The Next Hurrah

GOP Offer Healthcare to All Those without Pre-Existing Conditions

by emptywheel

According to the LAT, the GOP presidential candidates have come up with a brilliant way of offering insurance to the uninsured: leave out those with pre-existing conditions, including people with medical histories just like the candidates' themselves.

When Rudolph W. Giuliani was diagnosed with prostate cancer in the spring of 2000, one thing he did not have to worry about was a lack of medical insurance.

Today, the former New York mayor joins two other cancer survivors in seeking the Republican presidential nomination: Arizona Sen. John McCain has been treated for melanoma, the most serious type of skin malignancy, and former Tennessee Sen. Fred Thompson had lymphoma, a cancer of the immune system.

All three have offered proposals with the stated aim of helping the 47 million people in the U.S. who have no health insurance, including those with preexisting medical conditions.

But under the plans all three have put forward, cancer survivors such as themselves could not be sure of getting coverage -- especially if they were not already covered by a government or job-related plan and had to seek insurance as individuals.

"Unless it's in a state that has very strong consumer protections, they would likely be denied coverage," said economist Paul Fronstin of the Employee Benefit Research Institute, who has reviewed the candidates' proposals. "People with preexisting conditions would not be able to get coverage or would not be able to afford it."

I was drawn to the article because I'm one of those the article explains would be denied health care coverage in almost all cases.

An expert with access to a manual that insurers use to make coverage decisions said that most companies wouldn't consider a cancer survivor for 10 years, with some exceptions, and then would only issue a policy at a higher premium.

Nice to know I can always escape to Ireland if I lose my healthcare.

But in reading it, I wanted to recommend it because it is really the kind of coverage we need for a presidential election. It is informative, explaining in several different ways why and how cancer survivors cannot find affordable healthcare. It tells voters--in terms that put the voter at the center of the debate--information critical to assessing the candidates. And it's a great story, using the cancer history of three leading candidates to emphasize the gaps in their plans.

It's so rare we see good reporting on the presidential race, this article deserves attention.

 

 

John Tanner Doesn't Know Jack

By Mimikatz

John Tanner is the head of the Voting Rights section at DOJ,  He's the one who believes Georgia's voter ID law discriminates against whites because fewer elderly have photo ID's and Black people "don't age like white people, they die first."  It is ugly but entertaining to watch him squirm under questioning by Artur Davis and Keith Ellison.  Artur Davis pointed out that in Alabama actually a higher percentage of Black people vote than white people, and got Tanner to admit that he did not look at actual statistics, he is going by his prejudices.  Ellison tries to get him to see what was wrong with his comment, but Tanner just doesn't get it, except that his "tone" and "clumsy phrasing" hurt people.

But what no one seems to realize is that Tanner is just dead wrong statistically.  You can look it up.

It is commonly known that at birth the life expectancy of white people is higher than Black people, about 6.4 years for men, 4.5 years for women), although the difference has been shrinking and the discrepancies between men and women within each race are about as high (+5 years for white women, +7 years for Black women).  The differences between the races persist at about the same rate into the mid thirties.  But then they begin to shrink, year by year, and by age 65 are down to about a year and a half.  By age 80 the difference has disappeared, and after 80, Black people actually have a higher life expectancy than whites within each gender.  And the life expectancy for Black women is actually higher than white men at every age.  (But we all know women don't really count.)  So Tanner is not only insensitive, but wrong.

Just another example of the Bush-Cheney regime making policy based on prejudice and with GOP dominance as their goal.  And just another example that things that "everyone knows" sometimes aren't really true.

Lobbyist Logic

by emptywheel

I know you have all been worried at my seeming recovery from my obsession with Ed Gillespie. But worry not--the dearth of Gillespie posts was mostly explained by my travel schedule (which gets really bad again this week, then gets better), and not any disinterest in the guy who took over after they fired Bush's brain.

And this, I guess, is the kind of logic you get from the Lobbyist-in-Chief with which they replaced Bush's brain, from this NYT article chronicling how glum Republicans are at their diminishing (political) fortunes.

At the White House, administration officials urged Congressional Republicans to try to remain positive and ride out the current turmoil. Ed Gillespie, a senior adviser to Mr. Bush, told the visitors, according to multiple accounts, that had Republicans sided with Democrats on the health program, they would have opened themselves to withering criticism from conservatives and been in a worse position than they are now.

Let's see... "had Republicans sided with Democrats" on the S-CHIP vote. I wonder how Representatives Tom Davis, Heather Wilson, and Don Young feel about that assertion, since they were among the 45 Republicans in the House who voted for S-CHIP? Perhaps it's no accident that Tom Davis is one of the Republicans quoted as complaining about the Republican stance on S-CHIP.

“We need to be on offense,” said Representative Tom Davis, a Virginia Republican considering a Senate run.

Likewise, I wonder how Senators like Orrin Hatch and Kit Bond--and the 16 other Republicans who voted for S-CHIP--feel about Gillespie's suggestion that Republicans didn't side with Democrats on this bill. Last I checked, no one doubted that Orrin Hatch was a Republican, but I guess the Lobbyist-in-Chief knows better?

I'm also curious what Gillespie, who is himself Catholic, thinks about the campaign run by Catholics United, which is targeting 10 purportedly pro-life Representatives (including three in my heavily Catholic state!!) for their votes against S-CHIP. It seems to me that these 10 Representatives have "opened themselves to withering criticism from conservatives." But I guess that's not the kind of conservative that the Lobbyist-in-Chief had in mind?

In short, Gillespie's public accounting of the benefit that opposition to S-CHIP will have for the Republican party rings pretty hollow, if not outright false.

But I guess that's why Carl Hulse received "multiple accounts" of Gillespie's ridiculous comments?

Senate Minority Leader Fuels the Flames

by emptywheel

ThinkProgress got the email that Mitch McConnell's staffer claimed he had not sent out.

Seen the latest blogswarm? Apparently, there’s more to the story on the kid (Graeme Frost) that did the Dems’ radio response on SCHIP. Bloggers have done a little digging and turned up that the Dad owns his own business (and the building it’s in), seems to have some commercial rental income and Graeme and a sister go to a private school that, according to its website, costs about $20k a year ‹for each kid‹ despite the news profiles reporting a family income of only $45k for the Frosts. Could the Dems really have done that bad of a job vetting this family?

Gosh. You think maybe the mainstream press, which claims to pride itself on its accuracy, will admit that this smear was not solely blog-driven?

Don't answer that.

Chuck Grassley Agrees with the Netroots

by emptywheel

Like many of us, Grassley argues that if you bring an issue that has widespread support among the electorate up for a vote often enough, you will eventually convince intransigent Republicans to vote for it.

Grassley said if he were the Democrats, he would send the SCHIP expansion to a vote every three months, along with campaign advertisements accusing Republicans of abandoning children. That way, pressure would mount either on Bush to sign the bill or on House Republicans to override the veto.

Of course, Grassley is referring to SCHIP and not the Iraq War. But the comment--and the article more generally--is worthwhile nonetheless. For Grassley states clearly that the Bush Administration is willing to sustain awful policy outcomes to make an ideological point.

Sen. Charles E. Grassley (R-Iowa) and White House aides agreed that Bush's opposition to the legislation stems not from its price tag but from far larger health policy issues. The White House wants to use the issue of uninsured children to resurrect the president's long-dormant proposals to change the federal tax code to help the uninsured, adults and children alike, Grassley said, calling that a laudable goal but unrealistic politically.

[snip]

Asked if Bush was holding the children's health bill hostage, Grassley said, "Yes."

The reporter should have posed that last question again, asking Grassley whether Bush is holding children's health--and not just the bill--hostage. Because that's clearly what is happening.

And, as Grassley makes clear, Bush has created this crisis--in which children's health will suffer for Bush's ideological ideas. Back in the spring, Grassley encouraged Bush to work with Congress to push his privatized insurance scheme. But Bush did nothing, setting up the crisis we'll see after this bill passes and Bush vetoes it.

In talks this spring with Health and Human Services Secretary Mike Leavitt, White House National Economic Council Director Al Hubbard and Hubbard's deputy, Keith Hennessey, Grassley discussed linking an extension of the 10-year-old SCHIP program to a more ambitious effort to address the adult uninsured. Grassley encouraged the White House to try to round up Democratic support for that approach, but when White House officials made no such effort, Grassley told them in April that the children's health program would have to stand alone. [my emphasis]

Bush will willingly make anyone--including uninsured children--suffer to win his ideological pissing contests.
And if Democrats can't make it clear that these are the stakes, we might as well fold and go home.

Previvorship

by emptypockets

The New York Times ran a good "personal history" piece on a woman who knows she inherited from her mother a copy of the tumor suppressor gene BRCA1 that predisposes her to breast and ovarian cancers at a young age (probably by the time she turns 40). It describes her struggle with the decision merely to monitor herself carefully or to commit to the best cure available against breast cancer: double mastectomy. It's an informed choice her generation will be the first to face.

Joan Lindner, 63, is a cancer survivor. Her daughter, by contrast, is one of a growing number of young women who call themselves previvors because they have learned early that they are genetically prone to breast cancer, and have the chance to act before it strikes. [...]

Parents who have fought cancer typically have no experience with the choices that confront their children, and guilt over being the biological source of the problem can color their advice. Siblings and cousins who carry the risk gene evangelize their own approach to managing it, while those who dodged its inheritance seem unqualified to judge.

The story is a sign of our changing relationship with our genetic inheritance -- not only the substance of the story, but the very fact that an entire family's genetic pedigree and relevant medical data, with their photos, was published as a front-page story in a major newspaper. Maybe it's the exhibitionism of the reality TV age dovetailing with the post-genome era: only one member of the pedigree declined to have his name and photo published. (Why didn't the NYT respect his wish for privacy and just leave him off the tree?) Not only do we know more than ever about our genetic makeup, we are sharing it.

Importantly, our ability to read (and publish) our genes is outpacing our philosophy of when to do so. Ultimately, the answer is simple: it's up to the individual. But those individuals will want to make an informed choice, and (as I've written many times) in a setting where about 3/4 of us believe in angels but only 1/4 believe in evolution, the infrastructure is not in place for people to be savvy consumers of genetic information. Add into the mix the self-interest of counseling companies, pharmaceutical companies, and insurance companies and you get a recipe for confusion and frustration.

How will we overcome it? There may emerge trustworthy companies to help you interpret whether new medical studies apply to you: for example, 23andMe was started recently by the wife of one of Google's founders (and with a substantial investment from Google itself) for just these ends. (Hm, and they're hiring...) But, I'm afraid people will always crave certainty and a quick fix, and that's not what most legitimate research will offer -- so, unfortunately, it's not time to sell short snake oil futures just yet.

And who gets to read your DNA? Your employer? Your insurance company? The government? New York Gov. Eliot Spitzer has been trying to expand DNA databasing to anyone convicted of a misdemeanor, and some states apparently collect DNA from anyone arrested (whether or not they are convicted). Will your DNA become a bit of personal information like your social security number -- putatively private, but in reality requested every time you fill out a form, apply for credit, visit your dentist?

Below these pragmatic concerns there exists a deeper question about humanity and free will. How "proactively" do we want to try to control our future, and to what degree should we realize that we may be able to lightly weight the dice, but in the end we can only really control our own attitudes toward what may come? Arlo Guthrie decided not to be tested for the copy of the gene that led to his father, Woody, dying of Huntington's disease, for which there is still no treatment. He recently passed the age at which his father died, and is still going strong without any sign of illness -- he said, "I spent the day talking to my dad about it, as it were [...] I said, 'All right, there's progress. And if my kids live a day older than I get to be, we're moving in the right direction, anyway.' "

Medicare Giveaways!

by emptywheel

No, not to the seniors enrolled in Medicare, silly! To the private insurance companies. Yet another GAO report has found yet another contracting scam that BushCo is ignoring.

Private insurance companies participating in Medicare have been allowed to keep tens of millions of dollars that should have gone to consumers, and the Bush administration did not properly audit the companies or try to recover money paid in error, Congressional investigators say in a new report.

What's remarkable about this though, is it is at least the third incidence where--when faced with accounting improprieties from a corporation working with the government--the Bush Administration refuses to ask for the money back.

A Reminder About H5N1 and Pandemics

by DemFromCT

While it doesn't make news here, because it's not American deaths or a change from a simmering baseline, H5N1 still percolates in hot spots like Indonesia's Bali. Several resources help illustrate the problem. This map from Bali, Indonesia, where 1.5 million tourists from all over the world visit each year, tracks suspected cases of H5N1. It's put together by volunteers at Flu Wiki:


While a suspected case is not a proven case, not all samples in Indonesia make it to authorized labs for verification, and some of the suspects might have been placed placed on tamiflu, which is suspected of negating accurate testing. While the total number of cases is likely more than official counts, at this point it's not much more. There's no immediate pandemic happening, but H5N1 remains a candidate for one.

Also, a recent acknowledgment of human to human transmission in Indonesia (one of the human hot spots along with Egypt and Vietnam) highlights the need for vigilance.

A new study by a US university has apparently confirmed for the first time that bird flu has been transmitted from human to human.

It is the nightmare possibility that health authorities have been fearing ever since the disease first appeared.

It happened in Indonesia last year and reveals the world only narrowly avoided a global bird flu pandemic.

The World Health Organization and other international (that's international, including the US) agencies continue to plan and monitor:

The World Health Organisation warned Monday against complacency in the fight against bird flu, saying another human influenza pandemic is inevitable sooner or later.

"I am often asked if the effort invested in pandemic preparedness is a waste of resources," director general Margaret Chan told a regional meeting of the world organisation.

"Has public health cried wolf too often and too loudly?" she said in a speech.

"Not at all. Pandemics are recurring events. We do not know whether the H5N1 (avian influenza) virus will cause the next pandemic. But we do know this: the world will experience another influenza pandemic sooner or later."

WHO regional director Shigeru Omi noted that bird flu deaths in the Western Pacific -- which excludes Indonesia -- had fallen from 19 two years ago to five in the past year.

But he said the virus was still "entrenched" in several countries.

"Because the virus continues to evolve and mutate, we must maintain constant vigilance," he said.

This isn't a front page story, but it's information nonetheless worth posting. H5N1 is not guaranteed to be the next pandemic, but some flu virus out there will be, and there's nothing to say H5N1 won't be.

This fall, the focus will be on community mitigation guidelines and implementation. This means that if a severe pandemic strikes, the public schools in the US may close for up to 12 weeks. Pre-planning is essential for parents and employers. The focus will be on what's called COOP (continuity of operations planning) for individualsand communities.

Expect to hear more in coming weeks. While it's not the number one problem in the world today, it's certainly on the list of potential disasters, and mitigating disasters in advance is certainly a better idea than playing catch-up.

Severe Seasonal Flu in Australia And Health Infrastructure In The US

by DemFromCT

Did you know that there's a flu outbreak in Australia that's tying up their medical system in knots? And that six kids and nine adults have died? That's what happens in a bad flu season.

The figures, provided by the federal Department of Health and Ageing today, are believed to be just a fraction of actual flu infections, but they give the best seasonal comparison.

They offer official confirmation that the nation is in the grip of its worst influenza season in many years, with nine lives lost so far.

Six children from four states have died from one of two virulent strains of influenza A virus, H3N2 or H1N1.

Three adults – a 37-year-old Queensland man, a 48-year-old woman from South Australia and a 33-year-old Queensland mother-of-two – have also died after suffering flu-like symptoms.

Severe flu seasons can be as bad or worse than a mild pandemic. Here's a post from our colleague Revere, one of the epidemiologists at Effect Measure, the pogressive public health blog, outlining exactly that. From Effect Measure:

Given our posts (here, here) on the particularly severe flu season in Australia, we thought it useful to remind ourselves that a bad flu season can be really bad -- worse than the 1918 pandemic in some locations. Here is a post we did back in April 2006 about an interesting paper (see link in post) by Cecile Viboud and her colleagues at NIH that looks at historical records on flu mortality. Flu is a bad disease, pandemic strain or not. Why some flu is worse than others we don't know.

The hospital diversions and capacity overflow is a reminder that health issues in this country (not just Australia) need to be kept front and center as a priority. A bad flu season would overwhelm our own EDs

A [2002] study to be published in the April 2002 Annals of Emergency Medicine on emergency department use and capacity in California, sheds light on the overcrowding problem nationwide and provides the first objective data on this crisis in the United States. (Trends in the Use and Capacity of California's Emergency Departments, 1990-1999).

The study finds that in the past decade (1990-1999) emergency departments in California decreased by 12 percent, while the number of emergency department visits at each hospital increased 27 percent to about 25,778 annually.

and the efforts to prepare for a flu pandemic (whatever strain of virus) only highlight the health infrastructure issues here in the US that are every bit as ignored as crumbling bridges... until they collapse. To their credit, California is trying to address surge capacity issues in their hospitals. Is that happening in other states, with backing from the legislatures?

The SCHIP program's proposed expansion to cover underinsured children (and Bush's virulent and mean-spirited opposition) is in the news now, and other health care issues need to stay in the news through the primaries and right up to the election. Government has an important role in rebuilding our health infrastructure, and we need to make sure the candidates from both parties articulate what they see that role as.

From universal health care coverage to single payor alternatives to mental health coverage to SCHIP and children's insurance, there needs to be a question about health care and public health in every debate from here on in, both for the GOP and for the Democrats. America needs to know what alternatives they have when they go to the voting booth, and what the alternatives will cost (nothing is free). GOP reliance on private sector alternatives need to be highlighted and explored (See Gene Sperling's evaluation of SCHIP).

This election cycle, health and public health infrastructure cannot be ignored, or it, too, will crumble under the ordinary stresses of a flu season (or worse). There's a reason SICKO had such an impact when it was released. And "no one could foresee..." will not be an acceptable answer.

Bush To America's Children: Drop Dead

by DemFromCT

Amazing.

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess. In interviews, they said the changes were aimed at returning the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

After learning of the new policy, some state officials said today that it could cripple their efforts to cover more children by imposing standards that could not be met.

Ann Clemency Kohler, deputy commissioner of human services in New Jersey, said: "We are horrified at the new federal policy. It will cause havoc with our program and could jeopardize coverage for thousands of children."

The beef with SCHIP that Bush has? It interferes with private insurance. Forget about the fact that there are millions children currently uninsured, and millions more that are underinsured. Nothing could be clearer in terms of the priorities of this Administration.

To minimize the risk of such substitution, Mr. Smith said in his letter, states should charge co-payments or premiums that approximate the cost of private coverage and should impose "waiting periods," to make sure higher-income children do not go directly from a private health plan to a public program.

If a state wants to set its income limit above 250 percent of the poverty level ($51,625 for a family of four), Mr. Smith said, "the state must establish a minimum of a one-year period of uninsurance for individuals" before they can receive public coverage.

Gene Sperling adds analysis:

What is most inexcusable about the White House stance is what they don't say. They offer nothing -- no better idea, no alternative, no plan -- that has been shown to keep even a chunk of these 5 million to 6 million children from going to sleep every night without health insurance.

They are content to keep the status quo even with heartbreaking reports that uninsured infants with congenital heart problems are 10 times more likely to die because of delayed treatment than those with coverage.

Before, "compassionate conservatism" may have seemed like a political bumper sticker. Now it seems like the punch line of a sad joke, at the expense of millions of impoverished children. 

Once again, the White House, and Republicans, are on the wrong side of the health care issue, an issue the American people care deeply about. Where is Thomas Nast when you need him?