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"I don’t care what you call it," he says. "I care that we get it right."

About half of countries who attempt to build single-payer systems fail. That’s Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he’s in Taiwan, Cyprus, or Vermont, the process is roughly the same: meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.
Ezra Klein's Vox Media looks at the financial and administrative mechanics of Governor Peter Shumlin's quest to bring single-payer health care to Vermont. Bonus: 12 questions about single-payer.
posted by psoas on Apr 9, 2014 - 39 comments

 

The Voluntarism Fantasy

Mike Konczal, for Democracy Journal: The Voluntarism Fantasy [more inside]
posted by tonycpsu on Mar 18, 2014 - 33 comments

Congress examines single-payer healthcare EEK SOCIALISM!!!

Six years ago, PBS's feature documentary program, Frontline, aired Sick Around the World, a documentary examining health care systems around the world -- and specifically how all those featured were generally superior to the American system. (2008 MeFi post) Today, the American Senate subcommittee on primary health and aging brought the debate over single-payer care to Washington. C-SPAN has a fine video of the hearing, which features seven witness representing health care systems and think tanks from around the US and the world. [more inside]
posted by greatgefilte on Mar 12, 2014 - 57 comments

How Obama's tech team saved his presidency a second time

Inside the Nightmare Launch of HealthCare.Gov - "Unknown to a nation following the fiasco, McDonough's assignment from the President had boiled down to something more dire than how to fix the site. As the chief of staff remembers his mission, it was 'Can it be patched and improved to work, or does it need to be scrapped to start over? He wanted to know if this thing is salvageable.' Yes, on Oct. 17, the President was thinking of scrapping the whole thing and starting over." (previously) [more inside]
posted by kliuless on Mar 3, 2014 - 120 comments

eStonia

Estonia, with a population of 1.3 million, might just have the most technologically forward-thinking government around.
posted by gman on Feb 9, 2014 - 31 comments

She died well because she was willing to die too soon....

The Ultimate End of Life Plan. "...Torn, I called my mother's internist. 'I know your mother well enough, and I respect her,' he said. 'She doesn't want to risk a surgery that could leave her debilitated or bound for a nursing home. I think I would advise the same decision if it was my Mom.' I called my mother and said, 'Are you sure? The surgeon said you could live to be 90.' 'I don't want to live to be 90,' she said. 'I'm going to miss you,' I said, weeping. 'You are not only my mother. You are my friend.' That day I stopped pressuring my mother to live forever and began urging her doctors to do less rather than more. A generation of middle-aged sons and daughters are facing this dilemma, in an era when advanced medical technologies hold out the illusion that death can be perfectly controlled and timed."
posted by storybored on Feb 3, 2014 - 58 comments

Life After Jan. 1

As a result of new coverage under the ACA, many previously uninsured people in eastern Kentucky are giving the nation a glimpse of life under the new health care law.
posted by reenum on Feb 3, 2014 - 132 comments

On Breaking One's Neck

On Breaking One's Neck. Dr. Arnold Relman, former Editor in Chief of the New England Journal of Medicine, gives a first-hand account of a catastrophic accident, intensive care, and rehabilitation--as a patient. I am a senior physician with over six decades of experience who has observed his share of critical illness--but only from the doctor's perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.
posted by russilwvong on Jan 19, 2014 - 22 comments

Obamacare "horror stories"

"Obamacare horror stories" where innocent citizens are losing their insurance and being forced to pay astronomical costs for new plans on the exchanges are being reported by some media outlets. The problem is that most of these stories don't survive further scrutiny. [more inside]
posted by reenum on Jan 7, 2014 - 129 comments

Is the Affordable Care Act a 'Republican' Health Plan?

The conventional wisdom about the origins of the Affordable Care Act is that it is a reformulated plan from the Clinton era, one that right-wingers like Newt Gingrich and the Heritage Foundation created. How true is it? [more inside]
posted by MisantropicPainforest on Dec 9, 2013 - 141 comments

Thankfully, the Constitution says you only have to do this once a year.

It's time for Americans to gather around the dinner table, eat too much, and argue about politics! A new genre of Thanksgiving-themed web pages seems to be taking off this year, that being the "How to argue with your [opposite political party] family members at Thanksgiving" genre. From the left side of the political spectrum, the Democratic National Committee has launched "The Democrat's Guide to Talking Politics with Your Republican Uncle", and The Huffington Post chimed in with "Here's Every Argument You'll Need To Win Your Obamacare Debate This Thanksgiving". Not to be outdone, conservatives have responded with cheat sheets of their own, including RedState.com's "Thanksgiving dinner with your liberal relatives" and The Washington Examiner's "The Thanksgiving guide to making conservative arguments liberals can understand". [more inside]
posted by tonycpsu on Nov 28, 2013 - 126 comments

Texas' Other Death Penalty

A Galveston medical student describes life and death in the so-called safety net. [via]
posted by AceRock on Nov 16, 2013 - 78 comments

Will Play for Root Canal

The O+ Festival in San Francisco offers artists an opportunity to barter their services for dental and health treatment. "The O+ Festival in San Francisco this weekend would seem a typical indie arts event, with performances by local musicians and displays of funky art. But in a twist that highlights a longstanding problem in the creative economy, the artists involved will be paid not in cash but rather in something they may need just as badly: health care." [more inside]
posted by semaphore on Nov 15, 2013 - 17 comments

The State of Health Care on the Rosebud Indian Reservation

Native Americans were promised health care by the government, but what are they really getting? Stanford Medicine on the Rosebud Indian Reservation in South Dakota, where health services are underfunded, suicide rates are high, and the life expectancy is just 46 years:
posted by porn in the woods on Nov 2, 2013 - 10 comments

The Pills of Last Resort

How Dying Patients Get Access to Experimental Drugs
posted by Blazecock Pileon on Nov 1, 2013 - 16 comments

"Remember – language is the battleground of humanity."

In the Shadows. The healthcare and human rights challenges of the LGBT populations of Malawi -- where homosexuality is outlawed. Via
posted by zarq on Oct 28, 2013 - 1 comment

The Cost of Living

The Rising Cost of Cancer Drugs: "New drugs could extend cancer patients’ lives—by days. At a cost of thousands and thousands of dollars. Prompting some doctors to refuse to use them."
posted by lalex on Oct 27, 2013 - 50 comments

Doctor No

What doctors would not do
posted by paleyellowwithorange on Oct 24, 2013 - 53 comments

It Could Be Worse

I signed up for an account on Healthcare.gov last week. It wasn’t the smoothest process, but I was able to create an account. Some parts are slow; sometimes you have to reload a page to make progress. But it’s starting to work. It will be fixed, because it has to be. And now that the launch and inevitable crash has finally happened, in a way the worst is over. Real-world traffic is providing programmers all the debugging data that they could ever want, and “all bugs are shallow with the president watching,” as Paul Ford writes in Bloomberg Businessweek, paraphrasing the open-source-software advocate Eric Raymond’s assertion that “with enough eyeballs, all bugs are shallow.” -- Rusty Foster in The New Yorker
posted by jim in austin on Oct 22, 2013 - 585 comments

The Ultimate (Frisbee) Argument For Visiting Healthcare.gov

John Hodgman posted about the ACA, which led his followers to tweet him about the various health problems they had encountered and the effect insurance or a lack thereof had to their lives. Hodgman retweeted many of the stories from people in their 20's and then posted 17 reasons for young people to get insured to his blog.
posted by reenum on Oct 9, 2013 - 189 comments

"October is a fine and dangerous season in America"

Happy Political Clusterf*ck Day (U.S.)! In one corner: the first federal government shutdown since 1996, born of the House GOP/Tea Party faction's crusade to delay, defund, and destroy Obamacare (and the Democratic Senate and President's resolve to not do that). "Continuing resolutions" have ping-ponged between the two houses, fighting over language to cancel healthcare reform (plus a few other items, such as the implementation of Mitt Romney's entire economic agenda). National parks are closed, contractors are hamstrung, and 800,000 federal workers furloughed until Speaker Boehner drops the "Hastert Rule" and passes a bill the other branches can agree to. In the other corner, heedless of the chaos (though not without glitches of its own): the official rollout of the Affordable Care Act and its state insurance exchanges. The portal at Healthcare.gov is your one-stop shop for browsing, comparing, and purchasing standardized, regulated insurance coverage with premium rebates, guaranteed coverage, and expanded Medicaid for the poor (in some states). A crazy day, overall -- but peanuts compared to what might happen if the debt ceiling is breached in 16 days. [more inside]
posted by Rhaomi on Oct 1, 2013 - 2207 comments

Distance equation

  1. It is strange, in my opinion, that the insurance market has evolved so, that so few individuals understand the fundamentals of the medical insurance plans they are insured under."
  2. Among the 19% polled who are uninsured, nearly four in 10 don't realize the law requires them to get health insurance next year. Among young people, whose participation is seen as crucial for the exchanges to work, just 56% realize there's a mandate to be insured or face a fine.
  3. Health policy is an extremely personal and complicated topic... Observing historical patterns of attempted healthcare reform and backlash towards these reforms, we may begin to understand what is keeping such a prominent and promising nation from enlisting a social contract of health.

posted by four panels on Sep 26, 2013 - 172 comments

Because I Could Not Stop For Death Panels

The Collected Poems of the Affordable Care Act
posted by SkylitDrawl on Sep 25, 2013 - 13 comments

“It just got very, very old and all of us felt that we were whores."

More than half the population of small, rural Madras, Oregon (population: ~6059) and its surrounding community is served by one clinic: Madras Medical. At the beginning of 2006, the clinic's doctors and nurses decided to ban pharmaceutical reps from visiting their practice. No more free lunches. No more free drug samples. No more gifts. And yet.... "It's made us better doctors." (Via) [more inside]
posted by zarq on Aug 27, 2013 - 40 comments

A salt assault

How to Charge $546 for Six Liters of Saltwater - a brief story of the humble bag of saline solution given intravenously at ERs and hospitals, and how one unit of it can be marked up from 86 cents to $91 when given to patients
posted by Blazecock Pileon on Aug 27, 2013 - 69 comments

Fried Twinkies With a Side of Obamacare

A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare. The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers. “Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn't. If he signs up, it's a win-win, whether he knows he's been ensnared by Obamacare or not.
posted by reenum on Aug 26, 2013 - 63 comments

Sick Costs.

John Green: "Why Are Americans Health Care Costs So High?" A quick, handy little overview of common misconceptions on the US healthcare system. (SLYT)
posted by The Whelk on Aug 22, 2013 - 73 comments

'Paying Till It Hurts': Why American Health Care Is So Pricey

NPR's Fresh Air interviews Elizabeth Rosenthal about her year spent investigating the high cost of health care.
"Every part of the system needs to rethink the way it's working. Or maybe what I'm really saying is we need a system instead of 20, 40 components, each one having its own financial model, and each one making a profit." [more inside]
posted by arcticseal on Aug 11, 2013 - 105 comments

"We’re going from Bergdorf’s to Filene's here."

The New York Times is reporting that state health insurance regulators have approved 2014 prices for individual health insurance (SLNYT) in New York State that are on average 50% lower than 2013 rates. [more inside]
posted by medusa on Jul 17, 2013 - 149 comments

Only in America

American Way of Birth, Costliest in the World (SLNYT)
posted by MisantropicPainforest on Jul 1, 2013 - 104 comments

"We’re giving just enough to prevent them from dying."

Because of nationwide shortages, Washington hospitals are rationing, hoarding, and bartering critical nutrients premature babies and other patients need to survive. Doctors are reporting conditions normally seen only in developing countries, and there have been deaths. How could this be allowed to happen?
[more inside]
posted by the man of twists and turns on Jun 23, 2013 - 113 comments

All men are created equal (but some bits just cost more)

As part of the Affordable Care Act, The Centers for Medicare and Medicaid Services has released data that show significant variation across the country and within communities in what hospitals charge for common inpatient services. (via) [more inside]
posted by dubusadus on May 28, 2013 - 69 comments

The Oregon Health Insurance Experiment

The Oregon Health Insurance Experiment, an outgrowth of Oregon's 2008 lottery to allocate Medicaid slots to eligible residents, has released their second year of results (Previous discussions on the lottery and the experiment). The gist of the results are that they found statisitically significant reductions in catastrophic health care expenditures, improvements in the incidences of depression, and increased use of health care services. They found minimal (and not statistically significant) improvements in the rates of physical health indicators (diabetes and hypertension) they tracked. Because of ethical concerns, there are no other randomized controlled tests on this scale that study the effects of Medicaid and few on the effects of health insurance in general (the only significant one being a RAND study released 30 years ago). Because of the small amount of information available on the topic and the impending Medicaid expansion offered by Affordable Care Act, this study has drawn a lot of attention from political commentators. This will presumably be the last year these results will be published, as the state of Oregon was able to find extra money in 2010 in order cover the rest of its Medicaid-eligible population. [more inside]
posted by Weebot on May 3, 2013 - 20 comments

Texas Gets Its Report Card

While a bit parochial, this post reveals some things worth pondering if you are considering relocating to Texas...

The Texas Legislative Study Group released its 2013 “Texas on the Brink” report at the end of last week. The report is an annual study to determine Texas’ rankings among the 50 states and the District of Columbia on health care, education, and the environment. How’s Texas doing? Not so great: The state ranks 50th in high school graduation rate, first in amount of carbon emissions, first in hazardous waste produced, last in voter turnout, first in percentage of people without health insurance, and second in percentage of uninsured kids... - via The Texas Observer
posted by jim in austin on Apr 16, 2013 - 71 comments

How amazing is my thought!

Lewis Thomas (1913-1993) was a physician and essayist, writing gracefully on topics as varied as language, nuclear war, and our excellent health and deplorable health-care system (PDF). He believed that the existence of Bach vindicates humanity, that "ants are so much like human beings as to be an embarrassment", and that the Earth is perhaps best thought of as a cell. A three-time winner of the National Book Award, Thomas authored Lives of a Cell, which was voted the 11th-best nonfiction work of the 20th century by the Modern Library.
posted by seemoreglass on Apr 8, 2013 - 15 comments

Not So Evergreen

"India's supreme court has ruled against Swiss drug giant Novartis in a landmark case that activists say will protect access to cheap generic drugs in developing nations." [more inside]
posted by vidur on Apr 1, 2013 - 15 comments

We are powerless buyers in a sellers’ market

Bitter Pill: Why Medical Bills Are Killing Us. Summary: Inside the Cover Story. Related video: The Exorbitant Prices of Health Care [more inside]
posted by zarq on Feb 21, 2013 - 85 comments

this is why that is important

NSFWCORP presents This Is How You Healthcare: American Death in London by Sarah Bee:
The main things that keep me sane are the airy beauty and peacefulness of the hospital building, messages from friends and family far away on earth, the mundane magnificence of the staff: and the knowledge that all of this is free and taken care of and I do not have to fill in a single fuckforsaken form or bust one precious braincell worrying about how I might have to find money to pay for the futile care of my dying deadbeat dad.
[more inside]
posted by fight or flight on Feb 19, 2013 - 84 comments

Cat Bites Man. Hospital Charges $55k.

Call it the $55,000 cat bite.
posted by Kitty Stardust on Jan 28, 2013 - 205 comments

Abortion in America

The Geography of Abortion Access - Forty years ago Tuesday, the Supreme Court ushered in legal abortion for American women when it decided in Roe v. Wade. Today, states—particularly in the South and Midwest—are eroding that right by legislating hundreds of provisions intended to impede access with burdensome obstacles. To understand more fully the complex state of access to abortion services in America, The Daily Beast identified and confirmed the location of the country’s remaining 724 clinics and calculated the distance from every part of the country to its closest clinic. (more)
posted by Artw on Jan 24, 2013 - 26 comments

This is day-to-day, everyday life.

There are four states in this country where there is only one abortion clinic in the whole state, including Mississippi, which is facing the prospect of becoming the first state where abortion access is, effectively, gone. via
posted by roomthreeseventeen on Jan 19, 2013 - 53 comments

The Costs and Solutions to American Health Care

Three excerpts from David Goldhill's new book on American health care:

Part One: Focus on Health-Care Costs Causes More Spending

Part Two: Obamacare Math Doesn't Add Up to a Healthier U.S.

Part Three: To Fix Health Care, Turn Patients Into Customers [more inside]
posted by hopeless romantique on Jan 7, 2013 - 109 comments

Do Not Disturb: Grandma’s Having Sex

Adults over 50 are the fastest growing demographic for online dating sites, according to a recently [sic] study from UCLA’s department of psychology. Yet while older adults often value companionship over passion and marriage, experts say frisky behavior by seniors should never be underestimated. “I hesitate to generalize that they’re only having gentle, intimate moments,” says Melanie Davis, co-president of the national Sexuality and Aging Consortium. “Older adults can have really hot sex.” But not, typically, in long-term care facilities.
posted by Pirate-Bartender-Zombie-Monkey on Dec 21, 2012 - 34 comments

The Definitive Guide to the Medicare Debate

Jonathan Cohn compares the effects on Medicare from the Affordable Care Act with the proposals being promoted by Mitt Romney and Paul Ryan.
posted by reenum on Aug 23, 2012 - 27 comments

3D-Printed "Magic Arms"

Two-year-old Emma wanted to play with blocks, but a condition called arthrogryposis meant she couldn't move her arms. So researchers at a Delaware hospital 3D printed a durable custom exoskeleton with the tiny, lightweight parts she needed.
posted by Foci for Analysis on Aug 3, 2012 - 24 comments

Canadian medical professionals react in disbelief, shock and horror to how things work in the US

"I believed based on my politics that government mandated health care was a violation of my freedom." When a "die-hard conservative Republican" woman moves to Canada and encounters the universal healthcare there, hilarity ensues as cultures clash.
posted by MartinWisse on Jul 20, 2012 - 210 comments

Wait, wait...

But it is already too late. CNN has been carefully orchestrating its transformation into a shockingly efficient news distribution company. They have been planning to saturate every screen in reach with this story as fast as possible, and the producer’s initial go-ahead pulled the trigger. On the air, Wolf Blitzer is sending the coverage to the Courthouse steps. And as planned the reporter is putting her phone down to go on the air, which cuts herself off from the only CNN employee with access to the opinion. We’re getting wildly differing assessments: SCOTUSblog compiles first-hand accounts of the minutes between 10:06 and 10:15am on June 28, when CNN and FOX misreported and retracted that the mandate had been struck down.
posted by youarenothere on Jul 8, 2012 - 75 comments

Misconception #247: It's actually called Bidencare.

What's Obamacare? A studious Reddit user has read the mammoth 955-page Patient Protection and Affordable Care Act, and outlined the important points of what the new law actually does, with specific citations. While the recently-upheld law itself remains unpopular, most individual components of the bill enjoy widespread popularity among republican politicians and the public, despite the fact that both groups remain largely unaware of the bill's actual provisions. [more inside]
posted by schmod on Jul 2, 2012 - 82 comments

The end of "With this policy, I thee wed."

Obamacare: One Less Reason to Get Married. Erin Gloria Ryan of Jezebel writes: Insurance Marriages had become to the 21st century what shotgun weddings were to jokes about hillbillies. Back in 2004, the LA Times wrote about couples that married for insurance, couples who for varying reasons had not wanted to marry, but who had been driven to marriage by financial necessity. ABC News posted its own roundup of With This Policy, I Thee Wed-style couples in 2008, as did the New York Times. In 2008, 7% of couples who married reported doing so primarily for the insurance benefits. [more inside]
posted by Cash4Lead on Jun 30, 2012 - 61 comments

Tie game. Bottom of the 9th. Bases loaded. Two outs. Three balls. Two strikes. And the pitch...

In less than an hour, the Supreme Court will hand down its final judgment in what has become one of the most crucial legal battles of our time: the constitutionality of President Obama's landmark health care reform law. The product of a strict party line vote following a year century of debate, disinformation, and tense legislative wrangling, the Affordable Care Act would (among other popular reforms) require all Americans to buy insurance coverage by 2014, broadening the risk pool for the benefit of those with pre-existing conditions. The fate of this "individual mandate," bitterly opposed by Republicans despite its similarity to past plans touted by conservatives (including presidential contender Mitt Romney) is the central question facing the justices today. If the conservative majority takes the dramatic step of striking down the mandate, the law will be toothless, and in danger of wholesale reversal, rendering millions uninsured, dealing a crippling blow to the president's re-election hopes, and possibly endangering the federal regulatory state. But despite the pessimism of bettors, some believe the Court will demur, wary of damaging its already-fragile reputation with another partisan 5-4 decision. But those who know don't talk, and those who talk don't know. Watch the SCOTUSblog liveblog for updates, Q&A, and analysis as the truth finally comes out shortly after 10 a.m. EST.
posted by Rhaomi on Jun 28, 2012 - 1173 comments

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