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: Egg Salad Surprise! Congress Votes to Clean Up Food Supply

by Lindsay Beyerstein, Media Consortium blogger

It’s a Christmas-week miracle! The Senate, in a vote that astonished everyone, brought the Food Safety and Modernization Act back from the dead on Monday, as Siddhartha Mahanta reports in Mother Jones. The bill, which will enact tougher consumer protections against E. coli and other deadly contaminants in staples like eggs and peanut butter, died in the Senate last week when the omnibus spending bill it had been folded into kicked the bucket.

At Grist, Tom Philpott explains the initial demise, and the basis for the ultimate resurrection of the bill. The House passed the bill on Tuesday, having already passed it twice before.

President Obama is expected to sign the bill into law, which will usher in the first major overhaul of the country’s food safety system in more than 70 years. Food poisoning strikes 48 million Americans (1 in 6), lands 128,000 in the hospital, and kills 3,000 ever year, according to CDC figures released last week. Now that’s something to talk about with your relatives around the holiday dinner table.

Wisconsin clinic backs off 2nd trimester abortion care

A clinic in Wisconsin has reneged on its commitment to provide second trimester abortion care, as Judy Shackelford reports in The Progressive. Shackelford is outraged that the Madison Surgery Center walked back on its promise to patients. She knows first hand how important later term abortion access can be.

Shackelford found herself in need of a second trimester abortion when she developed a blood clot in her arm during her second, much-wanted pregnancy. She decided to terminate rather than risk leaving her 7-year-old son motherless. It was hard enough to find an abortion provider when she needed one, but if she needed the procedure today, she would have nowhere to turn.

Teen birth rate at record low

The birth rate for women ages 15-19 fell to 39.1 per 1000 between 2008 and 2009, the National Center for Health Statistics announced Tuesday. Many commentators, including Goddessjaz of feministing attribute the drop to the recession. The economy seems to be an important factor because birth rates dropped in all age groups, not just among teens.

Predictably, proponents of abstinence-only-until-hetero-marriage are trying to take credit for the falling birth rate. It’s not clear why they think ab-only is finally starting to work after years of unrelenting failure. Perhaps it was Bristol Palin’s electrifying performance on “Dancing With the Stars”?

Get the government out of my Medicare

We’ve become accustomed to the ironic spectacle of senior citizens on Medicare-funded scooters decrying the “government takeover of health care.” Medicare is wildly popular, even among those who decry “socialized medicine.” When the Affordable Care Act is finally implemented, it won’t feel like a government program, either. Paul Waldman of The American Prospect wonders if this “private sector” feel will undermine support for the program:

The Republican officials challenging the ACA in court have characterized its individual insurance mandate as an act of tyranny ranking somewhere between the Stalinist purges and Mao’s Cultural Revolution. But in the “government takeover” of health care (recently declared the 2010 “Lie of the Year” by the fact-checking site PolitiFact), Americans will continue to visit their private doctors to receive care paid for by their private insurance companies. The irony is that if the ACA actually were a “government takeover,” people would end up feeling much better about government’s involvement in health care. But since it maintains the private system, conservatives can continue to decry government health care safe in the knowledge that most people under 65 won’t know what they’re missing, or in another sense, what they’re getting.

If people don’t realize that they’re benefiting from government programs, they are less likely to support those programs. In an attempt to deflect Republican criticism, the Democrats assiduously scrubbed as much of the aura of government off of health reform as they could. This could prove to be a disastrously short-sighted strategy. If health reform works, the government won’t get the credit, but rest assured that if it fails, it will take the full measure of blame.

Funding for community health centers at risk

One of the lesser-known provisions of the Affordable Care Act was to expand the capacity of community health centers (CHCs) from 20 million to 40 million patients by 2015. This extra capacity will be key for absorbing the millions of previously uninsured Americans who are slated to get health insurance under the ACA.

CHCs have been praised by Democrats and Republicans as an affordable way to provide quality health care. However, state budget crises are threatening to derail the plan, as Dan Peterson reports for Change.org. States must contribute to the program in order to qualify for federal funding. However, state funding for CHCs has plummeted by 42% since 2007. So far this year, 23 states have cut funding for CHCs and eight have slashed their budgets by 20% or more.

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: Judge Rules Against Health Reform, Takes Cash from Opponents

by Lindsay Beyerstein, Media Consortium blogger

The Virginia federal judge who ruled against a key component of health care reform on Monday has ties to a Republican consulting firm. Judge Henry Hudson is a co-owner of Campaign Solutions, as Amy Goodman of Democracy Now! reports.

Hudson, a President George W. Bush appointee, has earned as much as $108,000 in royalties from Campaign Solutions since 2003. A cached version of the firm’s client roster lists such vocal opponents of health reform as Sens. Mitch McConnell (R-KY), Jim DeMint (R-SC), and Olympia Snowe (R-ME), Rep. Todd Tiahrt (R-KS), the Republican National Committee and the American Medical Association.

In November, Collins and Snowe joined McConnell in signing an amicus brief to challenge the constitutionality of health care reform in a separate suit in Florida. Campaign finance records show that Campaign Solutions has also worked for Virginia Attorney General Ken Cuccinelli, who is spearheading the lawsuit. Tiahrt added an amicus brief to Cuccinelli’s lawsuit.

Today, the mandate. Tomorrow, the regulatory state?

Hudson ruled that the individual mandate of health care reform is unconstitutional. The mandate stipulates that, after 2014, everyone who doesn’t already have health insurance will have to buy some or pay a small fine. The judge argues that this requirement exceeds the federal government’s power to regulate interstate commerce.

The Commerce Clause gives the federal government the power to regulate commerce between the states and international trade. Suzy Khimm of Mother Jones explains that this clause underpins the power of the federal government to regulate the economy in any way:

But the issues at stake in Cuccinelli v. Sebelius (Ken Cuccinelli is the conservative attorney general of Virginia; Katherine Sebelius is President Barack Obama’s Secretary of Health and Human Services, or HHS) are actually far broader. Hudson’s ruling doesn’t just show how the Supreme Court could gut the health law—it shows how the court could neuter the entire federal government.

Is it constitutional?

Chris Hayes of The Nation interviews Prof. Gillian Metzger, a constitutional law scholar at Columbia University, about the merits of challenges to the constitutionality of health care reform. According to Metzger, “the argument that [the mandate] is outside the commerce power is also pretty specious given the existing precedent.”

Steve Benen of the Washington Monthly accuses Judge Hudson of committing an “inexplicable error” in legal reasoning. There is a longstanding precedent that the federal government can regulate economic activity under the Commerce Clause. Hudson acknowledges this, but he maintains that this power doesn’t cover regulations of “economic inactivity” (i.e. not buying health insurance). As Benen notes, people who don’t buy insurance aren’t opting out of the market, they’re opting to let society absorb their future medical costs. Everyone who does buy insurance pays more because freeloaders coast without insurance and hope for the best.

Luckily for the Obama administration, the judge did not bar the implementation of health reform while the case works its way through the courts. The Supreme Court will ultimately hear this case. In the meantime, the federal government can continue building the infrastructure that will eventually support health care reform.

This is the third time a federal judge has ruled on the constitutionality of health care reforms and the first victory for the anti-reform contingent.

Mandatory mandate

Paul Waldman reminds TAPPED readers why the mandate is critical to any health care reform based on private insurance. With a single-payer system, you don’t need a mandate because everyone is automatically covered. A mandate only comes into play when you have to force people to buy insurance.

Without a mandate, healthy risk-takers who don’t buy insurance will starve the system of premiums while they are well and bleed the system for benefits when they get sick. Meanwhile, people who already know they’re sick will sign up in droves, and the Affordable Care Act will force insurers to accept them.  Without a mandate, the private health insurance industry would collapse and take health care reform down with it.

Is expanding Medicare the answer?

Matthew Rothschild of the Progressive argues that the legal headaches over the individual mandate illustrate why it would have been legally and procedurally easier to achieve universal health care by simply expanding Medicare to cover everyone.

At Truthout, Thom Hartmann argues universal health insurance in the form of “Medicare Part E” would spur economic growth and innovation because entrepreneurs could start businesses without worrying about how to provide health insurance for their employees.

Meanwhile, Brie Cadman reports at Change.Org, Sen. Tom Coburn (R-OK) is trying to defund health care reform by cutting funds for preventive health care. Coburn is urging his fellow Republicans to vote against a House-passed measure that would allocate $750 million for the 2011 Prevention and Public Health Fund. Cadman notes the irony of a medical doctor like Coburn, who also claims to be a fiscal conservative,  trying to scuttle funds to control preventable diseases which would otherwise cost society billions of dollars a year.

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.

 

 

Budgeting in the United States of Me

Taxes are a lot like salaries. If you paid someone $1 million a day (oh wait, we do) they’d scream bloody murder they should’ve gotten $1,ooo,ooo.o1. If you taxed someone 1%, they’d whine they shouldn’t have to pay more than 000.1%, with those whining the loudest being the people with the lowest tax rates and highest pay.

Perhaps the most oft-repeated charge against Obama bin Karl Marx and the Democrat Politburo is that they’re dangerous socialists. But according to a recent story from CNBC, a funny thing happened on the way to the Kremlin. If you look at their list of the 10 most socialist states, there’s a whole lotta red in Governors’ mansions. In fact, six of 10 governors sport big red Rs next to their names. BTW, the People’s Republic of California didn’t even make the list.

All the tri-cornered hats and tea bags notwithstanding, the charge that most states are tax and spend Central Bureaus is shaky too.

Despite the screeching about high taxes, Americans enjoy some of the lowest taxes in the western world. American companies pay the second highest taxes, but they don’t mention their taxes are high because American companies gorge on taxpayer-funded corporate welfare far more damaging than the most greedy, imaginary, Cadillac-driving welfare queen.

American Productivity: The Bee’s Knees
They also don’t say they’re not leaving the US so much because of high taxes, but because they can hire workers from Third World countries at pennies on the dollar relative to Americans workers. Oh yeah, American workers who are generally rated as some of the most productive in the world.

The uber-capitalist view on this is that government is inherently inefficient and can’t be trusted with a dollar and there is massive fraud out there to be picked like leaves from the Liberty Tree. However, everyone’s favorite tax and spend worker’s paradise, California, has the lowest number of employees per 10,000 residents.

And when it comes to California’s current economic pickle, it’s useful to remember that if California were a country, its economy would be the eighth largest in the world – somewhere around the size of Spain’s. Fixing California’s problems is as difficult as fixing the two national economies that’ve already gone off the edge – Iceland and Ireland. BTW, both have smaller economies than California’s. But take heart don’t tax and spender conservatives, if Ireland goes, we could overtake Spain. USA! USA! USA!

Plus, a remnant from the last misguided tax revolt is a draconian tax and spend process worse than the broke Eurotrash’s. You may have heard of it, Prop 13. Prop 13 makes it extremely difficult to raise taxes to support social programs, infrastructure projects, and most importantly, education. So, California’s educational system has dropped from best in the nation to sub-Alabama levels since its introduction, its roads look like mule trails to the Hindu Kush, and social and educational programs have taken the biggest hits in the sausage slicing process…in a state with more poor people than any other.

Rid the government of fraud you say?

That’s a dandy idea, but none of our erstwhile CEO/politicians can explain how much there is, where it is, or how to cut it. BTW, if we removed of all of it, the spending effect – like banning earmarks – would be like pissing into a hurricane.

Of course we could start cutting the continued contracts with known fraudsters like, Blackwater/XE, Halliburton, and dozens of others carbuncles on the ass of the American economy. But hey, what do I know…except that having worked in both the public and private sectors I can vouch for the fact that fraud, abuse, and waste in corporate America is roughly the same in government America after being scaled to their relative sizes.

Moossilini and the Gajillionaire
Yes, people have a right to complain when their tax money isn’t spent wisely and no one wants to pay any more than necessary (excepting gajillionaire Warren Buffet, but you know how crazy the unbelievably rich are). But there’s the rub. One man’s waste is another man’s essential. If it were easy, we wouldn’t have a problem – even if Moosilini says it is. Still, that doesn’t mean we shouldn’t try.

Yet, you can bet that when it comes to the cutting, some of the same folks who now complain righteously, albeit incorrectly, aren’t going to be happy.

Do you think that Granny holding the “Get Rid of Obamunist” sign is going to be happy when the people she voted for decide that her Social Security and Medicare are wasteful perks? How about those who are ready to send Junior off to college only to find that all that grant money went poof? And when Mom gets e-coli from some ConAgra-raised hamburger, treated with bum drugs, and it eventually kills her (without even the courtesy of a death panel) the FDA doesn’t look so wasteful anymore.

We are all Americans and part of the responsibility of every American is to chip something in for the common good of the nation – or we would be called the United States of Me.

Stop yelling about how bad you’ve got it.

You could be working 14 hours a day in an Indonesian sweatshop to make shirts you’ll buy on the cheap at Walmart.

Always low prices…Always.

Cross posted at The Omnipotent Poobah Speaks!

Budgeting in the United States of Me

Taxes are a lot like salaries. If you paid someone $1 million a day (oh wait, we do) they’d scream bloody murder they should’ve gotten $1,ooo,ooo.o1. If you taxed someone 1%, they’d whine they shouldn’t have to pay more than 000.1%, with those whining the loudest being the people with the lowest tax rates and highest pay.

Perhaps the most oft-repeated charge against Obama bin Karl Marx and the Democrat Politburo is that they’re dangerous socialists. But according to a recent story from CNBC, a funny thing happened on the way to the Kremlin. If you look at their list of the 10 most socialist states, there’s a whole lotta red in Governors’ mansions. In fact, six of 10 governors sport big red Rs next to their names. BTW, the People’s Republic of California didn’t even make the list.

All the tri-cornered hats and tea bags notwithstanding, the charge that most states are tax and spend Central Bureaus is shaky too.

Despite the screeching about high taxes, Americans enjoy some of the lowest taxes in the western world. American companies pay the second highest taxes, but they don’t mention their taxes are high because American companies gorge on taxpayer-funded corporate welfare far more damaging than the most greedy, imaginary, Cadillac-driving welfare queen.

American Productivity: The Bee’s Knees
They also don’t say they’re not leaving the US so much because of high taxes, but because they can hire workers from Third World countries at pennies on the dollar relative to Americans workers. Oh yeah, American workers who are generally rated as some of the most productive in the world.

The uber-capitalist view on this is that government is inherently inefficient and can’t be trusted with a dollar and there is massive fraud out there to be picked like leaves from the Liberty Tree. However, everyone’s favorite tax and spend worker’s paradise, California, has the lowest number of employees per 10,000 residents.

And when it comes to California’s current economic pickle, it’s useful to remember that if California were a country, its economy would be the eighth largest in the world – somewhere around the size of Spain’s. Fixing California’s problems is as difficult as fixing the two national economies that’ve already gone off the edge – Iceland and Ireland. BTW, both have smaller economies than California’s. But take heart don’t tax and spender conservatives, if Ireland goes, we could overtake Spain. USA! USA! USA!

Plus, a remnant from the last misguided tax revolt is a draconian tax and spend process worse than the broke Eurotrash’s. You may have heard of it, Prop 13. Prop 13 makes it extremely difficult to raise taxes to support social programs, infrastructure projects, and most importantly, education. So, California’s educational system has dropped from best in the nation to sub-Alabama levels since its introduction, its roads look like mule trails to the Hindu Kush, and social and educational programs have taken the biggest hits in the sausage slicing process…in a state with more poor people than any other.

Rid the government of fraud you say?

That’s a dandy idea, but none of our erstwhile CEO/politicians can explain how much there is, where it is, or how to cut it. BTW, if we removed of all of it, the spending effect – like banning earmarks – would be like pissing into a hurricane.

Of course we could start cutting the continued contracts with known fraudsters like, Blackwater/XE, Halliburton, and dozens of others carbuncles on the ass of the American economy. But hey, what do I know…except that having worked in both the public and private sectors I can vouch for the fact that fraud, abuse, and waste in corporate America is roughly the same in government America after being scaled to their relative sizes.

Moossilini and the Gajillionaire
Yes, people have a right to complain when their tax money isn’t spent wisely and no one wants to pay any more than necessary (excepting gajillionaire Warren Buffet, but you know how crazy the unbelievably rich are). But there’s the rub. One man’s waste is another man’s essential. If it were easy, we wouldn’t have a problem – even if Moosilini says it is. Still, that doesn’t mean we shouldn’t try.

Yet, you can bet that when it comes to the cutting, some of the same folks who now complain righteously, albeit incorrectly, aren’t going to be happy.

Do you think that Granny holding the “Get Rid of Obamunist” sign is going to be happy when the people she voted for decide that her Social Security and Medicare are wasteful perks? How about those who are ready to send Junior off to college only to find that all that grant money went poof? And when Mom gets e-coli from some ConAgra-raised hamburger, treated with bum drugs, and it eventually kills her (without even the courtesy of a death panel) the FDA doesn’t look so wasteful anymore.

We are all Americans and part of the responsibility of every American is to chip something in for the common good of the nation – or we would be called the United States of Me.

Stop yelling about how bad you’ve got it.

You could be working 14 hours a day in an Indonesian sweatshop to make shirts you’ll buy on the cheap at Walmart.

Always low prices…Always.

Cross posted at The Omnipotent Poobah Speaks!

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