Democrats Don't Work That Way

There is an upcoming vote on the Budget Reconciliation Bill, also known in Bushspeak as the Deficit Reduction Plan or some such nonsense.  Among other things, this bill would cut benefits under the Medicaid plan and student loans.    We can win this vote with just a few votes changing hands, which we can pull off if we handle it right.

I think Matt's idea about how to handle the Supreme Court nomination points out why we need to be networked.  Imagine the network that Matt discusses in place.  Now, the vote comes up this week and what kind of response would we see?

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Weekly Pulse: End-of-Life Counseling Returns, But Death Panels Still Nonsense

by Lindsay Beyerstein, Media Consortium blogger

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Weekly Pulse: #DearJohn, Does Banning Abortion Trump Job Growth?

by Lindsay Beyerstein, Media Consortium blogger

With millions of Americans out of work, House Republicans are focusing in on real priorities: decimating private abortion coverage and crippling public funding for abortion, as Jessica Arons reports in RH Reality Check.

In AlterNet, Amanda Marcotte notes that the No Taxpayer Funding for Abortion Act, or H.R. 3, also redefines rape as “forcible rape” in order to determine whether a patient is eligible for a Medicaid-funded abortion. Under the Hyde Amendment, government-funded insurance programs can only cover abortions in cases of rape and incest, or to save the life of the mother. Note that the term “forcible rape” is  legally meaningless. Supporters of the bill just want to go on the record as saying that a poor 13-year-old girl pregnant by a 30-year-old should be forced to give birth.

Feminist blogger Sady Doyle has launched a twitter campaign against the bill under the hashtag #dearjohn, a reference to Speaker John Boehner (R-OH). Tweet to let him know how you feel about a bill that discriminates against 70% of rape victims because their rapes weren’t violent enough for @johnboehner, append the hashtag #dearjohn.

Everybody chill out

A federal judge in Florida ruled the entire Affordable Care Act unconstitutional on Monday. However, as political scientist and court watcher Scott Lemieux explains at TAPPED, the ruling is not necessarily a death blow to health care reform:

[T]his ruling is less important than the controversy it will generate might suggest. Many cornerstone programs of the New Deal were held unconstitutional by lower courts before being upheld by the Supreme Court. This ruling tells us nothing we didn’t already know: There is a faction of conservative judges who believe the individual mandate is unconstitutional. Unless this view has the support of five members of the Supreme Court — which I still consider very unlikely — it won’t matter; Vinson’s reasoning would have a much greater impact if adopted by the Court, but for this reason it is even less likely to be adopted by higher courts.

In a follow-up post, Lemieux explains the shaky legal reasoning behind Judge Robert Vinson’s decision. The judge asserts bizarrely that being uninsured has no effect on interstate commerce. That premise is objectively false. Health insurers operate across state lines and the size and composition of their risk pools directly affects their business.

Given the glaring factual inaccuracies, Judge Vinson’s decision may be overturned by a higher court before it gets to the Supreme Court.

Scamming Medicare

Terry J. Allen of In These Times win’s the headline of the week award for an article entitled “Urology’s Golden Revenue Stream.” She reports that increasing numbers of urologists are investing millions on machines to irradiate prostate cancer in the office. The doctors can bill Medicare up to $40,000 per treatment, but they have to use the machines a lot to recoup the initial investment. So what does this mean for patients? Allen explains:

Rather than accessing centralized equipment and sharing costs, physicians are concentrating their own profits by buying expensive in-practice technologies that pay off only if regularly used. One result is overtreatment, which is driving up health care costs, exposing patients to unnecessary radiation and surgeries, and is frequently no better than cheaper approaches.

One third of Medicare patients with prostate cancer undergo the expensive IMRT therapy, as the procedure is known. In 2008, Medicare shelled out over a billion dollars on a treatment that has not shown to be any better for patients than less expensive therapies.

Obstetric fistula in the developing world

Reproductive Health Reality Check is running a special series on the human rights implications of obstetric fistula. Fistula is a devastating complication of unrelieved obstructed labor in which the baby’s head gets stuck in the birth canal and presses against the soft tissues of the pelvis. If labor goes on long enough, the pressure will starve the pelvic tissues of blood, and they will die, creating a hole between the vagina and the bladder, and/or between the vagina and the rectum. Fistula patients face lifelong incontinence, chronic pain, and social ostracism.

The condition is virtually unknown in the developed world, where women with obstructed labor have access to cesarean delivery. However, an estimated 2 million women, primarily in sub-Saharan Africa and Asia, have untreated fistulas with an estimated 50,000 to 100,000 new cases occurring each year. Without reconstructive surgery, these women will be incontinent for life.

Sarah Omega, a fistula survivor from Kenya, tells her story. Omega sustained a fistula when she delivered her first child at the age of 19. She suffered for 12 years before she finally obtained the surgery she needed. As Agnes Odhiambo explains in another installment in the series, fistula is a symptom of a dysfunctional health care system. Women suffer needlessly because they can’t get access to quality health care.

The most likely victims of fistula are the most vulnerable members of their respective communities. Early childbearing increases a woman’s risk of fistula. Pregnant rape victims may face even greater barriers to a safe delivery, thanks to the social stigma that accrues to victims of sexual violence in many societies. (Not to mention any names, House Republicans…)

Preventing and repairing obstetric fistula is a major human rights issue. The U.S. should make this effort a high priority for foreign aid.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

 

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