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]
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]
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.
'A childhood that began with a sort of cautious optimism quickly devolved into absolute horse shit.'
“Old age isn’t a battle, it’s a massacre.” A son’s plea to let his mother go.
One Hospital | Hundreds of Stories. A YouTube Playlist. Experience a day in the life of a public hospital (Highland Hospital) in Oakland, CA at a moment of profound change to the nation's economy and its healthcare system. [more inside]
ReachOut Healthcare America, a dental management services company, “built its business model on the premise that low-income parents often don’t have time or transportation to take children to the dentist. So mobile teams pack equipment in large cases, load up a minivan, head to schools and set up in gyms, libraries or classrooms.” Services are billed to Medicaid. ReachOut and other dental management services companies are increasingly backed by private equity firms. What could possibly go wrong? [more inside]
Consumer Reports May 2012: What to reject when you're expecting (10 procedures to think twice about during your pregnancy; 10 things you should do during your pregnancy; 5 things you should do before you become pregnant). Mentioned in particular is the conclusion found in a federal study: Babies Take Longer To Come Out Than They Did In Grandma's Day."One big implication: Today's obstetricians may be rushing to do cesarean sections too soon because they're using an out-of-date yardstick for how long a 'normal; labor should take... The definition of a 'normal' labor — the range of times when a woman in labor reaches certain milestones — was laid down in the 1950s. Contemporary obstetricians still use that 'labor curve.'"
A chronic public health disaster. Complex trauma and toxic stress puts children into a state of reflexive fight, flight, or freeze responses to a perpetually threatening world. The traditional authoritative response only serves to reinforce those behaviours and, perhaps worse, has long-term health consequences:
With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; suicide, 1,220 percent.One doctor describes it as “a chronic public health disaster”. Remediating this problem is going to require listening, kindness, and parachutes.
Since she is not truly an emergency patient, she is triaged to the back of the line, and other folks, those in immediate distress, get in for treatment ahead of her. She waits on a gurney in a cavernous green hallway. The “chief complaint” on her chart at Grady Memorial Hospital, in Downtown Atlanta, might have set off a wave of nausea in a hospital at a white suburb or almost any place in the civilized world. It reads, “My breast has fallen off. Can you reattach it?” (via Boing Boing) [more inside]
Choosing Wisely encourages physicians and patients to discuss whether certain medical tests and procedures are unnecessary, especially those that can cause harm. The site offers nine lists of Five Things Physicians and Patients Should Question about the most appropriate care for a patient, including lists for cardiology and oncology. [more inside]
Deep vein thrombosis is generally a topic that comes up with regards to airline seating and other periods of prolonged immobility (previously). Anna Brown was a homeless woman and constantly on the move, so doctors in the emergency room thought that her complaints of leg pain were just drug-seeking behavior. Unfortunately, drug seeking is a major problem in ERs in the United States. [more inside]
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.
The GOP’s woman problem is that it has a serious problem with women. Frank Rich on George Stephanopoulos's unanswered question, how the Republicans have shifted to being the party of misogyny since the 70s, and why Mitt Romney would be just as bad as Rick Santorum.
An intrepid American reporter tests out perineal re-education, a state-sponsored wonder of the French health care system. She plays a game she nicknames Pole Position (and a friend gets to play Cooter Pac-Man). Bonus: many gentle euphemisms for vagina (Earlier test here from the NYT).
Mary Brown, a 56-year-old Florida woman who owned a small auto repair shop but had no health insurance, became the lead plaintiff challenging President Obama's healthcare law because she was passionate about the issue. Brown "doesn't have insurance. She doesn't want to pay for it. And she doesn't want the government to tell her she has to have it," said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation's case, which the Supreme Court plans to hear later this month. But court records reveal that Brown and her husband filed for bankruptcy last fall with $4,500 in unpaid medical bills. Those bills could change Brown from a symbol of proud independence into an example of exactly the problem the healthcare law was intended to address. [more inside]
In the summer of 2007 on the campaign trail Barack Obama took a clear stance on the controversial subject of medical marijuana. “I would not have the Justice Department prosecuting and raiding medical marijuana users. It’s not a good use of our resources.” As President in 2009 he took action to follow through on this promise by instructing federal prosecutors to “not focus federal resources in [their] States on individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.” The memo cited the “efficient and rational use” of the U.S. Department of Justice’s “limited investigative and prosecutorial resources,” as a motivating factor in the decision." In the winter of 2012 Rolling Stone magazine takes a look back on this subject and the record is surprising. "With more than 100 raids on pot dispensaries during his first three years, Obama is now on pace to exceed Bush's record for medical-marijuana busts. "There's no question that Obama's the worst president on medical marijuana," says Rob Kampia, executive director of the Marijuana Policy Project. "He's gone from first to worst." [more inside]
Kevin Zelnio is a science writer with a degree in marine biology. He is the father of two children. And, like many in this country, he has no insurance. Earlier this week, his 6 year-old developed pneumonia.This is his account of what happened.
"Guardian 24/7 combines best-in-breed technology with protocols designed to serve the President of the United States, offering unprecedented medical attention to a demanding audience. Thanks to Guardian, your medical care can finally look like the rest of your life[...]. Our innovative ReadyRoom™ strategy places essential equipment, medications and supplies where you live, move and work. Yet everything is hidden away until needed. [...]Before Guardian, this kind of medical protection was only available to one person. But now, presidential-level care can be yours — on your schedule and your terms." Don't miss the embedded video. This appears to be in earnest.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.How Doctors Die.
"This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry."
The term never event describes when something happens in a medical setting that should never occur. The list of never events (formally called "Serious Reportable Events) released by the NQF includes mistakes such as performing surgery on the wrong body part (or the wrong patient!), or patient suicide while under care. Despite their moniker, "never" events do happen. [more inside]
Yesterday, the Supreme court granted certiorari to several of the challenges to the constitutionality of the Affordable Care Act. Here's a great roundup of several news stories. I like the NPR story for a quick summary of the issues. The Court will hear a total of 5.5 hours of oral argument, and a decision is expected by the end of the current term, in June.
Dr. Jim Withers practices street medicine in Pittsburgh, PA. Operation Safety Net provides house calls to the homeless - to meet them on their terms. [more inside]
"What Every Woman Should Know" by Susie Cagle on Cartoon Movement provides an illustrated investigation of "crisis pregnancy centers" like First Resort. (via)
"The Justices all sit in high-backed leather swivel chairs, and Thomas has set his so that he can recline so far that he appears almost to be lying down. He stares at the ceiling. He rubs his face. He does not appear to be listening. He closes his eyes and sometimes appears to be asleep. The over-all effect is rude, if not contemptuous." The New Yorker profiles Justice Clarence Thomas, his wife Ginni's Tea Party connections and what they might mean for the inevitable SCOTUS ruling on Obama's Patient Protection and Affordable Care Act, and looks back on his confirmation hearings. Previously, Justice Thomas and Ginni; Obama and healthcare; SCOTUS.
Effective January 1, 2013, United States insurers will now be required to make a variety of medical procedures and medications available without copay as part of President Barack Obama's Affordable Care Act. Although the availability of prescribed birth control without copay is likely to have the widest effect, the plan also includes breast pumps for nursing mothers, an annual well-woman examination, and testing for gestational diabetes and the virus that causes cervical cancer, as well as other services related to women's health. [more inside]
Hesperian is a non-profit publisher of books and newsletters for community-based health care, mostly aimed at the third world. Their first book, Where There Is No Doctor, A Village Health Handbook, has been translated into 88 languages and is one of the most widely used training and work manuals for community health care in the world. They have now made 20 of their publications available for free download, many of which can now also be browsed online through their website using an "Ebrary" in-browser interface. [more inside]
The Oregon Health Insurance Experiment: Evidence from the First Year (or, What Happens When You Give Poor People Health Insurance?) "We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group." [more inside]
John Hyduk, a middle aged blue collar worker in Cleveland, writes about his daily existence.
- "Despite the fact that the US spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That's a staggering statistic."
The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need. - Atul Gawande’s commencement address at Harvard Medical School.
On the same morning that Dane County Circuit Judge Maryann Sumi struck down Wisconsin's infamous union-busting bill on the grounds that it violated the state's Open Meetings Law (PDF of decision, previously), Vermont Governor Peter Shumlin signed America's first state-level single-payer legislation into law. [more inside]
Obstetricians and gynecologists are meeting the increased demand for cosmetic vaginal surgery (NSFW)
With the constitutionality of the Affordable Care Act being argued in lower courts, it's probably also worth looking at Vermont's adoption of single-payer health care: "On May 26, Gov. Peter Shumlin of Vermont is expected to sign legislation that will create universal coverage in the state—eventually. Vermont will use subsidies from the Affordable Care Act to help create a Canada-style system. And its system, or so the theory goes, will become so popular and cheap that the rest of America will want to copy it." [more inside]
"With regard to the idea of whether or not you have a right to health care, you have to realize what that implies... It means you believe in slavery." Senator Rand Paul weighs in on the notion of human rights at a Senate subcommittee hearing yesterday, equating the right to health care, as well as the right to water and food, as tantamount to a belief in slavery.
"For the progress of humanity, work alone is not adequate, but the work should be associated with love, compassion, right conduct, truthfulness and sympathy. Without the above qualities, selfless service cannot be performed."On Sunday morning, Indian guru Sri Sathya Sai Baba passed away. He leaves behind a massive empire, several million mourning devotees worldwide, an extensive religious philosophy, a great deal of controversy and a legacy of large-scale philanthropic projects in India, including free hospitals and mobile medical facilities, a free university and schools, and other efforts which included supplying clean water to hundreds of rural villages. [more inside]
Coalition health reforms will spell the end for the NHS and lead to U.S. style system, claim researchers. 'Prof Allyson Pollock, from the Barts and The London School of Medicine, and David Price, senior research fellow at its Centre for Health Sciences, write in a paper published on BMJ.com that the legislation “amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery”. They say the Government “has repealed the health secretary’s duty to provide or secure the provision of comprehensive care” in order to create a commercial market in care. Instead, under the new system the state "finances but does not provide healthcare", in “equivalent to Medicare and Medicaid schemes in the US”'. Meanwhile, Dr Kim Price, claims 'the UK coalition government's planned NHS and welfare reforms, and their use of 'nudge' theory, hark back to ideas on welfare and recession from the end of the nineteenth century, according to studies by a University of Leicester historian whose research paper has recently been published in the Lancet'. [more inside]
Progesterone caproate injections have been used to reduce the likelihood of premature births in at-risk pregnant women for years. Up until now, the drug was custom-compounded by wholesale and specialist pharmacies, legally, but without federal approval. These injections cost between $5 and $15 a dose and were regularly reimbursed by insurance companies and Medicaid. Last month, the FDA announced their approval of a commercially produced version of the compound, to be marketed under the brand name Makena by a company called KV Pharmaceuticals. No stranger to controversy and trouble, KV barely survived a rash round of layoffs and wrongful termination lawsuits. Their former chief executive now faces criminal charges surrounding the company's failure to notify the FDA that they were producing oversized morphine tablets. (He could also do for a shave, it appears.) Now, KV has announced that the new drug will be available at a cost of $1,500 per dose, bringing the total pregnancy term cost of treatment to $25,000-$30,000, from its former cost of $250-$300, a 100-fold increase—but it gets worse... [more inside]
Hello! I am a person who is training to become an abortion provider. As you can imagine, it is really fucking weird to be one of me, especially lately!
South Dakota Rep. Hal Wick (R-Sioux Falls), is sponsoring a bill [text] which would require all citizens to buy a firearm “sufficient to provide for their ordinary self-defense” within six months of turning age 21. Rep. Wick said he is introducing the bill to prove a point that the federal health care reform mandate passed last year is unconstitutional. [previously] [more inside]
It's Only Rape if They Say So House Republicans decide to fight abortion access by redefining rape.
The Hot Spotters examines the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them. — by Atul Gawande [more inside]
HR 2, officially the "Repealing the Job-Killing Health Care Law Act", has passed in the U.S. House of Representatives with a vote of 245 to 189. 3 Democrats (Reps. Boren (OK), McIntyre (NC), and Ross (AR)) joined all 242 Republicans voting Aye. The bill will not be brought for a vote in the Senate, nor would it escape veto by President Obama. [more inside]
As a result of legal settlements, 7 of the major drug companies, representing a little over 1/3 of the prescription drug market in the US, are publishing their direct payments to physicians and other medical professionals. All payments are supposed to be published by 2013. Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?
The tax cut created in the new health care reform law providing small businesses with an incentive to give health benefits to employees is working.
Major health insurance companies around the country are reporting a significant increase in small businesses offering health care benefits to their employees. (via Forbes)
Wikileaks may have been the big news, but there were numerous other data breaches in 2010. [more inside]
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]