Archive for the ‘Health Policy’ category

Pre-SOTU thoughts

January 27th, 2010

I have been an enthusiastic supporter of the President while he was campaigning. My problem with him since then is that he doesn’t appear to be the same person. We as progressives deal in a media environment in which the assumption is that we are a conservative country. This despite much evidence to the contrary. And there is some evidence that the GOP is misreading the public in this way again. Mike Lillis via Andrew Sullivan:

But while Republicans are hoping Brown’s victory foreshadows a GOP landslide, a number of political experts are warning that the country’s restless anxiety — as evidenced not only in Massachusetts, but in Virginia, New Jersey, and now Florida as well — is less a backlash against Democrats in particular than a rebuke of the business-as-usual politics of Capitol Hill in general. Even as unemployment soared and housing markets tanked, voters have watched lawmakers bicker endlessly over a stimulus bill that proved too small and a health reform proposal that remains unfinished. Meanwhile, the banks have bounced back on the wings of a taxpayer bailout, paying out billions of dollars in employee bonuses this month while the jobs crisis outside Wall Street only worsens. In such an environment, some experts caution, incumbents on both sides of the aisle could find themselves surprisingly vulnerable in November.

I have no doubt that he will give a stemwinder of a speech.  I’m just not sure what he really stands for anymore.  I want to see him fight.  He will bring up again a call to end DADT, but we’ve heard this before.  He will announce some spending freezes.  He is beginning to play more and more on the conservative side of the field.  I hope we see a change in this.  Not just from the speech, but from his actions.

I’m still bewildered by the Democratic Party’s inability to pass anything progressive or within a fairly centrist Democratic Party agenda.  We shouldn’t go Bill Clinton’s way.  No small ball.  The country needs more.

As an aside, can anyone tell me the last major piece of progressive/liberal legislation that has been passed in the country.

The Coakley Blues in the Bay State

January 18th, 2010

I have no idea what is going to happen in tomorrow’s special election to replace the seat once held by Ted Kennedy.  I don’t watch CNN, MSNBC, or Fox any more; I had found my general sanity had become more and more at stake.  But if you were to read the blogs and watch the network news, this is a forgone conclusion.  The Democrats are screwed.  It’s impossible to know from those sources what to take.  The cliche of course is that any news, good or bad, is always bad news for the Democrats as far as the media is concerned.  The news loves a story, and this would be a huge story.  It would be spun as a repudiation of Obama and health care and the end of the democratic party agenda.  That assumes it has had a coherent agenda, but you get my point.

The Repubs are energized to vote in Mass. and the Democrats are not.  That will be the tale.  If Coakley loses, a lot of recrimination will come about the time we’ve waisted trying to get bipartisan support for a health bill, and our lack of willingness to fight for anything.  It’s pretty known that I’m a bit down on the first year of the Obama presidency.  But the biggest fear I carry now is that the Blue Dog Dems will read a Bay State loss as vindication for their view that we’ve gone to far to the left.  I can’t for the life of me name one single left wing policy that we’ve passed except for the stimulus package as a Keynesian response to a tragic economic environment.  Our final health care bill is a pretty market friendly conservative bill that has some good things about it.

But here’s to hoping that the media is doing what they often do, build a story that really isn’t there.  Remember the Teabagger dude in upstate New York?  Didn’t win, did he?  In the end, we’ll know what we know tomorrow.  And don’t let anyone tell you the know what’s happening and what it all means.

Post script:  I mentioned yesterday the lovely comment that one of Republican Scott Brown’s supporters used in a rally (“let’s shove a curling iron up her ass”).  I just felt compelled to remind people of a bit of Scott Browns past and perhaps hanging out with people calling for rape isn’t a great idea when you’ve posed for this: (for real, him, years ago)

Holidays are over, and hope begins

January 4th, 2010

I have spent the last two or three years as a cynic. I’ve always been a bit of a cynic, but what I am referring to here is in the classical greek sense of the word, as in pulling one apart from politics or the believe in the ability to change a system as large as the political system of the US and indeed the world. So it’s a glorious ability to throw bombs and share a hopeless sense. But it is not a something you can live with forever. My disappointment in the loss of Constitutional control of the American government under Bush, and Obama’s willingness to not prosecute and in fact set up protections for the war criminals hurt. I left the country for a year and wanted to experience a different set of values. Values I treasure. Individual rights, regulated capatalism and a robust welfare system.

Yet, I am hopeful. I think with all the disappointment I have with the political structure in the United States and its inability to sustain real change and recognize true human rights, Obama has been a vast improvement. I do believe time will help us overcome.

I saw a concert this weekend with my personal diva, Bette, in Vegas. There’s her most signature song, The Rose. It is a song of the hope of a better spring time after a difficult winter. Our winter has gone on for so long, ten years. No job growth, war crimes, cowardize around LGBT rights. Eight years of war. But the seed, with the sun’s love, comes the rose.

I’m committed to fighting and not letting politicians off the hook. But I am also committed to hope. To holding ourselves to a higher standard. I am committed to global connection and universal citizenship. I am committed to be one of many suns that will bring light and bring the spring. In my current job, I’m committed to finding ways that every LGBT person in this city can find help when they need it. Substance abuse, mental health, poverty, HIV and AIDS, and building a sense of community have been my life for the last 25 years. I am recommitted.

What can you do to bring that light. To end the winter of our discontent, to borrow a phrase. To make this city and this country what it can be.

A perspective on debt and corporatism. Change the Banks and Health Insurance Companies Can Believe In

December 15th, 2009
Wins with no facts, principles, or reasons. Just bitter, old, Not better and bold

Wins with no facts, principles, or reasons.  Just bitter, old, Not better and bold

Taken from the always wonderful CrooksandLiars.com, this wonderful perspective:

This is about to put me in the mind of a stroke.  This is how FDR left you know.  This from the great Crooksandliars.com

How much is $140 billion?

The U.S. economy grew at a $89 billion annualized rate in the third quarter. That was the first growth since the second quarter of 2008 and came to $22 billion in actual growth in the third quarter.

The bankers, after causing the greatest economic calamity since the Great Depression, are rewarded with six times the growth accomplished so far in the much heralded “economic recovery.”

Meanwhile, seven million families face foreclosure and 25 million Americans can’t find full time work.

Add on top of this piece of job is that final version of the HCR plan that will go forward in the end will not have public health obtion or Medicare expansion.  We are going to force all Americans to buy insurance and pay big Health and big Farma with no way to control costs.  They get millions of new clients forced to pay whatever they want to charge.  And they will still be elegible for anti-trust protection.  You can’t stop them  Our guys in Washington are so brave.  Such heroes.

This is change that Corporations can believe in!  Can you?

Richard Nixon’s Health Care Proposal – Not bad at all

September 3rd, 2009

 

More courage than our current Dems?

More courage than our current Dems?

Hat tip to Yglesias on this, but here is a proposal made on health care by Richard Nixon that looks pretty good. Here is part of it, but go read the whole thing:

 

  • Upon adoption of appropriate Federal and State legislation, the Comprehensive Health Insurance Plan would offer to every American the same broad and balanced health protection through one of three major programs: –Employee Health Insurance, covering most Americans and offered at their place of employment, with the cost to be shared by the employer and employee on a basis which would prevent excessive burdens on either; –Assisted Health Insurance, covering low-income persons, and persons who would be ineligible for the other two programs, with Federal and State government paying those costs beyond the means of the individual who is insured; and, 

    –An improved Medicare Plan, covering those 65 and over and offered through a Medicare system that is modified to include additional, needed benefits. 
    One of these three plans would be available to every American, but for everyone, participation in the program would be voluntary. 

    The benefits offered by the three plans would be identical for all Americans, regardless of age or income. Benefits would be provided for: 
    –hospital care; 
    –physicians’ care in and out of the hospital; 
    –prescription and life-saving drugs; 
    –laboratory tests and X-rays; 
    –medical devices; 
    –ambulance services; and, 
    –other ancillary health care. 

    There would be no exclusions of coverage based on the nature of the illness. For example, a person with heart disease would qualify for benefits as would a person with kidney disease. 

    In addition, CHIP would cover treatment for mental illness, alcoholism and drug addiction, whether that treatment were provided in hospitals and physicians’ offices or in community based settings. 

    Certain nursing home services and other convalescent services would also be covered. For example, home health services would be covered so that long and costly stays in nursing homes could be averted where possible. 

    The health needs of children would come in for special attention, since many conditions, if detected in childhood, can be prevented from causing lifelong disability and learning handicaps. Included in these services for children would be: 
    –preventive care up to age six; 
    –eye examinations; 
    –hearing examinations; and, 
    –regular dental care up to age 13. 

    Under the Comprehensive Health Insurance Plan, a doctor’s decisions could be based on the health care needs of his patients, not on health insurance coverage. This difference is essential for quality care. 

    Every American participating in the program would be insured for catastrophic illnesses that can eat away savings and plunge individuals and families into hopeless debt for years. No family would ever have annual out-of-pocket expenses for covered health services in excess of $1,500, and low-income families would face substantially smaller expenses. 

    As part of this program, every American who participates in the program would receive a Health-card when the plan goes into effect in his State. This card, similar to a credit card, would be honored by hospitals, nursing homes, emergency rooms, doctors, and clinics across the country. This card could also be used to identify information on blood type and .sensitivity to particular drugs-information which might be important in an emergency. 

    Bills for the services paid for with the Health-card would be sent to the insurance carrier who would reimburse the provider of the care for covered services, then bill the patient for his share, if any. 

    The entire program would become effective in 1976, assuming that the plan is promptly enacted by the Congress. 

Feinstein Failure: Dianne just doesn’t get the public option

August 28th, 2009

dianne_feinstein_01Senator Feinstein released a statement on the health care debate, and at times really seems to understand what the key issues are and her stances are all along the lines of something I could support:

What I Support
I basically believe that reform should be incremental and should cover the following:

  • Allow people to keep their current healthcare coverage.  Millions of Americans have insurance that meets their needs.  In all of the proposals that Congress is considering, those happy with their current plan will be able to keep it. 
  • Stop certain practices of insurance companies.  Any bill should end discrimination based on preexisting conditions, stop insurance companies from dropping insurance when people become sick, and prevent the unreasonable denial of treatment.  There must also be limits to out-of-pocket expenses to ensure that Americans are not driven into financial ruin by illness. 
  • Control insurance premiums.  Insurance premiums have doubled over the last 9 years, 3 times faster than wages.  Meanwhile, the profits of the nation’s largest private insurance companies increased 428 percent from 2000 to 2008 (Health Care for America NOW).  This is unacceptable.  Insurance for healthcare is an urgent and universal need, but will not be sustainable and universal if the profit margin remains unconstrained. 

In order to see that premiums are affordable, I believe that all non-direct healthcare costs (advertising, overhead, profits, and other administrative costs) should be limited and not exceed 10 percent.  All premium rate adjustments should be subject to review and approval by a Health Insurance Rate Authority. Bottom line:  your health insurance must remain affordable.  Your premiums cannot be allowed to double again in the next nine years, as they have in the past nine. 

Another way of stabilizing premium affordability is the public option.  Depending how the competition is structured, this “option” could compel insurance companies to lower premiums to remain competitive.  It remains a viable proposal. The public option should be one of a variety of choices for people who want improved coverage, giving them an option between a private insurance plan and a public one.  The public option is simply that—an option.  No one will be required to enroll in the public plan.  Instead, it would offer consumers an additional choice as they select a health insurance policy.  Instead of choosing between policies offered only by private insurance companies, people could choose to buy a public insurance plan.  Those that prefer to buy private insurance could still do so. 

Not bad, but here is where she goes wrong (emphasis mine).

The purpose of creating a public plan is to increase competition so that premium costs can be controlled.  It is very clear that in the current market, private insurance companies do not control the price of premiums.  The public option will not replace anyone’s private insurance coverage, but it could prevent future premium increases as private insurance companies lower their prices to compete with a public option.  I am also open to considering a non-profit co-operative model, as long as it can accomplish the critical goal of controlling premium costs and spurring competition. Because insurance company profit taking has been so high, it will be very difficult to control premium costs without some non-profit option.

There is simply no way that non-profit co-ops can compete effectively or have the bargaining power that the private companies have.  Particularly in states where 80% or more of the private health insurance is provided by one health insurance company.  The only tool that stands a chance to compete is to give Americans the option of buying into a federal plan that can compete.

But there is more that is wrong.

With over 20 percent of Californians uninsured, healthcare reform must expand coverage to those who cannot currently afford it. Any expansion of coverage must be sustainable in the long-term, and be affordable without requiring adding costs to California and its counties, and without becoming another entitlement.  This is difficult to do, and it remains to be seen how it will be accomplished.

Senator, you’re just not being honest.  The best way to control growing costs is a single payer system.  That no one is willing to fight for it may be a truth, but it isn’t difficult to see how cost savings could be accomplished.

And one more:

Health reform should not address end of life care.  I feel strongly that anything relating to end of life care does not belong in the bill.  These are private family matters that do not require legislation.

Again, an untrue statement.  The bills making their way through Congress don’t mandate end of life issues.  They are designed to help pay for those expenses (counseling and consultation fees) for when the families make those decisions to talk to a professional about them.

Why can’t democrats stand up for the truth?  Sadly, it doesn’t seem that the California Senator will be a leader for a state that has higher than average uninsured numbers at all income levels.  This all seems pretty CYA to me.

____

Ted Kennedy, an American hero, has died

August 25th, 2009

 

Senator Ted Kennedy

Senator Ted Kennedy

Ted Kennedy has died before his dream of universal health care has come true. He fought the good fight for liberals and progressives as probably the Senate’s finest legislator in its history. He was a hero for me. I am deeply sad that politics has degraded to the point where absolute lies are reported without criticism by the press. Lies about issues important to this country and to this man. God bless his memory.

The dream shall never die.

An Irish Prayer:

Do Not Stand at My Grave and Weep
Do not stand at my grave and weep,
I am not there… I do not sleep.
I am the thousand winds that blow…
I am the diamond glints on snow…
I am the sunlight on ripened grain…
I am the gentle autumn rain.
When you waken in the morning’s hush,
I am the swift uplifting rush
Of gentle birds in circling flight…
I am the soft star that shines at night.
Do not stand at my grave and cry—
I am not there… I did not die…

A Republican response to a real health crisis

August 25th, 2009

Senator Coburn responds to one of his constituents in what can only be described as cold comfort.  Alone among industrialized and developed democracies, we are willing to leave our friends and neighbors on their own.  A government should be able to take care of its ill and its infirm.  What else is there to do?

Losing faith in the President

August 22nd, 2009
sam

Fighting for a Progressive America

I have long ago become accustomed to being called a radical lefty or a fringe democrat.  It’s odd really, because I would say that here in San Francisco, I would be something of a moderate.  In reality, I have become a social democratic if you were to pin me down.  Something that doesn’t exist in the US.  

I have concerns about the president’s lack of fire, willingness to fight, and blind allegiance to a mythical bipartisanship that the Republicans just don’t have any interest in.  Watching the pundits, one would think that my view on this is such a minority and fringe view that it can easily be dismissed.  

Yet, it is now becoming more and more widely discussed.  Columnists Paul Krugman and Frank Rich are joined today by Bob Herbert in the New York Times.

It’s still early, but people are starting to lose faith in the president. I hear almost daily from men and women who voted enthusiastically for Mr. Obama but are feeling disappointed. They feel that the banks made out like bandits in the bailouts, and that the health care initiative could become a boondoggle. Their biggest worry is that Mr. Obama is soft, that he is unwilling or incapable of fighting hard enough to counter the forces responsible for the sorry state the country is in.

More and more the president is being seen by his own supporters as someone who would like to please everybody, who is naïve about the prospects for bipartisanship, who believes that his strongest supporters will stay with him because they have nowhere else to go, and who will retreat whenever the Republicans and the corporate crowd come after him.

People want more from Mr. Obama. They want him to be their champion. But they don’t feel that he is speaking to them in a language that they understand. He is seen as more comfortable speaking the Wall Street lingo. People don’t feel that the voices of anxiety are being heard.

Obama is one of the best political salesmen of our time.  That he has failed to do the job on his core issue of health care is distressing.  Is he naive?  The Republicans never apologize for their views, especially the absolutely bizarre, beyond crazy views.  I’d like to see a president fight for what he campaigned for.  What’s the point of elected progressives if they are too worried that the conservatives might not like those views.  

Mr. President, fight for me.  I’ll fight for you.

“Socialized Medicine”

July 8th, 2009

healthcareI mentioned a day or so ago that I had to go to the Emergency Room here in Madrid because I was having extreme pain on one side of my body.  I thought you might be interested in how things work here and how it might compare to the United States.

I put “socialized medicine” in quote marks, because it really is a silly phrase when talking about almost any European health system.  Spain, like France, has private insurance available.  And all of these countries are active capitalistic states that also emphasize a more substantial safety net than the US.  Most people choose to stay in the public system because they feel the care is better and it has the best doctors.

I work in Spain, so I pay taxes for my health care, as does my employer.  The employer pays the larger share of the burden.  However, the total cost is significantly lower than health care premiums in the States.  All Spaniards and legal residents are covered.  Those who are here illegally can also gain access to a health card by registering at city hall.  Most do so.

I go to a health clinic within walking distance to my house.  There I have a doctor and nurse that are assigned to me.  I´m not sure if I can change my doctor if I want to, but I´ve been told that yes you can.  The law was changed several years ago to allow you to change.   But I´m quite satisfied with my doctor.  She´s thorough and concentrates most on the things that will keep you out of the hospital.  I have several health problems that she stays on top of.  I have seen her on average once a month since being here so she can monitor my progress.  I can tell you that I never saw my physician once a month in the US, and these health issues are not new.

If I need a prescription refill or to see the doctor for something, I have always gotten an appointment on the day that I requested it, with my own doctor.  I have never waited more than 5 minutes to walk out of a pharmacy with all my prescriptions.  On the meds that I currently take, my co-pay in the US was about $100 a month.  Here it is about $15.

Spain is ranked amongthe top 10 best health care systems in the world (#8) according to the World Health Organization.  People here feel it is their right to have health care, and are stunned and deeply upset with what they hear about the US system.

So, over the weekend I started having really bad pain in my side.  I mean really bad pain.  I tried to ignore it and thought it would just go away.  This is called the Lynch Health Care Plan.  But after 3 days of not being able to do anything but lay in bed and groan, I finally talked to a Spanish friend and asked how emergencies are handled.  Do I have to call the Primary Doctor, do I need to go to a certain hospital, does someone need to approve the ER visit?  The answer was to go to the nearest ER and if I couldn´t go on my own, to call for an ambulance.

I took a taxi to my hospital and signed in for the Urgencias.  You show your health card, they look you up, and then you go into a triage room.  A nurse came out to speak to me to evaluate the problem and they moved me along pretty quickly into an office with a doctor.  That doctor and another checked me over, order pain killers, lab tests, and fluids.  They suspected kidney stones, which was later confirmed.  They gave me a prescription for pain meds and referred me to a specialist whom I see tomorrow.  All in all I was in and out in 5 hours, and with a specialist appointment within 48 hours.  Pretty impressive.

The negatives were that pain treatment is not as big a concern as it is in the US.  There is something very Spanish about suffering.  I would have liked something stronger, because frankly, I´m still in pain, though the edge is gone and it is bearable.

No one spoke English, not surprisingly, as very few people in Madrid speak English.  But they sure were friendly and did everything they could to help me be understood and understand.

In short, I think the system here works.  It has less bureaucracy, and the doctor seems far more in control of what they are doing than in a US system.  By that I mean, there are not a lot of rules for them to deal with, not a lot of overlayered bureaucracies to deal with.

They say I may need surgery here.  I hope not.  But I feel like I´m in excellent hands.