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
posted by psoas
on Apr 9, 2014 -
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 -
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 -
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 -
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 -
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 -
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 -
Happy Political Clusterf*ck Day (U.S.)
In one corner: the first federal government shutdown
, 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
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 -
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 -
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 -
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 -
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 -
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 -
"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 -
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 -
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.
posted by Artw
on Jan 24, 2013 -
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 -
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 -
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 -
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 -
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
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 -