Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts

Saturday, July 24, 2010

Marceauxed

Mike3550 posted this hilarious and sad political ad a few weeks ago. Well, I think it may have a competitor: Basil Marceaux, your next Republican governor of Tennessee.


The barely intelligible website I just linked to is mostly Marceaux' (Marceaux's?) platform. Here is the Tennessee titan in a video outlining his proposed policies.

He is into gun control, education, and flying the flag right. (I'm looking at you, Arah-Say Alin-Pay; it's actually illegal to drape a flag like that.)

Some highlights from Marceaux' campaign platform:

--"Make sure that if national insurance is put in place, I will make sure the roots of such bill with not inclued any type measuring of the waist like other counties."

--"VOTE FOR ME AND IF I WIN I WILL IMMUNE YOU FROM ALL STATE CRIMES FOR THE REST OF YOU LIFE! (Except violating a citizen rights this would be a special punishment )"

Hell YES. Keep your grubby hands off our waists, government. I don't want my doctor knowing anything about my body. Just give me the pills! Also, immunity from crimes? How does that work? If he's sworn in and I get arrested, could my defense just plead "Marceaux voter?"

But let's cut to the chase. What does Marceaux really stand for? What will he be fighting for in government? What important? Well:

"WHAT IMPORTANT:
"1.Education
"a. School violents
"b. Add reading of the minutes to the U.S.Congress mandatory
"c. Get more of the lottery money to 1-12

"2.Equal Health care
"a. a free gift program
"b. take a look at and redo all mandtory insurance programs
"c. See why dental is not in most plans a tooth aches hurt more than a back aches and no teeths depresses people

"3.Citzens Safety+Citizens Constitution Rights

"4.Improving Our Environment

"5.Budget

"6.Open doors more for Tn.food manufactures

"7.My plan will give the state free gas for all governmental cars and trucks

"8.Make the U.S. Flag in all state buildings and court fly right. if you fly a U.S.Flag you will fly it right"

Honestly, this platform could use a copy editor or six, but I think I get it. Hey, at least he wants Tennesseans to have clean, lovely, pain-free teeth. I could even get behind at least 1, 2c, 3, 4, and 8. Maybe 5, if all he's saying is that the word "budget" is really important to think about - I mean, it's not hard to say, but did you know that it derives from Latin, via French? And what have the French ever done for us besides threaten to measure our waists?









See you at the polls!

Monday, October 26, 2009

Al Franken Explains Selection Effects

Al Franken is quickly becoming my hero. Below is a clip (h/t Effect Measure) where he not only makes a very prescient case for health care reform and the impact on "medical bankruptcies," but also shows that he is unwilling to be bullied, knows what selection effects are, and is able to explain them so that they can be understood in such a way that he uses them to make the case for health care reform.



I can admit that I was a little bit weary of Al Franken running for the Senate. I used to listen to his radio show on Air America and thought that he was a little arrogant and showed a lack of nuance in some of the opinions that he expressed on that show. I was also worried that he didn't have the discipline to stay on message and not make needlessly disparaging comments that would come back and haunt him later. But, he handled himself with incredible grace during the recount and subsequent court battles in Minnesota and has shown an incredible acuity for both politics and policies in the Senate.


Medical bankruptcies are bankruptcies that are related to medical or health-related issues. A 2005 study showed that medical bankruptcies affect between 1.9–2.2 million Americans in 2001 alone. As if filing for bankruptcy wasn't bad enough, the authors found that many of those who filed for bankruptcy had problems finding a future apartment, job, or cars because of their credit unworthiness. Sen. Franken points out that there are zero of these bankruptcies in France, Germany, and Switzerland.


Then, when the right-wing shill asks Sen. Franken if he knows the international disparities in cancer outcomes, he already has an answer that every intro stats class should watch for an explanation of selection effects. If, because we only treat people socioeconomically advantaged enough to not have serious complications for cancer, of course we would expect that our cancer outcomes would be much better than those who treat difficult cases as well. In other words, the design of the study selected on the dependent variable — likelihood to survive cancer treatment — to receive treatment; it is therefore, unsurprising when cancer patients here survive more.


As is becoming frequent of late around here, I congratulate Senator Franken for his outstanding representation of this country.

Wednesday, September 30, 2009

Republican Health Care Plan

Although this here blog has been silent for a while as I am knee deep in my crash-course on health policy and other distractions I will hopefully write about later, I thought that this succinct description of the Republican, courtesy of Rep. Alan Grayson (D-FL), was worth passing along (h/t TPM):


Thursday, September 10, 2009

Thoughts on Obama's Speech

I am positive that I am not that knowledgeable about the details of the health care debate. This is a little troubling on a personal level since, tomorrow (i.e., eight hours from now), I am going to a class focusing on health policy. Yes, I too thought that I was done with classes years ago, but it is part of my program that I take this class. Although I study health, I study neither health care nor health policy, though part of the program that I am in is designed to have participants think more about health policy. Can't say that there is much better of a time to have a tutorial than now and I am really looking forward to it.


Let me start my thoughts by saying that I think that Obama's speech was great. Given my cursory knowledge of the subject, I think that his plans sounded reasonable. Of course I would like a full-fledged universal insurance program, but I don't think that it is possible or, frankly, at this point that important. If insurance is made affordable enough to make good health care attainable to all Americans, I think that reform will have succeeded. While fully universal coverage would be a better option, having the organizational structure in place to show the American public that it is possible will succeed in making it impossible to get rid of it. The perfect demonstration of this point is the number of people out protesting last month against government-sponsored health care who didn't want Medicare touched. Beyond the cognitive dissonance that makes it difficult to believe that these people make it through a regular day, the fact that Medicare and Social Security are untouchable demonstrate my point.


At the same time, it is also true (again, to my limited knowledge) that both Social Security and Medicare have remained largely the same since their creation. The fact that neither has changed significantly doesn't bode well for incremental-style changes that some in the center and the right (including Newt Gingrich) are advocating. Simply doing something isn't going to cut it in terms of creating good policy; therefore, if anything like what Obama proposed tonight is passed through Congress, then he and Kathleen Sebelius need to develop a strong agency that is relatively impervious to meddling in the future and that aggressively pursues its mandate at its inception. If the agency that is developed is strong enough to assert itself and to regulate the insurance industry to accomplish the goals laid out by Obama, then I think that a bill resembling Obama's outline tonight — with all of its significant shortcomings — can actually improve the state of health care in this country.


Finally, from a political point of view, I think that Obama's speech tonight re-cast the debate in a way that is favorable to passage. I won't say that he re-framed the debate; the Democrats' lethargy during the summer and especially in August cost them the ability to really frame or re-frame the debate. But, re-casting the debate instead of re-framing it might actually work to Obama and the reformers' advantage. With Baucus' announcement today that a bill is going to be passed whether Republicans want to be part of it or not and Obama effectively portraying Republicans as obstructionists, I think that the Democrats painted Republicans into a corner. The Republicans even helped in this regard as Rep. Joe Wilson of South Carolina's outburst calling Obama a liar (pictured at left, from TPM) only showed how correct Obama was to chastise Republicans for failing to tell the difference between civilized debate and emotional outrage.[1] I think that tonight's speech was effective enough to persuade progressives to go along, point out the obstructionist and downright rude behavior of the Republicans, and emphasize the overwhelming mandate that health care be passed as an issue of morality and American pride. Although the final bill will not end up being everything that I would have hoped for myself, I think that it will be a drastic improvement on the current situation in health care in this country and really move the country forward.


[1] TPM has also noted that this might lead to a censure of Rep. Wilson by the House for violating the rules of decorum. Following these rules, the Minorty Whip, Rep. Eric Cantor (R-VA) was also caught violating the rule to "Refrain from eating, smoking, or using electronic equipment, including cellular phones or lap top computers, on the floor." Video here.

Tuesday, August 11, 2009

Dissent is *Still* Patriotic

The “debate” surrounding health care reform has caught almost everyone's attention. The vocal opponents of health care have been variously described as a “mob”, “un-American,” and even “brownshirts.” This isn't just anyone saying this, but it is (in order), arguably the leading progressive columnist (Krugman), the #1 and #2 Democratic leaders in the House, and a U.S. Congressperson. The hostility and animosity expressed during these demonstratiosn including firearms being brought to events or Sarah Palin saying that a “death panel” would euthanize her son because he has Down's Syndrome (before, gallantly calling for civility) is becoming downright scary, including the actual death threats against sitting members of Congress. But, to have the kind of people calling out opponents of health care as un-American or comparing them to fascists is downright wrong.


Although I disagree with the tactics used by those who oppose health care reform, Andrew got me thinking about what it means to denounce them. Very thoughtfully, he reminded me that the sort of “deliberative debate” that I would prefer


imply a particular kind of deliberative democratic subject:

- One who is calm, considered, rational, and deliberative. This worries me because it implies that emotion is an illegitimate way of engaging in politics. That, in turn, privileges particular kinds of people, and kinds of discourses, as a matter of form.

He is right to point out that many people, often those who I care about greatly and support, use these tactics. I have been to labor protests where the rules of civility were thrown out the window because civility favored management. Disruption hit the financial bottom line and forced the managers, who were hiding behind this cloak of civility, to take notice. There is, I suppose, nothing wrong with these protests as a tactic and, certainly nothing un-American or fascist about them (leaving any violence—real or implied—aside). Americans have a right to redress their grievances to their government; nothing ever said that the government had to like the way that citizens chose to carry out this redress.


This reminded me of a really influential passage in the book Urban Fortunes by John Logan and Harvey Molotch. The book describes the process of urban land development, providing an interesting synthesis between traditional neo-classical and human ecological models of urban growth and Marxian models of economic growth. One of their main points throughout the book is that:


The traditional academic literature on the topic tends to equate “community organization” with progressive social forces generally and to see all such groups as analytically equivalent because they are from the “grass roots” and help “empower” local people.

They go on to point out that many local organizations (their interest is in understanding the forces guiding urban development) are indeed not progressive. One can look back in history to local community forces that were, indeed, not so progressive such as the northern white block clubs that tried to maintain the starkly segregated residential color line.


I have seen the argument that there is a difference because these protests are “astroturffed”, insta-activism bought by the insurance lobby. Although it seems to be funded by the insurance lobby, I also have a hard time believing that all of these activists are bought off. I also don't think, as Paul Krugman suggests, that “the driving force behind the town hall mobs is probably the same cultural and racial anxiety that’s behind the ‘birther’ movement, which denies Mr. Obama’s citizenship.” Granted, many of the birthers are probably among the crowds, but to say that this is all about Obama's race or that the tactics are somehow un-American denies the reality that there is a substantial opposition to health care reform. I don't think that it is the result of deep-seated hatred (though, for some, this is undoubtedly the case), but is likely a fear and mistrust of the government that has a real basis in reality.


The answer to this is not to disparage and insult those who are protesting, to question their patriotism (remember the “Dissent is Patriotic” bumper stickers). It is to organize an opposition, including some who might simply be confused or nervous about changes and have real concerns about government-run programs. I'm not tilting at windmills; I don't believe that one will ever convince most of the people shouting at town halls and I think that it would be futile to do so. But there are lots of people, I would guess, who are hearing some of their concerns echoed by the vocal protesters and who see that people—fellow citizens—really care about opposing this bill. Without effective organizing to counter-act this movement and inoculation against the opposition's talking points health reform is unlikely to succeed. Reformers have the advantage is that there are many in the reform movement, including the President himself, who have learned how to build an effective organizing base from which to enact reform. If this truly is an astroturf campaign, then real organizing (with time) should be able to overcome it. I just hope that he remembers that is how he got to have the meteoric rise from a state senator to President in less than a decade and that he calls some of those advisors up to help rather than those he keeps finding from inside the Beltway.

Saturday, August 8, 2009

The Unconscionable Math of Insurance Fraud by Insurance Companies

E. and I were driving home from a family function last week and caught the end of the This American Life episode on "fine print." Among the stories was a heart-wrenching tale about the problem of rescission, which is basically where insurance companies take premiums for years and, right when you need an expensive procedure, drop your insurance because you "lied" on your application. This really affects people who get their insurance on the private market. During the episode (described in more detail by James Kwak at Baseline Scenario), the health insurance companies being grilled during congressional testimony argued that rescission affects about 0.5% of their clients.


But, in a truly amazing post, Taunter explains how conditional probability can explain why this 0.5% can sound so small but amount to an unconscionable fraud on the part of insurance agencies. Using the Monty Hall Problem (and, implicitly, Bayesian reasoning), he explains why the insurance executives essentially bank on rescinding one in two claimants for those in need of service! He points out that you have a three times better chance to survive a game of Russian Roulette. It is an amazing lesson in conditional probability and Bayes Theorem that could be an incredible teaching moment.


Until the patients needs an expensive procedure, patients are paying their premiums into the coffers of the insurance company and the pockets of their executives. The expensive procedures, of course, are why people need insurance. The insurance companies, though, get to keep all those years of premiums for all of those years even though they don't follow through on their commitment to pay out, getting rich off those years and years of premiums. The procedure goes something like this: take money from a group of people and promise them a return in the future, use the money to pay off claims of others (minus a heavy for the service), and when it comes time to pay out, renege. Taunter points out that this seems vaguely Madoffian.


The justification of this procedure is that, without it, insurance prices would rise for everyone in the system and that people should be punished for fraud. Of course, many of these people did not commit any sort of fraud and instead got confused by the leagalese and convoluted medical language which were intentionally designed to get people to slip up. It is probably true that insurance premiums would probably go up, but it doesn't really matter if people aren't getting a service that they pay for (in other contexts, that's called stealing). But, it is also an argument for why the "free market" does not always know best and why health care reform is so important. I hope that in the coming days and weeks, the Obama administration and Congress get their footing and actually start to stand up for reform.

Tuesday, January 27, 2009

The Health Care You Have, Not The Health Care You Want

I believe in health care reform, but since I can't read or listen to more than 20 or so words at a time without thinking about food or wanting to take a nap*, it's hard for me to sink my teeth into, you know, learning anything about it. Fortunately for me, there exist magazines to cater to me and my tiny attention span.

The New Yorker came out this week with Atul Gawande's kind of sweet overview of how universal health care evolved in slavering backwards socialist nations like France, Switzerland and the UK. The thesis is pinned to path-dependence: there was never a traumatic overhaul with bureaucrats scrambling to radically change everything, rather, things just kind of happened. For example in the UK, WWII required massive government assistance to put health services out in the sticks, where everyone's kids were fleeing, and then when all that stuff got bombed they had to redo it. So by 1948 the NHS sort of already existed.

Many Americans envision universal health care as a change on the level of a Bolshevik revolution, and the author's idea is that it doesn't really have to be that way. No one is going to shut hospitals down for 5 days and raise your taxes to 50%. You build gradually on what you have, and the result is an imperfect but workable patchwork-quilt-style safety net.

I like the idea of making universal healthcare a palatable idea, which Gawande does in a very straightforward, non-wonky way. The problem he overlooks, I think, is that for these European countries, there was a serious impetus for these incremental changes like war (UK), famine (France), everyone else is doing it (Switzerland). Here, it seems that impetus does not exist, but for the Cries Of The People (and who ever listens to those anyway).

Well, actually, there is the obvious: that nearly 50 million of us have zero insurance, but that doesn't seem to have resonated with many of us. (I don't like thinking that we're so callous as to say that a Teddy Grahams heiress should be able to have lots of extra money lying around for Botox but not have to contribute jack to a laid-off factory worker's cancer treatment. But maybe small, incremental edits to our collective consciousness have created that culture.) It does seem that at a minimum, almost everyone agrees that more people need to have their basic needs cared for. So, a journey of a thousand miles, etc. But will there have to be a catalyst to, you know, take that first step? A catalyst besides the problem itself? I hope an administration that is supposedly built on pragmatic competence will find a way to get us somewhere without requiring it.

*Which makes being a) married to an academic and b) the sister of a health policy nerd AWESOMELY FUNNY. Them: "So basically this method of measuring the effect gives us new ways to control for these variables, and predict the..." Me: "Look, a butterfly."

Wednesday, December 19, 2007

Another Reason to Hate Wal-Mart

The company that is the bane of most small retailers', employees', social justice advocates' and anti-globalization activists' existences has given them all another reason to hate them. Wal-Mart has decided to go after the legal settlement money of employees who were catastrophically injured in an accident. The terms of the health care coverage plan offered by Wal-Mart (and many other employers) demand that any settlement money for medical expenses be given to the medical insurance company. To not do so, they argue, is double-dipping and getting the same money twice.

I see several problems with this. Often settlements do not cover the complete cost of medical services, meaning the family is forced to find money from elsewhere. Also, any award given in settlement is only net of the legal expenses that it requires to recover that award. Essentially, then, what Wal-Mart is doing is outsourcing it's legal costs to recoup the money for its own insurance claims. The insurance provider can receive up to 100% of the settlement award after legal expenses meaning that the former employee (who, now, has no health insurance because they are no longer an employee because of said accident) is left with nothing after paying for attorneys and insurance companies.

And, to stick their thumb in the eyes of this poor couple going through this, Wal-Mart is now suing not only for the money received in the settlement award, but get this, they are also suing for the legal expenses incurred by their company to try and get this money from the couple! Nevermind that they paid nothing to aid in the legal claim to win the settlement.

I hope that, if there is a Hell--especially the fire-and-brimstone one favored by the Waltons--that there is a special ring of it reserved for their family.