Tag Archives: healthcare

Subverting Democracy by Corrupting Truth

States Not Expanding Medicaid

Source: WhiteHouse.gov

“None of my friends can afford Obamacare, either,” Meghan said indignantly, “it should be repealed.”

We were in the South Carolina Lowcountry. Meghan is a mid-to-late-thirties single mother who is balancing raising her child, her relationship and job while still working on her degree.

She was telling us about the hospital where she works. Like so many rural hospitals across the South, her hospital has a significant number of uninsured patients coming through the emergency room for treatment. Federal law (EMTALA) requires all hospitals with an emergency department that receive Medicare to screen, treat, stabilize or transfer anyone requesting treatment regardless of ability to pay.

Meghan told us that her hospital had to cut back staff, which backed up her ER waiting room even more. She told us that the hospital could not afford to treat really sick uninsured patients and mostly their doctors patched up the uninsured sick the best they could, gave the patients some medicine and sent them on their way with a prescription knowing the prescriptions were unaffordable and the patients would be back. Meghan blamed Obamacare for all of it.

That is when I chimed in and told her that things at her hospital were going to get worse. The Affordable Care Act (ACA, aka: Obamacare) is complicated and when passed, assumed every state would expand Medicaid. With almost everyone having insurance, there would be fewer uninsured at the ER and hospital costs would go down. With lower costs, federal Medicare reimbursements are being reduced each year.

That’s when Meghan said that Obamacare was too expensive and should be repealed. And that is when I told her that she had been lied to. That for people earning up to 138% of the poverty level, Obamacare was should have been free and is in free in 28 states. But that her state government decided that the fate of 340,000 South Carolinians was to bankrupt, go to the ER or die.

I wasn’t sure which one of us was going to scream or cry first. Meghan seemed bewildered and said, “It isn’t Obama’s fault that I don’t have health insurance, but it is the states? The state did this? None of my friends know that. All we hear is that it has to be repealed. This is terrible. Why would they do that to us?”

Then I told her about the money. The more than $15.8 billion that her state would have gotten from Washington that was to pay for 100% of Medicaid expansion. Money they will never get. Money that would have created many tens of thousands of good permanent jobs, saved countless bankruptcies, saved lives and made lives better. Money that South Carolina taxpayers are sending to other states.

It gets even worse as the states have to make up the difference for indigent care and the decrease in Medicare reimbursements – money needed to keep hospitals like Meghan’s open. The Robert Wood Johnson Foundation and the Urban Institute put that number at $167.8 billion for all the states not expanding Medicaid from 2013-2022 – for instance, Georgia will lose $1.2 billion in Medicare reimbursements in 2016– more than twice the cost of expanding Medicaid. Stupid and mean.

Despite this, there is good news even in the states which haven’t expanded Medicaid. The online marketplace makes it easier to enroll and determine eligibility. South Carolina, for example, had about 300,000 people who already qualified, but had never enrolled in Medicaid. Using HealthCare.gov, South Carolina has already added over 150,000 of them.

In fairness, there is a cost to the states to accept the expanded Medicaid money. States must provide basic benefits and offer it to all of their citizens below the poverty level, not just women with children. According to the Urban Institute and McClatchyDC.com, South Carolina’s 10-year cost to expand would have been about $1.2 billion – a lot of money, but not much to get $15.8 billion in return. For Georgia to get $33.7 billion, would cost $2.5 billion over 10-years (which could be funded by the governor’s discretionary budget) – one other note on Georgia – five rural hospitals closed since 2012 and more and six more are at risk (USA Today). Here’s a chart for other states.

Suggested reading: What Is the Result of States Not Expanding Medicaid?

Note: this story also published at LikeTheDew.com

The Big Day

Breaking News: CJ Roberts tacks left to uphold mandate and Affordable Healthcare Law; then to the right to allow states not to expand Medicaid.

America must have some of the stupidest, least informed and most gullible people on earth, but that is another story. Today the Supreme Court finally announced their ruling that there will be comprehensive reform of our badly broken healthcare system during our lifetimes.

We learned that the 6 percent among us who don’t have insurance and don’t want it are required to have it or face a penalty*; and if the other 10 or so percent who don’t have health insurance, but want it can buy it.

John Roberts, as Zeus, ruling from on high. (DonkeyHotey)

Today we learned that the 20 or so percent of us with preexisting conditions will get to keep our health insurance or ever buy it again.

Today we learned our children up to 26 can stay on our policies or finally be forced to leave the nest and do without healthcare.

Today we learned health insurance companies will have to spend money on covering the people they insure and prove it.

Today we learned preventive care to save money (and lives) is something that can survive in our late stage form of capitalism.

Today we learned we are to get health insurance exchanges to allow us to simply and clearly compare policy costs and coverage.

Today we learned our seniors’ prescriptions will not again have a “doughnut hole” of coverage forcing countless people to do without.

Today we learned small business tax breaks will continue.

Today we learned that the 13 million adults and 3.7 million children living within 133 percent of the poverty level will be allowed access to healthcare through Medicaid – if the state in which they live isn’t so stupid as to opt-out of the 100% federally paid program – first three years and then matched on a sliding scale thereafter – today we learned that our federal government cannot penalize a state for not taking care of some of its least fortunate citizens, but we can penalize them at the ballot box.

Today we learned that those working Americans who cannot afford health insurance because they are within 400 percent of the poverty level, will get some tax credit help.

Today we learned that we are going to continue to provide healthcare to seniors, the disabled, government workers, prisoners and some of the poorest among us, while tens of millions of working and recently unemployed Americans will no longer be denied healthcare and receive help to afford it.

We already know that this is about Republican politics and the corrupt lobbying power of their masters and that any suggestion of an independent judiciary evaporated a decade ago.

We expect that Sotomayer, Breyer, Kagan and Ginsburg will, at the very least, vote to preserve most of the intent of Congress.

We knew that Scalia, Thomas and Alito would nullify the entire bill. Roberts would naturally join them unless Kennedy negotiates a narrower decision on the Commerce Clause or jumps to the other side. That didn’t happen. Kennedy stayed with the Republican nominated justices. Together they decided this was not a valid extension of the the Commerce Clause. It was Roberts who would cast the deciding vote. Citing Hooper v. California, Roberts felt “every reasonable construction must be resorted to, in order to save a statue from unconstitutionality” and concluding the law was Constitutional because it was within the right of Congress to levy a tax on individuals who do not have insurance.

The bill before the court was terribly flawed (see my Dew story when the bill passed, Hold your nose and swallow), but throwing out the entire bill with this Congress would have been devastating in lives and at terrible cost to our economy. However, a more limited ruling would have made for great political sport watching this or the next POS Congress try come up with a compromise bill to fix the problems.

In retrospect, it would have been so simple, if two years ago, President Obama had just fired Rahm Emanuel and asked Congress for a one page bill that allows all Americans to purchase Medicare at any age. Then a separate bill on expansion of Medicaid. Maybe next time.

Money-Driven Medicine

Money Driven MedicineNext week on Bill Moyers Journal, the film Money-Driven Medicine reveals how a profit-hungry medical-industrial complex has turned health care into a system that squanders millions of dollars on unnecessary tests, unproven and sometimes unwanted procedures and overpriced prescription drugs. Based on Maggie Mahar’s book, Money-Driven Medicine.

SYNOPSIS (From the movie website: MoneyDrivenMedicine.org)
Money-Driven Medicine provides the essential introduction Americans need to become knowledgeable participants in healthcare reform, now and in the years ahead. Produced by Academy Award winner Alex Gibney (Taxi to the Dark Side; Enron: The Smartest Guys in the Room) and based on Maggie Mahar’s acclaimed book, Money Driven Medicine: The Real Reason Health Care Costs So Much, the film offers a behind-the-scenes look at how our 2.6 trillion dollar a year healthcare system went so terribly wrong and what it will take to fix it.

The U.S. spends twice as much per person on healthcare as the average developed nation, fully one-sixth of our GDP – yet our outcomes, especially for chronic diseases, are very often worse. What makes us different? The U.S. is the only industrialized nation that has chosen to turn medicine into a largely unregulated, for-profit business.

Effective Care or More Expensive Care?

In Money-Driven Medicine, Dr. Donald Berwick, president of the Institute for Health Care Improvement, explains: “We get more care, but not better care.” Our fee-for-service system channels resources into the high-tech, high-cost “rescue care” patients need after they become critically ill, while it skimps on the preventive primary care which could keep them out of the hospital in the first place. As a consequence, emergency rooms overflow while family practitioners are becoming an endangered species. Medical students explain that these perverse pay incentives drive them away from primary care into higher-paying specialties.

Medical ethicist Larry Churchill doesn’t mince words: “The current medical care system is not designed to meet the health needs of the population. It is designed to protect the interests of insurance companies, pharmaceutical firms, and to a certain extent organized medicine. It is designed to turn a profit. It is designed to meet the needs of the people in power.”

These businesses comprise the “medical-industrial complex” which has wrested power from physicians, turning healthcare into a commodity and patients into profit centers. As the eye-opening ads in Money-Driven Medicine reveal, the more new drugs, surgical procedures, diagnostic devices and hospital beds the health industry can produce, the more they can sell – whether we need them or not. It’s called “supply-driven demand” and it’s possible because a sick person can’t say no.

Although many uninsured and underinsured Americans receive too little care, the well-insured often get unnecessary, even risky care. More than two decades of studies by researchers at Dartmouth reveal that one-third of our healthcare dollars are squandered on useless tests and ineffective or unproven procedures no better than the less-costly ones they replace. The studies demonstrate that evidence-based, accountable care would be both more effective and less expensive.

Taking Back Healthcare

In Money-Driven Medicine frustrated doctors and outraged patients testify to the tragedies which can happen when profit trumps patients’ needs. Veteran physicians stress that reform must begin with a new doctor-patient partnership based on consistent, informed, shared decision-making. “Before patients can reclaim their rightful place at the center of our healthcare system,” Maggie Mahar notes, “we must empower doctors and nurses to practice patient-centered care based, not on corporate imperatives, but on the best scientific research available.”

Money-Driven Medicine will encourage health professionals and patients to work together to take control of American medicine back from the MBAs. The film will alert viewers that universal coverage is just the first step in a long and arduous battle for comprehensive reform continuing well after whatever bill Congress passes this Fall. We have seen that the industry’s lobbyists will resist every measure aimed at cost-containment and results-based care.

Screening Money-Driven Medicine will help viewers distinguish between structural change and sham reform. It will convince them that a sound, sustainable medical infrastructure is crucial not just to their personal futures but to the economy and society as a whole – why curing America’s healthcare crisis could be a matter of national life and death.



Opening Sequence


www.youtube.com/watch?v=oPHYb4g4oT8
Miracles



Now Treating Medicine



Questioning Healthcare



Intensive Care



Not the Best, Only the Most Expensive



Physician Focus



Patients for Sale

 

Editorial Note: This is part of an on-going series of videos shared by LikeTheDew.com readers. If you would like to share a video, send links to: [email protected].

Tell Congress to Go to Hell

fuck-youWednesday’s Democrat victory / compromise / cave-in is a harbinger. A public option won’t be able to negotiate for lower costs. Hmmm. Who benefits. Hospitals? Check. Big pharma? Check. Insurance companies? Check. People, sick or otherwise? Wonnnnnk. The smart money on Wall Street has been betting we’d be screwed and they’d get richer. Enough to make me hope nothing passes.

Not. Can’t go there. This is the most important thing this Congress and this President can do for about a hundred million of us who duck doctors and hospital bill collectors while we wince in pain. Not the most important thing this year … they’ve already shafted us on that — the stimulus (aka: bailout for the gloriously happy rich). No, this is life and death and they have chosen profits and to pretend (CNN wants you to believe that, too) that Wall Street mirrors America.

All to save a hundred billion over ten years? Sure. There is not a human being on the planet that believes any of it. Many trillions to make sure Ben Bernanke’s friends stay super-wealthy and the US government needs to screw me and my hundred million peers? F-them..

As God is my witness (oops, God left on the last train to the coast and is now on a slow-boat to China where they bailed-out people instead of banks), I will spend every moment I can afford (Hah! When this is passed, I won’t afford anything) working to defeat every single-sniveling-cowardly-corrupt-lobby-sucking-dickhead-congress-person I can find. I’ll march. I’ll picket. I’ll write. Email. You-tube. Twitter those [expletive deleted by editor] assholes the rest of my life. (Note to the Secret Service: strictly metaphorical threats.)

Folks, this ain’t over, but it will be soon.

I know. I know. I know. We just need to pass health care reform and will fix it in post (a video and audio production term that allows you to record something really badly and use various computer techniques — like Photoshop —  to make it seem better when people see it). Not this time. We’ll be dead broke and mostly dead before they take the power out of the cold live hands of the lobbyists.

I don’t have any power except to write you. If you can reach out and touch one, just one of the cretins we called leaders, please do it for me — or for one of the hundred million others who are more likeable.

Dinosaurs should be extinct

2ijpxr4Try living with them and you’ll trampled or eaten. One of the many notable dinosaurs surviving today is the health insurance industry. They are really big. Have voracious appetites. And their sole purpose is keep you alive just long enough to eat every dollar you have.

Way back in the World War II era (before the internet began recording history), these dinosaurs began roaming the US as result of the wage freeze during the war. Employers saw it as way to scam the freeze and attract employees when employees were scarce. By the end of the war, employees loved these cute little scaly creatures (Yabba-Dabba Do). They didn’t eat much back then, but as we started feeding them, they started growing and got bigger and bigger. They began eating each other and fighting over the food supply – us. Thick skinned, with no known predators, lots of lobbyists and seemingly impervious to regulation, they have continued to grow to their enormous present-day size. They also seem to have a particular love for the food in the South.

Quoting researchers at the Johns Hopkins Bloomberg School of Public Health (Click here for the full report), SouthernStudies.org, says the “Health insurance industry monopolizes the South. According to the report, insurer consolidation also disproportionately disadvantages rural states. In several rural states across the nation the two largest health insurers control at least 80% of the statewide market. In Alabama, for instance, the biggest insurer holds 89% of the statewide market, the highest rate in the nation for a single company. Even more populous states in the South have serious market concentration problems; Virginia’s largest health insurer, for example, controls a 50% share of the statewide market.

The combined market share percentage of the top two insurers in each state in the South:
Alabama – 88
Arkansas – 81
Florida – 45
Georgia – 69
Kentucky – 69
Louisiana – 74
Mississippi – n/a
North Carolina – 73
South Carolina – 75
Tennessee – 62
Texas – 59
Virginia – 61
West Virginia – 54

”In the past 13 years, more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets“ – HCAN

“94 percent of insurance markets in the United States are now highly concentrated, and insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries“ – The American Medical Association

”Health insurance premiums have skyrocketed, going up more than 87% on average over the past six years“ – The Department of Justice

From blog.AFLCIO.org and quoting a letter to the Department of Justice’s Anti-Trust Division, Richard Kirsch, HCAN national campaign manager, and David Balto, former policy director of the Federal Trade Commission and now senior fellow at the Center for American Progress, writes: “Simply put, the private insurance companies have secured monopolies or tight oligopolies and exercised that power to put profits ahead of patients….There were no actions taken against anticompetitive conduct by health insurers in the last administration, in spite of the fact that cases by state attorneys general have secured massive fines against these insurers. A lack of antitrust enforcement has enabled insurers to acquire dominant positions in almost every metropolitan market.”

Extinct in most of the world, the cost of maintaining these dinosaurs has soared.

According to the National Coalition on Health Care:

  • In 2008, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation.
  • Total spending was $2.4 TRILLION in 2007, or $7900 per person
  • Total health care spending represented 17 percent of the gross domestic product (GDP) – compared to 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France.
  • U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 TRILLION in 2017, or 20 percent of GDP.
  • The annual premium for an employer health plan covering a family of four averaged nearly $12,700.
  • The annual premium for single coverage averaged over $4,700.
  • Health care spending is 4.3 times the amount spent on national defense.
  • Health insurance cost in the United States have been rising four times faster on average than workers’ earnings since 1999.
  • The average employee contribution to company-provided health insurance has increased more than 120 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same period.
  • National surveys show that the primary reason people are uninsured is the high cost of health insurance coverage.
  • A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
  • A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.
  • Retiring elderly couples will need $250,000 – $300,000 in savings just to pay for the most basic medical coverage.
  • The United States spends six times more per capita on the administration of the health care system than its peer Western European nations.

64022626_711ca081eeWe obviously need a dragon slayer. We need to kill these evil beasts off once and for all. We cannot afford to wait. They will eat us all. Write your congressperson. Demand single payer and enforcement of our anti-trust laws. If for no other reason, do it because dinosaur farts contribute to greenhouse gases and some believe brought on the last ice age.



Mutant capitalism

x-men-groupWe have been warned for decades about the risks of playing God (or subverting evolution) through genetics. Take a gene from one thing. Splice with another. And, voilà!  You’ve either got a cure for cancer or a cow that tastes like tofu.

Our Congress, bless their teensy-tiny little hearts, have always known what was in our best interests – particularly when it came to genetics. Now they are really on to something. They have let the mad social scientists over on K Street do a little economic gene splicing. While the actual process must be way too complicated for wee voters/taxpayers to understand, they have taken the nucleus from the capitalism genome (patent pending) and isolated a faulty hereditary gene which causes the natural death of industries who have outlived their usefulness and replaced the faulty helix with a gene from a leech found on one of Stalin’s hemorrhoids.

“The trick really wasn’t finding the leech,” a spokesperson attracted to the camera lights like a bug on a Southern night said, “we had long know that would be a big part of the solution. No, the trick was splicing the genes in total darkness. Even the smallest amount of light would have ruined the result.” This new, mutant form of capitalism, called,“Antisocialism” (scientific name: thelmaandlouisism), is believed by members of both parties to be the answer to our heath insurance crisis and will require every one to purchase health insurance from private companies.

This really solves the long, thought-to-be-impossible-to-overcome-problem of how to appear to have universal heath care coverage while still preserving what was most important to Congress – the political contributions provided by the health insurance industry that would no longer have any valid reason to exist.

Congressional leaders, basking in the glow of bi-partisanship, are now planning to use Antisocialism to solve the economic crisis and are planning to introduce legislation that would require all Americans to buy cars, stocks and consumer products from companies who contribute to their campaigns.

Suggested reading: Politco

Southern Rankings








Here are the current Southern (as defined by the Southern Governors Association) rankings for population, unemployment, percent of population in prison, median income, population receiving welfare or foodstamps and percentage of population without healthcare insurance.

Click on the label in the top row to sort by each category.

States Population Unemployed Prison
Population
Median
Income
Receiving
Welfare
Receiving
Food
Stamps
Uninsured
AL 23 34 06 47 31 12 29
AK 32 16 22 49 39 10 41
DC 50 44 51 20 01 05 16
FL 04 41 07 36 45 28 49
GA 09 40 02 22 49 16 42
KY 26 39 17 48 19 07 27
LA 25 10 01 50 48 06 47
MD 19 18 26 02 29 40 24
MS 31 37 04 51 37 01 46
MO 18 33 18 37 12 02 22
NC 10 48 28 43 41 20 37
OK 28 09 05 44 42 15 44
SC 24 50 08 42 32 08 36
TN 17 37 15 45 04 03 28
TX 02 14 03 38 46 21 51
VA 12 16 13 08 34 38 25
WV 37 12 41 46 22 04 32

The chart is based on the most current figures available from the following sources:

Here are the raw numbers:

Population:
AL: 4,661,900
AK: 2,855,390
DC: 5,918,333
FL: 18,328,340
GA: 9,685,744
KY: 4,269,245
LA: 4,410,796
MD: 5,633,597
MS: 2,938,618
MO: 5,911,605
NC: 9,222,414
OK: 3,642,361
SC: 4,479,800
TN: 6,214,888
TX: 24,326,974
VA: 7,769,089
WV: 1,814,468

Unemployment Rate:
AL: 8.4%
AK: 6.6%
DC: 9.9%
FL: 9.4%
GA: 9.3%
KY: 9.3%
LA: 5.7%
MD: 6.7%
MS: 9.1%
MO: 8.3%
NC: 10.7%
OK: 5.5%
SC: 11.0%
TN: 9.1%
TX: 6.5%
VA: 6.6%
WV: 6.0%

Prison Population:
AL: 40,561 (0.87%)
AK: 47,974 (1.68%)
DC: 3,552 (0.06%)
FL: 148,521 (0.81%)
GA: 92,647 (0.96%)
KY: 30,034 (0.70%)
LA: 51,458 (1.17%)
MD: 35,601 (0.63%)
MS: 27,902 (0.95%)
MO: 41,461 (0.70%)
NC: 53,854 (0.58%)
OK: 32,593 (0.89%)
SC: 35,298 (0.79%)
TN: 43,678 (0.70%)
TX: 223,195 (0.92%)
VA: 57,444 (0.74%)
WV: 8,043 (0.44%)

Median Income:
AL: $49,901
AK: $39,452
DC: $50,318
FL: $46,383
GA: $49,692
KY: $40,029
LA: $39,418
MD: $63,552
MS: $36,499
MO: $45,924
NC: $42,219
OK: $41,578
SC: $42,477
TN: $41,521
TX: $58,950
VA: $57,178
WV: $40,800

Receiving State Welfare:
AL: 41,849
AK: 19,689
DC: 39,267
FL: 87,632
GA: 37,983
KY: 58,124
LA: 19,545
MD: 57,601
MS: 23,714
MO: 101,916
NC: 49,653
OK: 19,170
SC: 38,050
TN: 144,705
TX: 115,690
VA: 65,546
WV: 22,927

Receiving Federal Food Stamps:
AL: 61,377
AK: 387,956
DC: 92,288
FL: 1,694,649
GA: 1,139,309
KY: 663,591
LA: 687,571
MD: 402,892
MS: 472,537
MO: 949,404
NC: 1,012,481
OK: 432,642
SC: 636,698
TN: 977,109
TX: 2,651,370
VA: 582,494
WV: 285,242

People Without Health Insurance:
AL: 632,000
AK: 485,000
DC: 64,000
FL: 3,698,000
GA: 1,658,000
KY: 569,000
LA: 807,000
MD: 761,000
MS: 543,000
MO: 723,000
NC: 1,469,000
OK: 640,000
SC: 705,000
TN: 830,000
TX: 5,687,000
VA: 1,031,000
WV: 268,000