Archive for the 'Health care reform' category

Speaking of health care reform

Sep 04 2009 Published by under Health care reform, Medicine

You really should be reading Zuska's pieces. As usual, she cuts through the crap to the meat of the issue. Go now and read.

2 responses so far

Government-mandated circumcision? Not so much...

Aug 31 2009 Published by under Health care reform, Medicine

For the last five hundred years, white America has feared black America. When physical chains were broken, the fear only increased. Rumors of black on white atrocities frequently circulate in white communities that live on the edge of black communities. As my home town integrated, rumors of white women being raped weren't uncommon. One particularly tenacious rumor had it that a white boy had been castrated by a group of black men at a local mall.
All of these rumors were, of course, untrue, and served as both a barometer of fear, and a tool of control. If fear could be maintained, otherwise "neutral" white people could be pulled to the side of continued segregation and racism.
Rumors of black on white physical crimes (and of mixed relationships) are still used as a tool to control racial discourse in the US, and they are a measure of desperation as well. As the Right continues to find itself on the wrong side of public debates such as health care reform, they struggle to re-frame the debate. Instead of being about health care, it's about "freedom". Instead of increasing coverage, it's "death panels". It's a tribute to the intelligence of the American people that these arguments have so far failed to gain mainstream traction.
But now the Right is even more desperate, and the racism simmering under the surface of the debate is boiling over.

RUSH: By the way, leave our penises alone, too! This is getting out of hand. There is a story that some officials in the Obama administration are pushing for circumcision for all boys born in the USA to fight HIV/AIDS. Not that I'm against circumcision, but it's a family's decision. Leave our penises alone, too, Obama! ...So here's Obama out there saying we have to have circumcision of every young boy born in the country...

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28 responses so far

China---a (medical) capitalist paradise

Aug 30 2009 Published by under Health care reform, humor, Medicine

China's a communist country, totally different from the capitalist U.S., right? They probably have some sort of socialized health system that makes Canada look downright libertarian. Right?
No.
I was talking to a friend (who I'll call "Pu") this week. She was surprised that I had to bend over backward to get someone insulin.
Pu: "In China, this would never happen."
Pal: "Really? You mean because the State would take care of it?"
Pu: "No. In China, you pay a deposit for your care, and have to pay as you go, or that's it. Can't afford insulin? Tough. Go home and die."
Hmmm...socialist paradise.

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10 responses so far

More health care problems that no one talks about

Aug 30 2009 Published by under Health care reform, Medicine

From time to time we see an article (usually from LA) about hospital patients being "dumped" on street corners. I don't know how wide-spread this problem is, but the systemic problem that leads to this is common and serious.
Most American hospitals are required to render emergency care to anyone who comes in the door. In practice, this means hospitals provide a great deal of uncompensated care. For example, if some guy with a couple of bullet holes is dumped in front of the ER by his "friends", the hospital is required to stabilize him. But let's say they then wish to transfer his care because he's uninsured, or for any other reason. Who will accept him? You can't just dump him in the ER of a public hospital---it's wrong from both a legal and moral perspective. In practice, patients like this are cared for until discharge, sometimes for days, sometimes for months. Sometimes hospitals will receive public funds to compensate them for this type of care, but it's never enough.
Lack of universal insurance encourages a choice between economically unwise behavior and morally repugnant behavior. Hospitals have to choose to cut services or close their doors if uncompensated costs rise too steeply, hurting employees and the people in the hospital's catchment area. And those who are the most vulnerable are left to either burden the hospital, or risk being dumped on the street. If the patient is well enough to leave the hospital but not well enough to care for themselves, there's no safety net. The hospital must keep them as a "border". No nursing home would accept someone without means to pay, and our society has no good backup plan. Sometimes, Medicaid can cover patients like this, but often they cannot.
Our system, as it stands, actually encourages immoral behavior. How proud does that make you?

8 responses so far

The health reform lie that just won't die

Aug 25 2009 Published by under Health care reform, Medicine

The Right is desperate---desperate to derail any sort of health care reform. Notably absent from their diatribes is any debate on the merits of one plan or another. They know that the only way to convince Americans to keep the terrible system we have now is to make them think that any reform would be worse. And so they are blowing their dog whistles, talking about "culture of life" and "culture of death", and along the way encouraging ignorance about one of the most important aspects of medical care.

Any rational person knows that there are no proposed "death panels"---it's a blatant lie by the far Right designed to frighten the ignorant. And given that the "death panel" wording just isn't playing as well as they'd hoped, they're hunting for more "evidence" that government health insurance will kill you. Of course, this requires ignoring the fact that Medicare, the government health system that insures most seniors still hasn't managed to produce a single gram of Soylent Green.

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16 responses so far

Recursive nonsense on health care

Aug 24 2009 Published by under Health care reform, Medicine

People who support our current abominable health care system like to cite Canada's supposed failures as an example of what could happen to us. The argument is a non-starter---it's a straw man designed to scare people. We are a very different country, with a different economy and different needs. Even with a single-payer system, we are unlikely to have the exact same successes and failures as the Canadians. Still, the Right has latched on to any lie they can to try to scare us. That's why a recent article from my hometown newspaper is so upsetting.

Any of us who have practiced medicine near the border have seen Canadian patients---not a lot, but some. I've heard very few horror stories, but that's not the point. The point is the fundamental idiocy of people in the mainstream media trying to write about this.

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14 responses so far

Health care reform---strike while the iron is hot

Aug 23 2009 Published by under Health care reform, Medicine

I'm really trying to understand this. Really. Why is the outcry against health care reform so much louder than the call for reform? I have a very hard time believing that a majority of people are against some sort of improvement in our system. Around here, people are losing their insurance right and left. But they sometimes seem more scared of reform than of remaining uninsured.
Those of us in favor of a single payer system are shut out of this one. "Medicare for all" is uttered only quietly among well-known co-conspirators. When people who oppose this plan, or even just oppose the president, continue violent rhetoric, bring loaded firearms to rallies, is it any wonder we are silent? How is bringing a loaded gun to a rally not intimidating? And don't give me the "it's only one dude" argument---that's disingenuous and unconvincing. There has been more than once incident, but more important, there has been overt support and quiet assent for nuts like this from the right. When prominent journalists and prominent right-wing politicians fail to condemn this sort of behavior, the intimidation is magnified.
I'm not saying there isn't real opposition to health care reform, but there is an almost complete absence of real debate, and this implied violence is playing a role. We already entrust our elderly to the government's care, and we're pretty damned happy about it, so why not expand it? Do people seriously believe they will have decreased access to services? Do they have any precedent showing that extreme forms of rationing are taking place in any other democracy? Do they have data showing dissatisfaction or worse health outcomes?
Of course not. It's a purely ideological debate, leaving real, suffering people behind. Let's start interviewing people recently released from the hospital and staring at a $60,000 bill. Let's interview former auto workers who are both unemployed and uninsured. Let's talk to doctors on the front line, trying to find ways to treat diabetic patients who can't afford medications or testing supplies. Let's visit rehab wards and dialysis centers where these folks end up after our first failure to care for them.

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28 responses so far

Stewart v. McCaughey---more to it than you think

Aug 21 2009 Published by under Health care reform, Medicine

Last night's Daily Show was hands down the best discussion of the health care reform insanity on TV, radio, or web. What interested me the most was how McCaughey revealed some of her real agenda, and how she actually brought up some almost-right points. Even more surprising, Jon Stewart misunderstood some bits that need fleshing out, so here we go.
We've met McCaughey before as the right wing wacko pushing the death panel idea. She does a good job hiding her real agenda for a while with Stewart, insisting on her support for public health care, and for end-of-life discussions. Let's review her words from Rush Limbaugh's show:

The health care reform bill "would make it mandatory -- absolutely require -- that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."

In her interview with Jon Stewart, she's a bit more careful with her words. What she does is draw a line from reimbursement for end-of-life counseling to practice quality measures, to physician incentive payments, implying that this tenuous line will lead to "bad things".
What Stewart missed was the whole "quality measure" thing. Medicare has a program called PQRI in which they collect data on quality of care and reimburse physicians who track these measures (many physicians, myself included, believe this really means that we will only be given full payment for tracking PQRI). For example, if I track data on whether my diabetics are offered certain tests, have their blood pressure checked, etc., I get a bonus payment (supposedly). At this point, I don't get penalized for bad blood pressures, or rewarded for good ones. The only reward is in the tracking.

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5 responses so far

What is "health care"?

Aug 19 2009 Published by under Health care reform, Medical ethics, Medicine

In his latest comment, Philip H has accelerated my reluctant discussion of health care reform. In fact, it was Philip who bullied me into writing about this topic in the first place. I've been avoiding wading into this mess, but being on the front line, it's in my face every day.
What he says in his latest comment is this:

[T]he idealogical leap PalMD is asking for is a good one, but it misses the mark. The leap we need to make is that healthcare is not a good, like Cheerios, or cars, or flatscreen tv's, that exists in anything like a free marketplace.


Commenter Donna B.
makes a tangent assertion, that in fact health care is, "a service, a good to be purchased, and is therefore not a "right" as such (she also does not have a problem with government subsidizing or being involved in some way, so don't stomp all over her without reading her full words).
If health care isn't a "good" in the sense of "commodity", and it isn't a "right", then what is it?

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31 responses so far

Pre-existing conditions, perverse incentives

Aug 18 2009 Published by under Health care reform, Medicine

Once again, I'm sucked into the discussion on health care reform. I despise this topic, because so much of what is wrong with our current system could be fixed relatively easily, if Americans could just take an ideologic leap.
Most of us have heard of "pre-existing condition (PEC)" clauses---those rules that allow insurance companies to deny payment for care based on your previous history. There's a lot of facets to this, and laws vary tremendously (your results may vary). For example, a company may simply refuse to insure you (although some companies don't have that choice, but they can still price you out), but more commonly insurers will refuse payment on services related to conditions that existed before you enrolled in the policy. You remember (don't you?) the huge questionnaire you filled out before you got your insurance? And the request for all previous records? This is where you can end up in a heap of trouble.

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18 responses so far

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