Cantor’s Defeat–Wittiest One-Liners

Eric Cantor’s shellacking has drawn much attention–perhaps two much commentary. (After all, this was just a primary.  I don’t think that it “Changes Everything.”)

That  said, here are my favorite comments on this event::

— “‘Brat Upsets Cantor’ . . . The headline sounds like a failed Bar Mitzvah” — Delaware Dem

On Tuesday night, Ezra Klein wrote:“John Boehner must be having an emotionally complicated evening.”

 

 

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Longevity and Long-Term Care: The Medical Crisis of the 21st Century : Part 2

Throughout the 20th century, most Americans saw “longevity” as a goal. If we took care of our bodies, we reasoned, we could “live longer and better.”

But in the 21st century, I suspect that some of us will learn to fear “longevity” the way we now fear cancer.

This is the second in a series of posts that will explore the anguish that some experience when they live into their late eighties and nineties–and how we, as a society, can address the hardships of “old, old age.”

                                           Senile Dementia   

Thanks to better diets, exercise, and advances in medical knowledge, more and more of us are living to four score and seven. But the downside is that in too many cases, our bodies are out-living our minds. As I note in the post below, since 2011, 40% of the increase in Medicare’s outlays can be attributed to spending on Alzheimer’s patients.

Why is the incidence of Alzheimer’s (AHD) spiraling? Because we are less likely to die of heart disease or strokes, millions of Americans are living long enough to be diagnosed with senile dementia. One could say that longevity is the proximate cause of Alzheimer’s.

Because women live longer than men, they are more likely to fall victim to AHD, the most common form of dementia. If a woman lives into her 60s her risk of being diagnosed with Alzheimer’s at some point over the rest of her life is 1 in 6. By contrast, for breast cancer, her risk is 1 in 13.  By 2050, the number of people age 65 and older suffering from Alzheimer’s may well triple, rising from 5 million to as many as 16 million.

Why then don’t we hear more about this scourge? Because at this point there is little or nothing that doctors can do to stop it. The Mayo Clinic’ website explains: while some drugs can “temporarily improve symptoms of memory loss and problems with thinking and reasoning . . .  these treatments don’t stop the underlying decline and death of brain cells. As more cells die, Alzheimer’s continues to progress.”

Last month Consumer Reports warned that “the overall results” for Alzheimer’s drugs “are far less encouraging than the ads portray. Most people who take them don’t experience a meaningful benefit.

More than half experience side effects. And they’re expensive, costing anywhere from $140 to more than $656 monthly..

Even a small benefit or chance of improvement might be worth it if Alzheimer’s drugs were risk free,” Consumer Reports observed. “But they are not. They can cause side effects such as insomnia, nausea, muscle cramps, diarrhea, and reduced appetite, all of which can be troublesome for people with dementia.” Occasionally, the drugs may cause more serious side effects such as internal bleeding and a slowed heart rate that could be potentially dangerous.

Meanwhile, the average Alzheimer’s patient lives 8 years—and 40% of those years are spent enduring the most severe, late stages of that disease. Some patients linger for 20 years. This is what makes Alzheimer’s so expensive.

                                The Need for Long-Term Care

At this point, we cannot cure senile dementia, but we can reduce the suffering that patients and their families endure by creating the long-term palliative care system that millions of baby-boomers and many of their parents will need. First, this means figuring out how to fund such a system. Medicare pays for some treatments, but it does not cover long-term care.

Up until now relatives have provided much of that care at home, but increasingly, the burden is becoming too great for aging spouses. And even if their children live close to home, daughters as well as sons have jobs that they cannot leave.

Medicaid will pay for nursing home care, but only after the patient and spouse spend down nearly all of their resources. (New laws now make it very difficult families to transfer assets to heirs when they see Alzheimer’s coming.) And even when families exhaust their assets, nursing homes and hospices often do not provide the combination of palliative care and skilled nursing that patients require.

Finally, and most importantly, we need to think about how to ease the path to death. Here, I am not talking about euthanasia. (In a later post, I will address  “aid in dying” –a.k.a. “physician-assisted suicide”–and explain why some palliative care specialists have had second thoughts about that solution.)

In this post, I am focusing on reducing the fear, the panic, the overtreatment, and the medical flailing about that makes what I have called “the American way of dying” so traumatic. Death always will involve loss and suffering, but it does not have to be impossibly cruel, and it does not have to wreck families.
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The Next Plague: Alzheimer’s

In the 1970s and 1980s, a plague called AIDS swept through this country. Like a medieval scourge it was mysterious, incurable, and ruthless as it killed those who were far too young to die.

Now, baby-boomers have reason to fear a new scourge: It won’t cut them down in their youth, but if they dodge heart disease and beat cancer they may find themselves trapped in their bodies, watching their minds dissolve.

Did you know that a woman who is now 65 stands a 20% chance of dying of Alzheimer’s? (See Michael Kinsley’s essay in the New Yorker.)

On Bloomberg View Matthew C. Klein has put together a booklet of “visual data” titled: “How Americans Die.” These stunning interactive graphs will startle you. For instance, were you aware that suicide has recently become the leading cause of violent death in the U.S.?

But it is the pages devoted to Alzheimer’s here  and here that stopped me in my tracks.
I turns out that about 40% of the increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment.(We don’t have reliable data on Alzheimer’s spending before that.) And that number is bound to climb.)

The Boomers will be the second generation to die of dementia, but the first to see it coming. 

These charts are terrifying but important. We need to begin thinking about how to cope with Alzheimer’s. Here, The Mayo Clinic outlines “What is On the Horizon for Alzheimer’s.

I’m not optimistic about a cure anytime in the foreseeable future. But we definitely need to think about how to care for the many who will be suffering from this dreadful disease.
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Why Are So Many Americans Confused About Obamacare? How a Video Produced by CBS’ Washington Bureau Misled Millions –Part 1

For nearly four years, poll after poll has shown that the majority of Americans remain flummoxed by Obamacare.  Many are confused; some are afraid. They don’t know what the Affordable Care Act (ACA) says, and they don’t know how it will affect their lives

From the beginning, many in the media have blamed the White House.

Early in 2011, when a CBS poll showed that only 56% of Americans said the bill’s impact had not been explained well—or even “somewhat well”– CBS senior producer Ward Sloane summed up the prevailing view: “To me, that is a Monumental Failure by the Obama Administration. . . . [my emphasis]  And it opens up a big hole for the Republicans which they have driven through with, you know, several tanks.

Because Democrats had botched explaining the legislation, Sloane argued, Republicans “can say whatever they want about the healthcare bill … whether it’s true or not, and  . . . it will resonate . . .  People are afraid. People are afraid of things that they don’t understand and they don’t know. . . The Republicans are playing to this fear and they’re doing a masterful job.”

Sloane slid over the role that reporters might play in helping the public understand an enormous—and enormously important– piece of legislation.  If Republicans were spreading disinformation, shouldn’t news organizations like CBS try to separate fact from fiction?

Network and cable news shows are in our living rooms every evening. President Barack Obama and Health and Human Services Secretary Kathleen Sebelius are not. In speeches and in press conferences Obama and Sebelius can address a handful of questions, but they cannot explain the hundreds of interlocking details that will benefit millions of Americans. The public needs an independent, informed press that will dig into the major provisions of Obamacare and explain them, not once, but again and again.

There was just one problem: As Sloane suggested, the Republicans were doing “a masterful job” of misleading the public. What he didn’t take into account is that journalists are part of “the public.”

                      The Networks Spread Fear and Confusion

Fast forward two years to the fall of 2013.

Little has changed; most Americans still don’t understand the Affordable Care Act, and many are convinced that they have been betrayed by the president they elected.

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Did President Obama “Lie” When He Said “If You Like the Policy You Have, You Can Keep It”? Context Is Everything

How many times have you heard that the President of the United State “lied” to the American people when he said “If you like the policy you have, you can keep it?”  Even some liberals have swallowed this Republican talking point.

In December, Politifact, the Tampa Times Pulitzer-prize-winning online fact-checker, went so far as to name Obama’s  statement “the lie of the year.”

Since then, the story has generated headlines like this one: ““Reporter Asks Obama, “What’s It Like to Be Called Liar of the Year?” 

What most people don’t recall is that in 2008 m when President Obama first uttered those fateful words, Politifact—the very same fact-checking organization– graded his statement as “True.”

What is going on here?

                          Context: Who Was Obama’s Audience?

It should come as no surprise that Obamacare’s opponents ripped the president’s original statement out of context. This was easy to do because so few people remember the third Obama/McCain debate that took place in Hempstead, New York, on Oct. 15, 2008.  During this debate then-Senator Obama uttered the words that would haunt him: “you can keep your plan.”  

A transcript of the debate reveals what he meant. In response to a question from the debate’s moderator, Obama laid out a thumbnail sketch of healthcare reform:  “Here’s what my plan does. If you have health insurance, then you don’t have to do anything. If you’ve got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan.”

Obama had said something similar in his second debate with McCain a week earlier, in Nashville Tennessee.  “If you’ve got health care already, and probably the majority of you do, then you can keep your plan if you are satisfied with it. You can keep your choice of doctor.”

Few remember that when Obama assured Americans that the Affordable Care Act would not interfere with the benefits they had, he was addressing “the majority” of insured Americans–people who worked for large companies that offered comprehensive coverage.  More than two-thirds of the American work-force is employed by firms with more than 100 workers, and at the time, 99% of large companies offered health benefits.  He was not talking to the 5% of Americans who purchased their own coverage in the individual market, or the 17% who were covered by a small firm. (Only 35% of the U.S. work-force is employed by small companies and less than half of those firms offer health insurance.)

                 Context: What Was the Issue Obama and McCain Were Addressing?

In  2008 when Americans who had good health benefits at work heard the phrase “healthcare reform,” many worried that this would mean a “government takeover” that would eliminate their employer-sponsored plans. In short, they feared a single-payer system. Obama was trying to reassure them that this wouldn’t happen.

At the time, Politifact understood that this was the concern that Obama was addressing.  Here is what Politifact’s Angie Holan wrote in October of 2008:

Obama is accurately describing his health care plan here. He advocates a program that seeks to build on the current system, rather than dismantling it and starting over. People who want to keep their current insurance should be able to do that under Obama’s plan. His description of his plan is accurate, and we rate his statement True.”

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Obamacare “Horror Stories”–Who Are These People? How Many of These Stories Are True? Part 1

No doubt you have seen or read stories about innocent Americans who have become casualties of Obamacare. The law that was supposed to help middle-class families is now asking them to pay unreasonable premiums and sky-high deductibles. In many cases, they had perfectly good coverage that has been cancelled because it didn’t meet the Affordable Care Act’s (ACA’s) “standards.”

Trouble is, some of these anecdotes  just aren’t true. When an unbiased  reporter begins to make some phone calls, they start to fall apart.

Nevertheless,  these tales of Americans harmed by Obamacare  are being promoted by various conservative groups–including the Republican National Committee.  An internal RNC memo provides advice on how to collect stories of “victims” and feed them to the press.

Knowing this, when I read the horror stories,  I can’t  help but wonder: have the folks who are quoted checked prices on their Exchange?  Do they know  whether they are eligible for government subsidies?   How many didn’t  even try to find out because they just don’t like the ACA?  Who are these people who step forward to  identify themselves victims of the trainwreck called Obmacare? Where did they come from? How did the reporters who wrote the stories find them?

Finally, and perhaps most importantly, are journalists  fact checking their tales? How many are just writing down whatever their sources tell them?

          A Young Mother Suffering From MS Searches For Insurance

A few weeks ago, I stumbled upon a story that ran in the Fort Worth Star Telegram on November 26. The lead is compelling:

“Whitney Johnson, an Arlington 26-year-old with multiple sclerosis, can’t afford to go without health insurance. Her life depends on it.

She gave birth to her first child Sept. 2 after undergoing a series of rigorous steroid treatments, surgeries and a plasma exchange that saved her life. She pays $325 a month for an individual insurance plan – a drop in the bucket compared with the cost of her plasma protein replacement therapy, which runs $40,000 a pop. She undergoes treatment every five weeks.

But now, with the Affordable Care Act in full swing, Johnson’s insurance is under threat.. . .

Recently, the story  explains, Johnson’s insurer sent her a letter saying that because her policy “does not comply with Obamacare” it will be cancelled Jan. 1, 2014. Initially she hoped that she might shift to her husband’s employer-based health plan  For $325 a month, it covers him and their son. But it  turns out that if Whitney were added the policy, their premium would triple.

Meanwhile, she “has been unable to access the federal health exchange website” the newspaper reports, “which has been hampered by technical problems.”

In a video talking about her experience,  Johnson claims  that when she began “trying to shop around ‘ outside the Exchange, “the rates went from $1,000 to $1,800 a month for not even close to the coverage that my previous  insurance had offered me.”

This is when I knew that there was something very wrong with Johnson’s story.

                        $1000 a Month To Insure a 26-Year- Old ???

Anyone who knows anything about Obamacare would realize that under the ACA, no 26-year-old would be asked to pay $12,000 a year – even if she had MS. Obamacare does not let insurers charge more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.

And Johnson is just 26. In most exchanges, 20-somethings pay far less than older Americans.  I was certain that that she could get a much better deal. It didn’t take me long to find one.

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HHS Announces How Much Insurance Will Cost in 36 State Exchanges

These are the numbers we have been waiting for. This week the Department of Health and Human Services (HHS) published a report revealing what insurers will be allowed to charge in the largest cities in 36 states, when selling policies Americans buying their own coverage in the state “Exchanges.” The report also shows the size of the subsidies that Exchange shoppers  will receive. Previously, we had hard numbers for only 14 states.

In addition, HHS announced averaged premiums, state-wide, for Bronze and Silver plans in those 36 states. (We will be getting more information on rates in other cities very soon.)

Fear-mongers should blush.

It turns out that, on average, rates are 16% below the Congressional Budget Office’s projection—and that is BEFORE factoring in the subsidies.

I found what the report has to say about premiums in Texas particularly interesting. Many observers had suggested that while rates in the Blue States might be surprisingly low, Red States would let carriers charge far more.

I’ve written about the report—and the media’s reaction to it—here on healthinsurance.org. 

You can comment there, or return here to comment.

If you use Facebook, you may want to put a link on your Facebook page. More people need to hear the facts about Obamacare.

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Fighting Fire with Fire—What is the Point of a Limited Attack on Syria?

I can’t help but wonder what President Obama hopes to accomplish.

Are we taking military action simply to “send a message”?   If so why not use words rather than weapons?

Obama can be a powerful orator. Why not take to the bully pulpit and explain, to the world, the horrors of what is happening in Syria? .

A few days ago, New York Times columnist Charles M . Blow asked a provocative question: “Is America’s moral leadership in the world carved out by the tip of its sword?”

Wouldn’t it be better to demonstrate our “moral leadership” in some other, wiser way?  Can anyone point to an instance where a limited military action brought an end to violence?

Over at the Guardian Michael Cohen insists that we must attack in order to “enforce global norms”—in this case, the rule that the use of chemical weapons is simply beyond the pale. http://www.theguardian.com/commentisfree/2013/aug/29/liberal-case-for-striking-syria  Cohen claims the taboo dates back to World War I.

Has he forgotten about our use of Napalm in Vietnam?  Is he simply too young to remember the photo of a 9-year-old girl, wailing “too hot, too hot,” as she runs down the road, “naked after blobs of sticky napalm melted through her clothes and layers of skin like jellied lava.” http://news.yahoo.com/ap-napalm-girl-photo-vietnam-war-turns-40-210339788.html

Writing for the Atlantic, James Fallows quotes budget-policy expert, Mike Lofgren: “The US has in the recent past violated international norms on aggressive war, torture, rendition of POWs, assassination, use of chemical weapons (phosphorous, napalm, etc.), land mines, ad infinitum.” http://www.theatlantic.com/politics/archive/2013/09/your-labor-day-syria-reader-part-1-stevenson-and-lofgren/279254/
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