had profound effects on our politics. While the Democratic Party may have been moving to the left on health care anyway, its momentum in that direction may now be unstoppable. And the entire country will be more receptive than ever to the arguments Democrats will make. This, by the way, will also be the case if the GOP repeal effort succeeds, because it will make so much that people hate about our health-care system a lot worse.

Let me point to one politician as an illustration. For years, Sen. Elizabeth Warren’s position on single payer has essentially been “Maybe someday” — not opposed to it, but focused in the short term on the more urgent priority of defending and enhancing the ACA. But in an article in today’s Wall Street Journal, we learn that she is now ready to take that plunge:

“President Obama tried to move us forward with health-care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts,” she said during an interview in her Senate office last week. “Now it’s time for the next step. And the next step is single payer.”

Warren is not going to be the last Democrat to take this step. In fact, any Democrat who runs for president in 2020 — and there will be a lot of them — will have a hard time explaining to the primary electorate why they don’t want single payer, and most or all of them will probably say they do.

We can make an analogy with what happened in the GOP after the failure of comprehensive immigration reform [in 2013]…. The situations aren’t exactly the same, but … a dramatic political failure — whether it’s yours or the other party’s — can have profound effects on the choices politicians make about how to approach the electorate. And it’s important to understand that while there are some Democratic politicians who emphatically favor single payer and would be unsatisfied with anything less, most of them would be willing to advocate for a range of policy options, depending on what looks politically achievable and what their base demands at a particular moment.

All the ups and downs of the past eight years, from the beginning of the debate on the ACA to the end of the debate on Republican repeal plans, hold many lessons for Democrats who are still eager to address the problems in the American health-care system. Among other things, we know that voters are risk-averse, that they’re extremely sensitive to out-of-pocket costs, that they want security and that arguments about the glories of the free market aren’t going to be persuasive to them. After seeing how desperately unpopular this Republican plan is, Democrats are going to be much less afraid to defend government health care and advocate its expansion.

And they know that whatever they propose next has to be simple and understandable. We can debate whether the ACA had to be as complex as it was, but next time around, no Democrat is going to believe that you can take on President Trump with a technocratic approach to health care. Saying “Here are the 10 tweaks I’d make to the ACA” isn’t going to cut it.

That isn’t to say that whatever plans they propose won’t be fully fleshed out under the hood, but they’ll have to be presented in a way that is easy for voters to understand. And, yes, Republicans will cry about “Washington bureaucrats making decisions for you,” but Democrats are less likely to be intimidated. Ask your parents or grandparents on Medicare how they feel about their coverage — Medicare is the most popular health insurance program we have, and it’s run by Washington bureaucrats.

It’s important to keep in mind that “single payer” isn’t one thing — if you look around the world at highly developed countries, there is a spectrum of health systems with various levels of public and private involvement. But what they have in common is that they achieve universal coverage while working better and costing less than ours. We could well have 15 Democratic presidential candidates proposing 15 different kinds of single payer. Some may be highly socialized systems — what Bernie Sanders would likely advocate if he runs again — but the ones that are most appealing could be hybrid systems of the kind that have been successful in countries such as France. The way it works is that there’s a government plan that covers everyone’s basic needs, but you can also buy supplemental private insurance to get as many more benefits as you want.

Among the advantages of a hybrid system is that one can actually see a path from where we are now to there. That path runs through Medicaid, which now covers nearly 75 million Americans. What if we auto-enrolled everyone under 65 in Medicaid — it’s there if you need it, but if you have different insurance you’d prefer, go ahead and use that instead. No one would be without coverage. Private insurance would evolve into something you buy to fill in the gaps and get perks that Medicaid wouldn’t provide. Instead of covering all your health care, employers could provide the supplemental private insurance.

As a political matter, you could sell this as something that we could transition to over an extended period, and as a system that satisfies the goals of both liberals and conservatives. Liberals get the universal coverage and security they want, and conservatives get the freedom they want — if you’re rich enough to buy a supplemental plan that includes deliveries of Dom Perignon during any hospitalization, go right ahead.

That isn’t to say that Republicans wouldn’t resist and there won’t be more intense arguments about health care, because they would and there will be. But by handling this debate so terribly and proposing something so monstrous, Republicans have opened up the space for Democrats to go much further than they’ve been willing to before. It’s not impossible to foresee Democrats winning the House in 2018, then taking the presidency and the Senate in 2020 — and then taking the first steps toward making single-payer health care in America a reality. 

End quote.

“An Act of Both Unconscionable Heartlessness and Epic Cowardice”

From Greg Sargent, “How the Republican Coward Caucus Is About to Sell Out Its Own Constituents — In Secret” (The Washington Post):

The fate of the American health care system now rests with a group of allegedly “moderate” senators, who are getting ready to approve a bill to repeal the Affordable Care Act, a repeal bill so monumental in its cruelty that they feel they have no choice but to draft it in secret, not let the public know what it does, hold not a single hearing or committee markup, slip it in a brown paper package to the Congressional Budget Office, then push it through to a vote before the July 4th recess before the inevitable backlash gets too loud.

“We aren’t stupid,” one GOP Senate aide told Caitlin Owens — they know what would happen if they made their bill public. Even Republican senators who aren’t part of the 13-member working group crafting the bill haven’t been told exactly what’s in it.

Today, we learned that in a break with longstanding precedent, “Senate officials are cracking down on media access, informing reporters on Tuesday that they will no longer be allowed to film or record audio of interviews in the Senate side hallways of the Capitol without special permission.” Everyone assumes that it’s so those senators can avoid having to appear on camera being asked uncomfortable questions about a bill that is as likely to be as popular as Ebola….

This is how a party acts when it is ashamed of what it is about to do to the American people. Yet all it would take to stop this abomination is for three Republicans to stand up to their party’s leaders and say, “No — I won’t do this to my constituents.” With only a 52-48 majority in the Senate, that would kill the bill. But right now, it’s looking as though this Coward Caucus is going to be unable to muster the necessary courage.

To understand the magnitude of what they’re doing, let’s focus on Medicaid, because it was supposed to be a sticking point on which some senators wouldn’t budge, particularly those whose states accepted the ACA’s expansion of the program. But according to various reports, the moderates have already caved….

Last week The Hill reported that [Sen. Capito of West Virginia] now supports eliminating the expansion after all — just doing it over seven years instead of the three years that the House bill required. The Charleston Gazette-Mail in Capito’s home state noted that Capito had said she didn’t want to drop all those West Virginians off a cliff, but “Instead, she would drop them off a cliff on the installment plan — around 25,000 per year for seven years.”

Or how about Ohio’s Rob Portman? In his state, 700,000 people gained insurance as a result of the Medicaid expansion. He drafted a letter to Majority Leader Mitch McConnell stating his opposition to the House bill because it didn’t protect those who gained insurance from the expansion. Now Portman also wants to phase out the expansion over seven years….

It’s important to know that the Medicaid question isn’t just about the millions who would lose coverage if the expansion is eliminated. Paige Winfield Cunningham reports today that Senate Republicans are considering even deeper cuts to Medicaid than the $880 billion the House bill slashed out of the program. They’d pay for the slower elimination of the expansion by cutting money out of the existing program, so they could get rid of all of the ACA’s tax increases — which mostly affected the wealthy. In other words, they want to cut Medicaid to give a tax break to rich people.

Just as critical, they want to end Medicaid’s status as an entitlement, meaning that the program wouldn’t cover everyone who’s eligible. States would get a chunk of money to spend, and if more people turned out to need coverage, tough luck for them. The states would be offered “flexibility,” which in practice would mean permission to kick people off the program and cut back on benefits. And don’t think this is just about poor people — over half of Medicaid dollars go to the elderly and disabled. That means that they aren’t just undoing the ACA; they’re making things substantially worse for tens of millions of America’s most vulnerable citizens than they were even before the ACA passed.

And they’re hoping they can do all this before anyone realizes what they’re up to, making this an act of both unconscionable heartlessness and epic cowardice. Their efforts to hide what they’re doing show that they are still capable of feeling some measure of shame. But it might not be enough to stop them.

All is not necessarily lost, since making it easier for relatively evil Republicans to vote Yes on the bill should make it harder for purely evil Republicans to vote Yes. So maybe the bill won’t make it out of the Senate. 

Assuming, however, that it passes the Senate, the bill will go to a conference with the House Republicans. Since the average House Republican is even more evil than the average Senate Republican, the bill could run into trouble in the conference. If the members of the conference can’t agree on the final language of the bill, it will die there. But it’s more likely that a final version of the bill will be sent back to the House and Senate for a vote.

That’s when all the Representatives and Senators (even the Democrats!) will get a chance to have their say on the bill. Assuming logic and morality don’t win the day, and simple majorities pass the bill in both houses, it will go to the President. If that sleazeball cares what’s in the bill, he’ll veto it, since it won’t be anything like the health care bill he promised. But we know how much we can count on him.

Even though we don’t know what will be in the final product (assuming there is one), it isn’t too soon to tell our members of Congress what we think of this monstrosity. There is no point in complaining to House Democrats, of course, since they have zero influence. But Senate Democrats can be encouraged to slow the process in the Senate as much as possible. As for Republican members of Congress, they deserve to be reminded that fewer than 20% of Americans approve of the Republican proposal (based on the last time they got a look at it) and there’s an election in 2018.

Who Says Republicans Don’t Have a Sense of Humor?

Example 1:

“House Republicans have found a subject for their opening review of conflicts of interest under Donald Trump: the federal official in charge of investigating conflicts of interest.”

Yes, the Republican chairman of the House Oversight Committee, Jason Chaffetz of Utah, is mad at the head of the Office of Government Ethics for pointing out (as both Democratic and Republican ethics lawyers agree) that the President-elect’s “plan” to avoid his many, many conflicts of interest is “meaningless”. There are hysterical details here. 

Last night, I found the ethics official’s explanation of his negativity at the Office of Government Ethics site. It was a four-page PDF file, but the lawyer who wrote it isn’t nearly as funny as Rep. Chaffetz. Unfortunately, the link isn’t working at the moment (because of heavy traffic or those madcap Russians). But maybe it will work for you.

In a related, even more priceless development, Rep. Chaffetz announced a few days ago that he plans to keep investigating Hillary Clinton’s emails! This lovable scamp Chaffetz is relentless!

Yet:

When asked about T__p’s potential business conflicts, [chairman Chaffetz] noted that the law‎ exempts the president of the United States, calling the push from Democrats to launch a committee investigation on T__p’s business ties “premature at best.” [CNN]

I suppose “premature at best” implies “totally ridiculous at worst”!

best-dad-jokes

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All right, now that I’ve recovered my composure…

Example 2:

It might seem like yesterday, but it was almost seven years ago that America’s first step toward universal healthcare became law. It was officially called the Patient Protection and Affordable Care Act, but rapidly became known as Obamacare. The law included many (in fact, mostly) conservative ideas, but in the end not one Republican Senator voted for it. In fact, Republicans immediately began calling for the law’s repeal.

Now that the Republicans control Congress and are about to occupy the White House, they’re beginning the effort to repeal the ACA, but questions are being raised, even by Republicans. Should the law be repealed in toto, which would mean taking health insurance away from millions of people, including lots of Republican voters? Or should it be left in place until the law’s terrific right-wing replacement is all ready to go? 

Since they’ve had seven years to think about it, they must have something wonderful (“My God, it’s full of stars!”) waiting in the wings. So here’s what happened last night at Speaker of the House Paul Ryan’s nationally-televised “town hall”.

From the GQ site:

The event began with a question from a polite, middle-aged gentleman named Jeff Jeans, a small-business owner:

“I was a Republican, and I worked for the Reagan and Bush campaigns. Just like you, I was opposed to the Affordable Care Act. When it was passed, I told my wife we would close our business before I complied with this law. Then, at 49, I was given six weeks to live with a very curable type of cancer. We offered three times the cost of my treatment, which was rejected. They required an insurance card. Thanks to the Affordable Care Act, I’m standing here today, alive. Being both a small businessperson [and] someone with preexisting conditions, I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?”

Chuckling nervously like a local-news anchor who suddenly lost his teleprompter feed, Ryan began explaining to Jeans that his party in fact does have a proposal—it’s just a secret one that he still hasn’t shared with his colleagues. Jeans, however, still needed to twist the knife.

RYAN: We wouldn’t do that. We want to replace it with something better. First of all, I’m glad you’re standing here! I mean, really, seriously, I—

JEANS: Can I say one thing? I hate to interrupt you.

RYAN: Yeah, yeah, yeah.

JEANS: I want to thank President Obama from the bottom of my heart, because I would be dead if it weren’t for him.

Seeking further information, I was led to a site called “A Better Health Care Plan”. It’s run by a bunch of Republicans who call themselves the “American Action Network”. The first thing you see is a link to a YouTube video: “A New Path Forward”. Here’s the video’s entire script: 

Imagine a new path forward. Health insurance that provides more choices and better care at lower costs. A system that puts patients and doctors in charge, provides peace of mind to people with pre-existing conditions, and paves the way for new cures by eliminating senseless regulations. House Republicans have a plan to get there without disrupting existing coverage, giving your family the health care they deserve.

You’re then invited to visit the very site you’re on, “A Better Health Care Plan”, for further information. And here it is: 

House Republicans have a plan to get there

Our Congress is fighting for us: lowering costs, providing more control and more choices to pick a plan that meets our needs, not a plan that Washington mandates.

That’s all the further information provided. In toto.

Now who doesn’t think Republicans have a terrific sense of humor? 

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It’s Alright, Ma (I Was Only Bleeding)

Here’s one of those inventions that sounds too good to be true. From Suneris Inc.’s site:

Constantly experimenting with different natural materials in the lab as a young adult, Joe Landolina conceived an adhesive hemostatic gel composed of plant-based polymers that could adhere to a wound site and simultaneously support the natural clotting process.

In other words, you squeeze some of this stuff on an open wound and it stops the bleeding in seconds. In addition, it apparently grows new tissue.

Discovery News reported on this Star Trek-like technology three years ago (warning: video contains jokes and blood):

Vetigel is now being sold to veterinarians. Let’s hope it works well enough to be used one day on soldiers, accident victims and other human beings, including iconic bleeding rock stars:

It Was the Understatement of the Year

Planned Parenthood’s president Cecile Richards said it this morning when she testified before the Republican-run House Oversight and Reform Committee:

It doesn’t feel like we’re trying to get to the truth here.

If only Ms. Richards had noticed the inscription on the wall behind her.

Richards

“We are not trying to get to the truth here” is the committee’s official motto.

Of course, I made that last part up (with apologies to the Associated Press), but it might as well be true.

For more sober coverage of today’s event, National Public Radio has a few choice audio clips that “you should hear”, Jezebel has a summary that’s painful to read and Mother Jones shows how to make a misleading chart by leaving out the y-axis.

It’s My Blog and I’ll Rant About My Visit to the Doctor If I Want To!

Yesterday, a friend and I happened to get on the subject of restaurants, waiting rooms and (yes) elevators that have televisions. We agreed that the relatively recent practice of putting a TV everywhere possible in order to entertain or distract us is annoying. Obviously, some may enjoy watching TV while they’re waiting to see their doctor or eating lunch in a cafe or riding in an elevator. Also obviously, some people don’t. 

So I was psychologically primed when I entered a doctor’s office today and found a TV in the far corner of the empty waiting room. It was tuned to a talk show about cooking. Even worse, the sound was extremely loud. Instead of politely asking the staff if it would be possible to turn off the TV, I did it myself. In retrospect, I should have asked, but since I was the only one in the room, pushing the “off” button seemed like an acceptable thing to do. (Have you ever noticed that they never leave the remote control next to the television, a courtesy we patients might appreciate? Given how loud that TV was today, I think it’s really there for the office staff, who happen to be in a different room.)

After a while, one of the staff noticed that the TV was off and used the remote to turn it back on. I objected, saying that I had turned it off. We went back and forth a bit, and I raised my voice a little (no personal attacks were made). The staff member said the TV was there “for the entertainment of the patients” and having it off was merely my preference. Since another patient had entered the waiting room by then, I gave up. Even when I was alone again, the TV kept going, albeit with reduced volume.

Eventually, I got to see the doctor. He seemed upset about something. He spoke very fast and not very clearly. He was brusque, interrupted me when I asked questions, and kept telling me I didn’t understand his precise reasons for doing an MRI of my hip. Near the end of the examination, I said “Well, it will be good to find out what’s going on in there” (referring to my hip). I thought that was a pretty innocuous thing to say, but he insisted on again repeating why an MRI was a good idea (it was merely to rule out the presence of an anatomical abnormality or a tumor, not “to find out what’s going on in there”).

Having agreed about getting an MRI, I then made the mistake of asking about a different bone-related issue, since this doctor is an orthopedic surgeon who specializes in knees and shoulders and similar bones. My question was “Is surgery often done for bone spurs in the foot?”. He told me in no uncertain terms that asking a doctor a question like that is the worst thing a patient can do. He gave me a brief lecture, explaining that you should never ask a doctor about anything the doctor isn’t prepared or qualified to talk about. He seemed quite upset and left the room. I called after him “Should I follow you?”, he made a noise and I did.

While waiting for the MRI to be scheduled, I asked him if I could speak to him about something else. He said “No”. I then said I wanted to discuss the TV issue. I said that if a patient wants the TV off, it would be a good thing for the staff to honor that request. In response, he severely criticized my failure to initially ask the staff to turn off the TV, instead of pushing the off button myself. “How would you like it if I came to your house and drove your car? Or came into your house and turned off your television? It’s not your television. It’s ours.” (Gosh, I thought the TV was for the entertainment of the patients.) I admitted I would have asked if there had been anyone else in the room, but still felt what I had done wasn’t so bad.

At this point, I told the doctor that he had the worst bedside manner of any doctor I’ve ever visited (and I’ve visited a lot). Talking fast, interrupting, constantly correcting my choice of words, saying he didn’t “give a sh@t” about something and generally looking and sounding pissed off. He said he was still willing to treat me. I said “I don’t think so” and left. (This area isn’t short of orthopedic surgeons.)

Now, I assume this guy was angry about the TV thing when he entered the examining room. Maybe he heard my exchange with his staff. Maybe one of them mentioned the difficult patient in the waiting room. But if he was already angry with me, it would have been much better (and more “professional”) if he’d said so up front. He might have even declined to treat me. I would have been surprised but would have left quietly. Instead, he behaved like a jerk (another word came to mind, but this aims to be a family-friendly blog). Or maybe he treats lots of patients that way and it had nothing to do with the television.

So here’s a good part of this story (ok, this saga). I thought it would be appropriate to share my strange experience with the rest of the world (meaning the part of the world that, for some mysterious reason, doesn’t read this blog). Since we now have the internet, I went to a couple of those doctor-rating sites, Healthgrades and Vitals. That last site allows you to enter comments. So I did.

My conclusion was that this doctor might be very good, except for his personality. The treatment plan (the MRI) he recommended made sense. But I wouldn’t recommend him and would never see him again. 

After entering my comment, it occurred to me that maybe I was being a little unfair to the guy. Maybe he was having a bad day. So I looked at the other comments. These are some of my favorites:

Only drawback – he is very hard to talk to or get understandable information from. He gets very impatient with explanations.

He has a big ego. He does not like being questioned…. Instead of giving you understandable answers and showing that he cares, he gets impatient and annoyed very easily.

AVOID [Dr. X] AT ALL COSTS. There is not enough room for his ego and the patient in the exam room.

My experience with [this doctor] was disastrous.

... a horrible and unprofessional surgeon… As [the vomiting] got progressively worse I decided to page [Dr. X]… His words went something like this (and keep in mind I could barely talk because I was vomiting so often) He basically told me that I was interrupting his dinner and that it was not right that I was doing so….I actually started crying so my amazing sister took the phone … This is but one of my horrible experiences with [Dr. X]. Please Please Please Please, I beg you not to see this Doctor!!! 

One of the worst experiences of my life… I told him about the problems I was having after the surgery. He went off the handle and acted very unprofessionally by yelling at me. His behavior made me cry and I never went back to him.

I echo all of the negative comments already posted here: he is impatient, belligerent, insulting, difficult to comprehend, excessively … antagonistic when you explore his incomprehensible answers, actually told me one of my questions was “Bullsh-t”, and that I was wasting his time by asking questions…I would not feel comfortable going under the knife of such a disordered personality. I think he’s sociopathic.

Of course, there are glowing reviews as well. But the lowest grade he gets is for (surprise!) “bedside manner”. All I can say is that if you’re ever in the market for an orthopedic surgeon in or around Springfield, New Jersey, be careful. It’s a jungle out there!

PS — Other people object to all these televisions. From a doctor:

Welcome to the world of the “captive audience… Take them out. Take them all out. That includes the four flat screens on different channels at the local restaurant. I can’t find a single study that shows any legitimate health benefit to support their presence in a doctor’s office, but I can think of 100 reasons to take them out.

From an educational site for doctors:

An informal survey conducted in a variety of waiting rooms found that the presence of television adds to stress, especially when people believe they are unable to control the volume or programming…. If your waiting room includes a television, consider offering patients options. Rather than exposing them to specific programs at a certain volume, for instance, offer television with closed captioning or hygienic headphones on loan from the waiting room desk.

And keep them out of the damn elevators too!

A Bit More on the Cost of Health Insurance

A Vox article cites a report from the Center for American Progress that helps explain why many employees who get health insurance at work don’t like the Affordable Care Act and believe it’s causing the cost of health insurance to go up:

In recent years, the growth in overall health care costs has slowed dramatically. But for millions of Americans with employer-sponsored insurance…, this slowdown is illusory. From 2008 through 2013, the average annual growth rate of employees’ monthly premium contributions and out-of-pocket expenses, adjusted for inflation, was more than double that of average annual growth in real per-capita national health care spending, which was less than 2 percent per year. This growth has also outpaced employers’ costs of offering these benefits by more than 40 percent.

Employees experiencing higher health care costs tend to blame the Affordable Care Act, or ACA, even though the law largely leaves the employer-based system alone….The actual reason why employee and employer costs are increasing at different rates is because employers have, over time, shifted greater responsibility for health care expenses to their employees through higher deductibles, higher copayments, and higher coinsurance—a practice that began long before the passage of the ACA. Other employers pay smaller shares of their employees’ health care premiums….

In other words, almost everyone in the health care system is realizing savings, but employees’ costs are rising.

Or as Vox puts it, in still other words:

Your company’s health insurance costs are going down. But yours are going up.

This is in addition to many companies incorrectly telling their employees that the ACA is to blame for rising costs.