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]
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]
John Green: "Why Are Americans Health Care Costs So High?" A quick, handy little overview of common misconceptions on the US healthcare system. (SLYT)
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.
This morning marked day two of marathon proceedings in what's likely the most momentous and politically-charged Supreme Court case since Bush v. Gore: the effort to strike down President Obama's landmark health care reform law. While yesterday was a sleepy affair of obscure technical debate, today's hearings targeted the heart of the law -- the individual mandate that requires most Americans to purchase insurance by 2014. With lower courts delivering a split decision before today, administration lawyers held some hope that at least one conservative justice could be persuaded to uphold the provision, which amortizes the risk that makes universal coverage possible. But after a day of deeply skeptical questioning by swing justice Anthony Kennedy and his fellow conservatives [transcript - audio], the mandate looks to be in grave trouble, with CNN legal analyst Jeffrey Toobin going as far as calling the day "a train wreck" for the administration. But it's far from a done deal, with a third day of hearings tomorrow and a final decision not expected until June.
Per capita US spending on health care in 2008 exceeded $7500-- more than any other OECD nation, half again the spending of the runner-up [PDF], and double its spending in 1990. Why? Aaron Carroll of the Incidental Economist explains in 12 parts. [more inside]
What US Health Care Needs Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. (via)
How American Health Care Killed My Father After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem. (via mr) [more inside]
Search for an Rx - We asked Johns Hopkins administrators, physicians, and researchers about the health of a system Americans rely on to keep them healthy. Afterall, an ounce of prevention... [more inside]