Texas' Other Death Penalty
November 16, 2013 8:02 AM   Subscribe

A Galveston medical student describes life and death in the so-called safety net. [via]
posted by AceRock (78 comments total) 57 users marked this as a favorite
 
My friend wrote this article! Thanks for posting it.

So many things to be upset about here. The lack of medical providers in many parts of the country; the fact that the not-big-enough safety net of charities and free clinics and indigent care in hospitals is getting smaller and smaller and more and more insufficient; the political callousness of states refusing the Medicaid expansion, thus hurting millions of people.

We've always (shamefully) accepted a world where poor people don't have the same rights and dignity as people with resources. Seems like it's getting worse - more people are getting pushed into the situation poorer people have always been in, and for those people there are fewer and fewer resources for help.
posted by aka burlap at 8:16 AM on November 16, 2013 [14 favorites]


Vanessa’s request for UTMB funding wasn’t approved. She has received a $17,000 bill from UTMB for the visit when Jimmy went through the ER, and a $327,000 preliminary bill from the Houston hospital.

Christ.

They worked hard. They got married. They moved for better job opportunities. All so they could be thrown away like garbage because they had the moral failing of being employed and uninsured.
posted by rtha at 8:20 AM on November 16, 2013 [31 favorites]


Thank you for posting this.
posted by you must supply a verb at 8:28 AM on November 16, 2013 [3 favorites]


I read this earlier and I still can't get it out of my head-- just as I can't get the images of various cancer patient fundraisers, or the article on similar stop-gap care at Atlanta's Grady Hospital from last year. The article's comments are splattered with the predictable froth about "death panels," but they never seem to recognize that we already have them: the insurance companies who won't cover treatments, the hospitals that can't afford (or won't) treat charity patients, the representatives of states who refused to accept the Medicaid expansion. Those are the terrifying and omnipotent guardians of health care against the tired, the poor, and the huddled needy.

I have amazing healthcare in the United States. I could get a CT scan or an MRI on Monday, if I needed to, and I would probably pay $30 bucks. I can walk to several hospitals and medical specialists of every stripe and color (but we also have public transportation, cabs, and at least one hospital has valet parking options.) I have gotten refunds from my health insurance company when they have overcharged me. Why? Because I have a job that happens to have nice benefits, in an area with an extraordinary amount of wealth. Because I got lucky. Why is the US still fighting for a system that primarily benefits the wealthy and the lucky?
posted by jetlagaddict at 8:30 AM on November 16, 2013 [55 favorites]


She's right, these people do matter. For Rick Perry to decline Federal aid to increase Medicaid coverage is a moral failing and I hope he lives to regret the decision while he still has a chance to fix it. Unfortunately, that doesn't help those in need now. How did we end up with a situation where a supposedly Christian state feels it is okay to say "I've got mine, screw you"? It makes me weep.
posted by arcticseal at 8:36 AM on November 16, 2013 [14 favorites]


I couldn't finish that article; too hard to read in such a clear way how American health care "system" lets people die.
posted by MartinWisse at 8:49 AM on November 16, 2013 [3 favorites]


It's a sad commentary on our society that stories like these of genuine, verifiable suffering are drowned out in the mainstream press by op-eds from healthy people whose biggest problem is that their insurer tried to push them into a more profitable plan. The 25% uninsured number in Texas just blows my mind, and reading the stories of the people behind that number confirms that the ghouls trying to use emotional stories of canceled plans to ensure that many more sick people can never have the opportunity to get coverage in the first place are the worst people in the world.

"Doctor" Rachel sounds like a wonderful human being. It's a shame so many vile human beings are making her uncommon level of generosity necessary.
posted by tonycpsu at 8:50 AM on November 16, 2013 [15 favorites]


The article does a good job of mentioning where Hurricane Ike and its aftermath affected the community, and specifically how state and local officials used the situation as a passive-aggressive excuse to push a quiet agenda against regular folks.
posted by gimonca at 8:51 AM on November 16, 2013 [4 favorites]


Why is the US still fighting for a system that primarily benefits the wealthy and the lucky?

Because never in history have the wealthy lacked sycophants to lick their assholes and promote their interests.
posted by Steely-eyed Missile Man at 9:21 AM on November 16, 2013 [23 favorites]


This reminds of something Brad DeLong posted on his blog about his experiences working in the Treasury Department in the Clinton Administration. DeLong posted a conversation between him and another assistant secretary at the Treasury Department who made it clear that DeLong had a lot to learn about Texas Republicans:

Another Treasury Department Assistant Secretary (ATDAS): "You don't understand the Republicans we have in the South, and in Texas. You know of Northeastern and Left Coast Republicans. Even Midwestern Republicans--especially Bob Dole--actually think that sick and disabled people, even if they are poor, should be able to get the health care that is good for them, without having to beg. That's not the case with Republicans down in Texas. Republicans in Texas think that if you can't pay the doctor out of what is in your pocket and from the insurance policy you bought, then you need to go beg at your church. And only after you have begged at your church, and begged sincerely and abjectly enough, might your church find itself paying for you out of Christian charity--the benefit of which is to save their souls, not your body!"

DeLong: But...

ATDAS: "They don't like Medicaid. They don't like Medicaid because it short-circuits this process. You get treated but you don't have to beg for it. The only reason they vote for Medicaid--and Texas only votes for grinchy Medicaid--is that the rich doctors of Dallas and Houston who contribute so much to the Republican Party think that Medicaid means that they don't have to dig into the pockets of their practices to support charity care."

DeLong: But what if you don't have a church!

ATDAS: "Then you should go join one, shouldn't you? That's a benefit..."

Me: But...

ATDAS: "You listen to Moynihan talk about how Texas taxes pay for only half of federal Medicaid dollars that go to Texas, and you think Medicaid should be popular even among Texas Republicans for the same reason that Fort Hood and the Johnson Space Flight Center are popular among Texas Republicans? But Medicaid is unpopular in Texas--not because rich Texans know their federal taxes go to it, and not because state taxes have to be raised to pay for the state match, but because it short-circuits the begging process..." (link)
posted by jonp72 at 9:29 AM on November 16, 2013 [59 favorites]


DeLong posted a conversation between him and another assistant secretary at the Treasury Department who made it clear that DeLong had a lot to learn about Texas Republicans

I don't think it's just Texas Republicans -- I think a lot of self-identified "conservatives" in this country view being sick or losing your job as some sort of moral failing. Thus you are not worthy of help. It also helps them characterize you as "the other" so they don't have any self-doubt when they implement the policies that adversely impact people.
posted by CosmicRayCharles at 9:41 AM on November 16, 2013 [6 favorites]


jonp72: Mind blown. The article and this snippet is another reminder that some people truly live in a different world. The republican mindset is so different to my own that I can not even begin to understand it. Thanks for posting this, OP and jonp27.
posted by nostrada at 9:43 AM on November 16, 2013 [1 favorite]


This kind of suffering-- this structural violence against people-- is omnipresent. The photos of that tiny clinic could have been taken at my tiny clinic. It's a familiar picture right down to the patients who are going to die because my governor also refused the medicaid expansion. And to think four years ago we were talking about ending homelessness in Philadelphia.
posted by The White Hat at 9:46 AM on November 16, 2013 [23 favorites]


As Joy Reid pointed out on Twitter:

Understand how thoroughly the insurance cos have won the healthcare debate. The entire debate is down to their right to sell junk policies.

Not how we care for everyone, but how everyone has to buy insurance and whether or not they can keep the policy where they pay to be uncovered for anything major.
posted by fifteen schnitzengruben is my limit at 10:04 AM on November 16, 2013 [9 favorites]


Hello from only a few miles away from Galveston. The most frustrating thing is, the people hurting from this (the desperate, the poor, the folks with the bad luck to be poor but have not reproduced, but also the contractors who work without insurance and the other groups who have about 100 other reasons we have a high uninsured rate), will either ferociously defend their "right" to not have insurance or else will not vote.

It's frustrating.
posted by Houstonian at 10:18 AM on November 16, 2013 [4 favorites]


I grew up in Houston and live in Austin. This is one of those articles I had to file away for a time when I'm able to handle reading it. The state of healthcare for the uninsured here is appalling and depressing.

And I can totally believe that DeLong conversation. If you posed it to an actual churchgoer that way, they'd be horrified, but there's a lot of truth to it.
posted by immlass at 10:28 AM on November 16, 2013 [1 favorite]


As long as health care is viewed as a business opportunity instead of a basic human right, there is no hope for change.
posted by thatweirdguy2 at 11:22 AM on November 16, 2013 [21 favorites]


From to time I fantasize that should make it part of a congress critter's job to go down to the free clinic every few months and tell someone they will be dying from a treatable disease.

Then I get frightened that they'd actually feel good about themselves for doing it.
posted by Tell Me No Lies at 11:25 AM on November 16, 2013 [10 favorites]


Our governor also refused the Medicaid expansion because even though it would cover 123,000 more Utahns it would likely be "a wash" budget-wise.

It wouldn't affect the budget, and it would cover 123,000 more people. NO THANKS, OBAMA.

Jesus, I hate this state sometimes.
posted by mr_crash_davis at 11:29 AM on November 16, 2013 [13 favorites]


There is only one medical procedure that qualifying patients will get in Texas regardless of their financial status:

An autopsy
posted by Renoroc at 11:31 AM on November 16, 2013 [3 favorites]


I don't think it's just Texas by any means. Sadistic poor-hating is so widespread among Americans that probably several people you know and think well of practice it. I'd go so far as to say that it's basically normal.
posted by Pope Guilty at 11:36 AM on November 16, 2013 [9 favorites]


Thanks for the post, AceRock.

It's not bad enough that TX and other GOP-dominated states refuse Medicaid expansion denying health care to millions, they pull no stops to try to deny care to everyone.

TX is also enacting navigator suppression tactics to limit or deny information and help about ACA eligibility to people. For states that didn't set up their own exchanges, the feds financed grants for navigator outreach to help people understand and enroll in ACA -- but At least 13 states have established navigator suppression measures (PDF).

"These excessive requirements include such things as residency rules, fingerprinting, extra fees, superfluous certification exams and background checks, even though previous experience with Medicare counselors suggests that no such protections are needed.

The net effect of state-led navigator suppression will be to perpetuate the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in
minority and lower-income populations."

More here in The New Yorker: Obstructing Obamacare’s Navigators.

The audio portion of this NPR story discusses TX suppression measures: Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups

This makes me spitting mad. If you want to do something between now and when we can vote some of these bastards out, blog, tweet or FB post this TX article and other articles about the real effects that obstruction has.
posted by madamjujujive at 11:40 AM on November 16, 2013 [18 favorites]


Some branches of "Christianity" are making it more difficult for the poor.

But if you're not rich, then what? Are the poor cursed by God because of their unfaithfulness? And if God were so concerned about 401(k)s and Mercedes, why would God's son have been born into poverty?

Nowhere has the prosperity gospel flourished more than among the poor and the working class. Told that wealth is a sign of God's grace and favor, followers strive for trappings of luxury they can little afford in an effort to prove that they are blessed spiritually. Some critics have gone so far as to place part of the blame for the past decade's spending binge and foreclosure crisis at the foot of the prosperity gospel's altar.

posted by leftcoastbob at 11:53 AM on November 16, 2013 [2 favorites]


In a functioning polity Rick Perry's and the legislature's decisions not to expand Medicaid would get them brought up in front of a tribunal. We love attributing deaths to tyrants in other countries whenever we can, but how many thousands of deaths (and shortened life spans) belong at Perry's (and others') feet?

Next time someone randomly claims that Stalin killed X million, I know I'll wonder how many we should count for Perry.
posted by allen.spaulding at 12:03 PM on November 16, 2013 [20 favorites]


NPR had a segment yesterday which had a discussion about ACA insurance policy guidelines which nearly went into "we need a single payer program" territory.
SIEGEL: You mentioned maternity and newborn care benefits, which are mandated. We've heard from some people who say, look, my husband and I are in our late 50s. Our children are long grown and out of the house and off our policies. We're within, you know, a decade of qualifying for Medicare. Maternity care is just not something that we need. They can't buy a policy that excludes that benefit?

POLLITZ: Well, today, they will buy a policy that excludes the benefit. But in the future, no. All policies will have to cover it and...

SIEGEL: And what's the rationale for that?

POLLITZ: The rationale for that is when you're buying insurance, you and everybody else who's buying the policy are buying protection and you're sharing in that protection. So, you know, you don't have to buy a policy that covers maternity care, even though you're never going to have a baby. Maybe I don't want to buy a policy that's going to cover prostate cancer even though I'm never going to have that. So the policy takes care of people and all of the conditions that can happen to people, and we all kick in a premium so that there will be enough to take care of any one of our conditions when they arise.
posted by hippybear at 12:11 PM on November 16, 2013 [1 favorite]


As a country, the US has a poverty of everything not physical and its rotting the foundations. Not so slowly as it used to, either.
posted by Slackermagee at 12:29 PM on November 16, 2013 [1 favorite]


I've had a couple of heated discussions in the last week or so about insurance and how to provide for those that don't have enough. The point seems to be lost on some people that the well pay for the sick and to some extent the rich pay for the poor because that's how health insurance works.

Then again I was the only one in my circle to support the thesis that there are legitimate and necessary forms of human enterprise from which no one should be allowed to make a profit, chief among them health insurance and incarceration.

I mourn for those caught in such a sadistic system and count my blessings that — for now — I am not among them. God Bless America.
posted by ob1quixote at 12:42 PM on November 16, 2013 [16 favorites]


The point seems to be lost on some people that the well pay for the sick and to some extent the rich pay for the poor because that's how health insurance works.

I assure you, the point wasn't lost on them. They're completely aware of that point. It's that exact point that they want to change. They want to disconnect the well and rich from the sick and poor. It's all part of their "I got mine, fuck you" worldview.
posted by Thorzdad at 12:48 PM on November 16, 2013 [12 favorites]


So. Angry.
posted by maxwelton at 12:55 PM on November 16, 2013 [1 favorite]


Thorzdad, that's why those "fuck you/got mine" people are a threat to our national well being. They aren't negotiating in good faith. They're enemies of humanity.
posted by wuwei at 1:05 PM on November 16, 2013 [5 favorites]


The Affordable Care Act, better known as Obamacare, could have been a huge relief. However, Gov. Rick Perry rejected billions of dollars in federal funding to expand Medicaid, funding that should have brought access to more than a million Texans, including many St. Vincent’s patients.

For everything they have done to harm Texans I hope Rick Perry and his supporters rot in hell.
posted by WalkerWestridge at 1:08 PM on November 16, 2013 [4 favorites]


Working in a public, county hospital, I find this article incredibly resonant. More than 95% of my patients are sick because of poverty. The folks who are struck by random bad luck/weird genetics are so much worse off than they'd be if they had money. Every one else is sick from diseases of poverty which, where I live, are diabetes, heart disease and gun violence. The experience of receiving health care is further impoverishing for most of them - losing work, astronomical medical bills. There are days when the only people I feel I'm really helping are the homeless, who at least got a few days off the street while they're in. But of course when our 3 day shelter voucher runs out, they're back on the street, sicker.

It's terrible.
posted by latkes at 1:19 PM on November 16, 2013 [6 favorites]


I have a friend who provided medical care to a prison population in Galveston. After Ike, that whole program just. ... it ended.

Hell. Rotting. Rick Perry. Yeah.
posted by Lesser Shrew at 1:27 PM on November 16, 2013 [3 favorites]


I was the only one in my circle to support the thesis that there are legitimate and necessary forms of human enterprise from which no one should be allowed to make a profit, chief among them health insurance and incarceration.

I've gotten some shocked reactions when I say things like this, but my list includes not only health care and incarceration, but covers military contractors (like Blackwater/Xe) and basic public education. There are some things that really are done best by the government, because introducing a profit incentive leads to bad policy outcomes.
posted by ambrosia at 1:33 PM on November 16, 2013 [25 favorites]


As another point- I can't speak to this with authority because I'm not all that bright or skilled but it's worth noting the way that program funded care helps create the environment where hospital systems have the room to provide swanky muffin-basket-for-visitors care in surgical centers and what have you. As I understand it, hospitals lobbied long and hard to make their states take expansion. And that's outsided of meaningful use concerns.
posted by Lesser Shrew at 1:37 PM on November 16, 2013


Which prison is in Galveston?
posted by Houstonian at 1:47 PM on November 16, 2013


It is likely that Texas politicians are going to face increasing pressure from their wealthy contributors in the health industry to accept Medicaid expansion. In the past, Medicaid paid billions of dollars to hospitals to reimburse them for uncompensated care to the indigent. Starting in 2014, those payments are being phased out because the assumption is that everyone will be insured, regardless if states accept Medicaid expansion. So in states that aren't expanding Medicaid, hospitals and other health service providers are going to be stuck with billions in unpaid medical care. Health care executives are going to be screaming like stuck pigs.
posted by JackFlash at 1:52 PM on November 16, 2013 [1 favorite]


Thanks for the post.

Looking at the US from outside, I see "life, liberty, and purfuit of happineff", which was a radical concept 250 years ago, but unquestioned today...and I think that good health and freedom from being bankrupted by catastrophic illness are the next natural steps to take, for both moral AND economic reasons.
posted by Artful Codger at 1:52 PM on November 16, 2013 [2 favorites]


Mother Jones science writer Chris Mooney, host of the Inquiring Minds podcast and author of The Republican Brain: the Science of Why They Deny Science – and Reality:
liberals feel, most of all, this harm-care-compassion thing. Conservatives ... have this other morality. Haidt compares it to karma... where basically, you’re supposed to get what you deserve. And what really bothers them is somebody not getting what they deserve. So the government getting involved and interfering with people getting what they deserve is really bad.
posted by ohshenandoah at 1:55 PM on November 16, 2013 [3 favorites]


Conservatives ... have this other morality. Haidt compares it to karma... where basically, you’re supposed to get what you deserve. And what really bothers them is somebody not getting what they deserve.

This is obviously a definition of "deserve" which needs to be examined and perhaps changed.
posted by hippybear at 2:08 PM on November 16, 2013 [1 favorite]


I just don't understand. I don't fucking understand. [/Canadian]
posted by jokeefe at 2:24 PM on November 16, 2013 [4 favorites]


jonp72's quote above put me in mind of this book review and shredding of David Frum (’s Dead Right). It's a long but fun read.

The central point is simple, and seems to apply well here: The values and philosophy of Conservatism is the appreciation of hardship, therefore in order to make the world right again you need to make it hard to live again.
posted by tychotesla at 2:36 PM on November 16, 2013 [1 favorite]


I just don't understand. I don't fucking understand. [/Canadian]

Canada doesn't have the solo pioneer myth? The rugged individualists who took their families into the wilderness and built farms and were entirely self-sufficient?

It never happened in the U.S. but it's a big part of our mythology. In that view healthcare and big city doctors are a luxury. Americans have been removing our own appendixes since the founding of this country and if poor people aren't up to the task they are just a symbol of how decadent we've become as a society.

In short people may want healthcare, but they don't *need* it. Same goes for food, shelter, etc. Our (mythical) ancestors hacked them out of the forest with an axe, people today can and should do the same.
posted by Tell Me No Lies at 2:42 PM on November 16, 2013 [5 favorites]


Our (mythical) ancestors hacked them out of the forest Native People with an axe

FIFY.
posted by hippybear at 3:04 PM on November 16, 2013 [4 favorites]


Conservatives ... have this other morality. Haidt compares it to karma... where basically, you’re supposed to get what you deserve. And what really bothers them is somebody not getting what they deserve.

This reminded me of a something I had been following for a while - "the family" - a group of republicans who had sort of a dominionist philosophy that leaders were chosen by God and good works were sort of a trickle down affair from the mighty.
This NPR interview with Jeff Sharlet from a few years back is about his book The Family: The Secret Fundamentalism at the Heart of American Power. It's a movement/philosophy with deep roots and it goes a long way to explaining the Rick Perry type of outlook. It's well worth the 20 minutes to listen to - in fact, I have always meant to get that book and may do it now.

Related prior post: The New Chosen.
posted by madamjujujive at 3:09 PM on November 16, 2013 [4 favorites]


To me it's summed up by Craig T. Nelson's immortal line, "I've been on food stamps and welfare, did anybody help me out? No." In his personal narrative, he pulled himself out of poverty by hard work, and such is his cognitive dissonance that his definition of poverty includes the safety net that caught him, and which he is specifically railing against being available to others.
posted by George_Spiggott at 3:10 PM on November 16, 2013 [24 favorites]


in fact, I have always meant to get that book and may do it now.

I "found" an electronic copy of that book a while back. It was terrifying to read. I highly recommend it.
posted by hippybear at 3:25 PM on November 16, 2013 [1 favorite]


This is shameful.

I am so ashamed of my country when reading this. I want to apologize to these people, I want to tell them how sorry I am that our society has failed them so terribly.

"That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying"

I want everyone who thinks that "anchor babies" and "freeloaders" and "illegals" and whatever other awful terms people use to describe those less privileged than they are, who complain about all the free healthcare they think hospital emergency rooms give out to people to have to read this sentence over and over again.
posted by inertia at 3:48 PM on November 16, 2013 [7 favorites]


My wife and I are dealing with Oklahoma's rejection of ACA right now. Her situation isn't necessarily life-threatening, but she's got a lot of problems that are bad and getting worse. I just woke up, and have to go to work, but here's a blog post I did about our situation.

tl;dr: According to the Federal Government, my wife is eligible for "free or low-cost" health insurance, but the State of Oklahoma has "chosen not to offer it" to her.

Gotta go for now. Which is probably a good thing. I get too angry about all this.
posted by landis at 3:57 PM on November 16, 2013 [6 favorites]


I have a friend who provided medical care to a prison population in Galveston. After Ike, that whole program just. ... it ended.

I assume you're talking about this dispute:

Making good on an earlier threat, officials at the University of Texas Medical Branch in Galveston are seeking to stop providing medical care to the state's 154,000 convicts at in-prison clinics it now runs.... [Dr. David Callender, UTMB's president, said in the letter that the university "is principally interested in continuing to provide offender health care services at UTMB facilities on Galveston Island." The acute care at the prison hospital is the most lucrative part of the prison health care system; the 85 in-prison clinics have been tagged in the past as money-losers.] -- Austin Stateman

The other 76 percent of the contract makes no sense. That money is spent at the prisons. There is no academic interest there. Doctors are not trained there. Neither are nurses. The services the medical branch provides are on a contract basis, and the state resolutely has declined to pay for the costs. That leaves the medical branch to cover the debt until the legislature belatedly appropriates the money to cover the bills. -- Galveston Daily News


Via Grits for Breakfast, which has as its top comment the relevant:

Or we could just stop furnishing convicted criminals such expensive healthcare when there are millions of law abiding citizens in this country who are desperate for medical care and insurance coverage. It's always struck me as an odd notion that somehow the state is obligated to provide anything other than rudimentary medical care to people who demonstrate that they cannot abide by the law or conform to societal norms..... &c.
posted by dhartung at 4:03 PM on November 16, 2013 [1 favorite]


Canada doesn't have the solo pioneer myth? The rugged individualists who took their families into the wilderness and built farms and were entirely self-sufficient?

Nope. We have the myth that the RCMP arrived before the setters, and made everything nice and orderly on the frontier so that the settlers could go about their law-abiding business in a community-minded way.

I was actually taught this in elementary school, along with the contrasting "This is how we are different from America" lessons on the Melting Pot vs. the Cultural Mosaic.
posted by jokeefe at 4:04 PM on November 16, 2013 [6 favorites]


landis, that is really horrific about your wife, I am so sorry. I don't even know what else to say about that. Is it OK if we share your blog post?
posted by madamjujujive at 4:40 PM on November 16, 2013 [2 favorites]


jokeefe: "Nope. We have the myth that the RCMP arrived before the setters, and made everything nice and orderly on the frontier so that the settlers could go about their law-abiding business in a community-minded way."

There was a wonderful Paul Gross movie about culture clash along the border in the Old West.
posted by workerant at 4:44 PM on November 16, 2013 [2 favorites]


Via Grits for Breakfast, which has as its top comment the relevant:

What, does that person think prisoners are getting nose jobs or pectoral sculpting or something? Or does treatment for depression, diabetes, arthritis, asthma, cancer, etc. not count as "rudimentary" for a population that is entirely under the state's control? What an asshole. By the way, internet commenter on some other blog, the prison population is also aging, and geriatric care ain't cheap. Have fun paying for that!
posted by rtha at 4:48 PM on November 16, 2013 [3 favorites]


Remember, we're talking about people who were legitimately shocked and horrified when it turned out that poor people have refrigerators and televisions, so they can't be legitimately poor at all. We don't just want you indigent, we want you completely degraded. We want you to have nothing whatsoever and then you can beg and we'll spit on you even more for daring to pollute our space.
posted by Ghostride The Whip at 5:28 PM on November 16, 2013 [19 favorites]


Let me share an interesting discussion I had with my (aging, retired, very conservative, FoxNews-watching, once told me we should nuke Iran) brother.

He asked me if liberals "all liked Obamacare." I said no, many of us thought it didn't go far enough and Medicare for all would work better.

Then he said, "How would we pay for that?" I said, well it's complicated but basically by forcing the richest people at the top to pay more of their share in taxes.

He said, "You know, I always thought maybe I'd be one of those at the top."

I laughed and told him I'd never really thought I would be.

"I'm starting to think I won't either. I don't know if I'm even a Republican anymore. I don't like all this craziness. But I'm not a Democrat either. I don't like any of them."

And then we wrapped up the call. But I see an opportunity here, and I'm going to have to bone up on my ACA/socialized healthcare knowledge before we get together for the holidays. Because if my brother, whose political views have made me despair, is starting to see things are fucked up and he's being lied to, maybe others are too.

The thing about this pain is, it's spreading. Lots of people who used to be comfortable and could dismiss liberals as exaggerators are starting to feel the wolf breathing down their necks. I know his kids are struggling; I wouldn't be surprised if he was too. He's too young for Medicare yet, and he's had health problems. I'm not happy about any of that, of course, but if it makes him a tiny bit more open to alternatives, something positive may come of it.

The saddest part of this, for me, is: he's a former preacher, graduated from Seminary. And yet when we argued in the past, none of my pointing out that Jesus was about healing and helping the poor made any kind of dent.
posted by emjaybee at 5:29 PM on November 16, 2013 [15 favorites]


I guess when it comes to why some people — "conservative" people — are so despicable, I'll drag out a favorite quote: "Five year-old children would rather get less to make sure the other gets none. Some people never grow out of this and we call them Republicans."
posted by ob1quixote at 5:46 PM on November 16, 2013 [4 favorites]


Houstonian: The Hospital Galveston medical prison is the prison in Galveston.

This crap is in no way unique to Texas. My state got a shout-out in the links madamejujujive posted about obstructing Obamacare:
For example, Georgia Insurance Commissioner
Ralph Hudgens recently said that navigators in
his state must pass an exam that is “basically…
the insurance agent test,”23 even though federal
laws make clear that navigators are not insurance
brokers and should not be held to the same
standards.24 In a speech, he described this tactic as
just one part of his campaign to do “everything
in our power to be an obstructionist” regarding
the ACA.25


I hope the ACA makes it through these initial difficulties; if it does it may be a real game changer in the way Americans view healthcare. The ACA does have the advantage that the insurance industry stands to gain a lot of new customers if it succeeds and they are as powerful a force in politics as any.
posted by TedW at 5:59 PM on November 16, 2013 [3 favorites]


Then he said, "How would we pay for that?" I said, well it's complicated but basically by forcing the richest people at the top to pay more of their share in taxes.

I'm pretty sure you wouldn't even have to do that. If you and your employer didn't have to pay insurance premiums to a private, for-profit system, then you could easily afford a higher medicare deduction. The net effect on your paycheck should actually end up in the plus column.
posted by George_Spiggott at 6:37 PM on November 16, 2013 [7 favorites]


Also, this off-the-cuff assessment from Turbo-B a few weeks ago, suggesting that Canadians with socialized medicine get off easier than Americans without it -- in other words our healthcare costs are on top of this figure where theirs is inclusive of it -- is really eye-opening. I'd love to see a more thorough across the board analysis of what we're really paying, once you actually factor in our medical costs, compared to the rest of the world.
posted by George_Spiggott at 6:44 PM on November 16, 2013 [2 favorites]


The especially awful part of this, which the article sort of alludes to, is that the largest medical center in the world is right next door to Galveston. There are more doctors and nurses and medical staff concentrated in one spot in Houston than anywhere else in the world. All 50 of the institutions that make up the Texas Medical Center are (Wikipedia says) nonprofit. Most of them are university- or religiously-affiliated.

So the thought that people are dying in Galveston because of lack of care is particularly egregious. It's not like we lack for doctors, y'know?
posted by librarylis at 7:49 PM on November 16, 2013 [2 favorites]


I despise the health care system. For every caring, conscious medical professional like the author of the story, there are three shitty, under-compassionate staff to not only provide balance, but to down right dwarf the good.

This problem is only worse in rural areas, where the population of doctors, nurses, etc goes down but the ratio stays the same. These are the gastroenterologists who make fun of you when they think the sedative has taken effect. The ER doc who can't fathom that being admitted for your anemia means lost work which means lost money. Nevermind the fact that your life, lower middle class and below, operates in real time. It's precariously stacked on bills and paychecks and making sure that they both coincide. Nevermind the specialists who put in big bold letters "MEDICAID NOT ACCEPTED" on their front doors. No use even opening the door poor person, no use at all.

I think, hope, that the ACA will do something for people like the patients in the story, people like my diabetic brother.When his factory job will end in a month (I honestly believe its cost cutting due to the ACA, but who knows), perhaps he will qualify for a plan that will make his insulin affordable. But I fear, through the law of unintended consequences and the lobbyist driven atmosphere of modern Washington D.C, that things like mandatory childbirth coverage point towards the insurance companies as clear winners. Any other social benefits will be secondary. Business as usual.

Both groups, the shill doctors and the insurance companies who are being "forced" to retool their policies so that their earnings (and profits) grow on the health care exchanges are businesses. I can, to a degree understand why they complain about the sick and poor. "God, if only you'd take your medicines." Yeah, well, I'm on one that costs $4000 a month. It's a phosphorus binder. It will not save my life, cure me, and only staves off the long term effects of hyperphosphatemia. It's side effects can be graphic and though substantial, not worth mentioning here. My insurance brings that cost down to an "affordable" $80. Perversely, the manufacturer gives people with private insurance a coupon lowering that cost further to $5. Those on Medicare, Medicaid and other public insurance programs need not apply. The company must bristle under government negotiated pricing, it's the only thing I can think of to encourage such classism. It makes little economic sense.

The fact that states such as Texas and my good old home of Virginia actively refuse federal monies targeted at expanding health care out of "principle" also escapes reason. Medicaid expansion is feeding the beast, within the bounds of government controlled prices, sure, but providing more willing "customers" all the same.

It should be good economics, whether you believe in demand or supply driven models. Doctors get more money, which should eventually trickle down to their patients working at McDonalds. They'll buy more cars; do more work on their homes. The rush of people wanting simple services should allow them to drive up prices during their next negotiation period with the private insurance companies and so on. Or so my undergraduate understanding of economics leads me to suppose. But this is principle, which trumps good governance, the responsibility of government to promote social development, or the fact that affordable health care might allow that chronically sick author to finish the Great American Novel.

TL;DR: America's health care model sucks.
posted by ptaav at 7:53 PM on November 16, 2013 [4 favorites]


It's funny, I read this article on The Atlantic and this part jumped out at me:

But unlike Coach Buchanan and his players, the actual bully deliberately sets out to make his victim feel inferior. It helps to view the bully as a kind of competitor on the social playing field, one who strives not only to win but to triumph over the social losers and destroy their sense of self. As in competitive sport, where winners and losers exist in a binary relation to one another, the bully is yoked in identity to his victims. To a significant degree, his self-image depends upon having those losers to persecute: I am a winner because you are a loser.

And that's basically what I was saying but so eloquently expressed it took my breath away, which led me down a rabbit hole to this and this on bullying in American culture. And that's basically it. We hate poor people because they're losers and by shoving them around, we can prove we are the winners.
posted by Ghostride The Whip at 8:00 PM on November 16, 2013 [4 favorites]


For madamjujujive and anyone else; feel free to link to the blog entry I posted up thread.
posted by landis at 8:08 PM on November 16, 2013 [1 favorite]


SIEGEL: You mentioned maternity and newborn care benefits, which are mandated. We've heard from some people who say, look, my husband and I are in our late 50s. Our children are long grown and out of the house and off our policies. We're within, you know, a decade of qualifying for Medicare. Maternity care is just not something that we need. They can't buy a policy that excludes that benefit?

This argument came up in my policy class just this week!! Listen, people- we don't all get diabetes, we don't all get cancer, we don't all break a hip- BUT WE WERE ALL BORN. Tired of hearing maternity care discussed like it's a special interest frivolity. It's the one thing that affects every single one of us!!! It should be priority #1!!!
posted by ThePinkSuperhero at 8:13 PM on November 16, 2013 [12 favorites]


NOT TO MENTION that if old folks want to get out of paying for childbirth because it's a service they don't need, I don't want to pay for the stuff I don't need- heart attacks, strokes, all that other nasty stuff that doesn't generally affect young people. But jk I don't really want that because A, I'm not an asshole and B, that's not how insurance works. You're not just paying for the stuff you "use", you're paying for part of the safety net for your worst case scenario.
posted by ThePinkSuperhero at 8:22 PM on November 16, 2013 [6 favorites]



I would have thought that US conservatives could be brought around to something approaching single payer, or at least better-regulated healthcare because... it would lower healthcare costs across the board. At least it has elsewhere.

A couple lines from that link:
 Country_____________________Cuba____United States   
 Rank (efficiency)           28      46              
 Efficiency score            46.8%   30.8%           
 Life expectancy (years)     79.1    78.6            
 Cost (% of GDP per capita)  11.3%   17.2%           
 Cost (per capita )         $606    $8,608 
In terms of life expectancy and healthcare efficiency, Cuba is kicking the US's ass. Cuba, ffs.. As a percentage of GDP, they spend LESS per-capita on healthcare than the US. And they're providing universal care.

...wow. Just wow.
posted by Artful Codger at 8:25 PM on November 16, 2013 [7 favorites]


The mistake we make when talking about the "health care industry" is that we're talking about two fundamentally different things and lumping them together in a way that makes no rational sense. The health insurance industry is a branch of the financial services industry and has nothing to do with making you well. Quite the reverse: every single penny it spends on its own operation, beit salaries, infrastructure, overhead, marketing, lobbying and of course profit is a penny someone spent for healthcare that nobody got. It is utterly parasitic and it's past time we stopped flattering it by lumping it in with "healthcare". It is the care denial industry.

And as if that weren't enough, simply dealing with them is an additional overhead that sucks time and money out of the actual health care industry; time and money that is also not spent on caring for anyone. And then there are the price distortions where the market clout and negotiating power of the insurers force providers to raise retail rates that the uninsured have to pay... and can't. The perversity of all this simply can't be overstated. It's time to end this.
posted by George_Spiggott at 8:40 PM on November 16, 2013 [9 favorites]


jonp72: "This reminds of something Brad DeLong posted on his blog about his experiences working in the Treasury Department in the Clinton Administration. DeLong posted a conversation between him and another assistant secretary at the Treasury Department who made it clear that DeLong had a lot to learn about Texas Republicans:

Another Treasury Department Assistant Secretary (ATDAS): "... And only after you have begged at your church, and begged sincerely and abjectly enough, might your church find itself paying for you out of Christian charity--the benefit of which is to save their souls, not your body!" [snip...]

DeLong: But what if you don't have a church!

ATDAS: "Then you should go join one, shouldn't you? That's a benefit..." (link)
"

So here's a story: I was born and raised in Texas and my parents (mostly my mother, but dad was an Easter Christian) were a member of a reasonably well-off church in a decent part of town. We--yes, including me--attended church faithfully every Sunday and even most Wednesdays for years; my mother still does. We did youth group things, volunteered with the church, and I remember my mother still doing turns in the church nursery long after her kids had grown out of it. Because this was a reasonably compact (at the time) suburban area, I went to school with several of the kids from the church.

My family was poor growing up. This isn't a sob story, just the truth. We're talking "power is out because the power bill can't be paid" poor and "one child still qualifies for WIC, that better feed all of us" poor. When I was a teenager, I saved enough for a cheap car and I had a car problem (insofar as the engine burning itself to a crisp can be a "problem"). It, and other things, panicked my mother so strongly that she had to go to the hospital for four days after suffering a panic attack and a "partial" stroke. Dad worked for Wal-Mart at the time, in a distribution warehouse not in a store, and so he had some health insurance but it was very limited. Eventually mom left the hospital with about $28,000 in bills. This was in the late 1990s so that's roughly $41,000 today. Oh, and no pay from her hourly job while she was in the hospital.

Two things changed me and my views on church and religion from how "our" church handled this. First off, no one from the church visited her, even though I as a kid and teenager had gone with my mother to visit others from the church who were in the hospital, nor did they do the traditional sending of a meal or two to the home. Second, and I didn't find this out until a couple of years later, when my parents asked for help from the church because mom's minimal part-time income was needed to not-at-all-metaphorically keep the lights on, my parents were told "no." "Our" church didn't feel that "mental illness" was something they needed to help with. Had it been a purely physical ailment, then maybe. Panic "can and should" be solved with the power of prayer and placing your situation in God's hands.

My mother, for some reason, still goes to that church, still helps out, and has even gotten the occasional bit of help from them, mostly from when her mother died and when dad went into the hospital with an actual, full-on stroke. I haven't been back since I turned 18 and never will.

I can't speak for every church, but at least one church in Texas will still deny your claim just as often as any private insurer.
posted by fireoyster at 8:45 PM on November 16, 2013 [15 favorites]


I am personally dreading Thanksgiving this year. My wife and I will be going to her nephew's home for a family celebration. Said nephew is in his mid-20's, owns a little computer/phone repair shop, is a hard-core evangelical and a faithful FOX News viewer. He's never shy about spewing a constant stream of conservative talking points throughout the day, and I'm sure he's going to be a non-stop fountain of Obamacare bile this year (as well as a lot of "told you so" because of the website snafu.) I am seriously considering coming down with something in order to not go.
posted by Thorzdad at 5:42 AM on November 17, 2013


Thorzdad: yeah, if I were you, I would either not go, or I would have a prepared mental list of topics to which the conversation could be changed which are neutral or even pleasant to discuss. Either that or, with his first diatribe, I'd say "you know, this weekend should be for celebrating family and finding reasons to be thankful for being together. You need to stop with the political stuff while we are here."

But the easiest thing would just be to not be there.
posted by hippybear at 7:37 AM on November 17, 2013 [3 favorites]


And tell everyone else why you're not going. Seriously, don't tiptoe around that shit.
posted by Steely-eyed Missile Man at 7:40 AM on November 17, 2013 [1 favorite]


The chickens (ducks?) are coming home to roost -
"Plain and simple, this was Riser's election to lose. Riser was the favorite going into the evening. He had the dollars. He had the endorsement of the Republican establishment. He had a strong showing in the primary. Yet, he lost it," said Joshua Stockley, a political science professor at the University of Louisiana at Monroe.

Riser and McAllister are both conservatives and largely agreed on many issues. Both oppose abortion, favor strong gun rights and criticize the levels of federal spending and debt.

Their sharpest distinction rested with President Barack Obama's signature health care law.

Both opposed the health overhaul, but Riser wanted only repeal, saying the law will harm businesses and families and can't be fixed.

McAllister said repeal had no chance with Democrats leading the Senate and White House, so he said Congress should work to improve the law. He also wants Louisiana to expand its Medicaid program to give insurance to the working poor, an expansion that Riser opposes."
posted by Slap*Happy at 7:57 AM on November 17, 2013


As much as the Republicans wanna talk about family, morality, the justness of the American purpose, the entire party -- including each and every one of them that have voted against sensible health care access for all -- this position makes their entire belief system morally bankrupt.
posted by skepticallypleased at 8:14 AM on November 17, 2013 [4 favorites]


Primum non nocere, indeed.
posted by Sphinx at 9:03 AM on November 17, 2013 [1 favorite]


We are proud of and shall continue our far-reaching and sound advances in matters of basic human needs—expansion of social security—broadened coverage in unemployment insurance —improved housing—and better health protection for all our people. We are determined that our government remain warmly responsive to the urgent social and economic problems of our people.

To these beliefs we commit ourselves as we present this record and declare our goals for the future.

[...]

The Federal minimum wage has been raised for more than 2 million workers. Social Security has been extended to an additional 10 million workers and the benefits raised for 6 1/2 million. The protection of unemployment insurance has been brought to 4 million additional workers. There have been increased workmen's compensation benefits for longshoremen and harbor workers, increased retirement benefits for railroad employees, and wage increases and improved welfare and pension plans for federal employees.

[...]

Assure equal pay for equal work regardless of Sex

[...]

[Our] leadership has enlarged Federal assistance for construction of hospitals, emphasizing low-cost care of chronic diseases and the special problems of older persons, and increased Federal aid for medical care of the needy.

- Guess Who and When
posted by rtha at 9:37 AM on November 17, 2013 [5 favorites]


"Our" church didn't feel that "mental illness" was something they needed to help with. Had it been a purely physical ailment, then maybe. Panic "can and should" be solved with the power of prayer and placing your situation in God's hands.


Not just your church:

Right-Wing Evangelicals Claim 'Good Christians' Can't Get PTSD: Conservative evangelicals have politicized psychology and made the church hostile to the mentally ill.
The idea that major illnesses can be cured by prayer feeds the idea that mental illness is the fault of the ill. A 2008 survey conducted by Baylor psychology professor Matthew Stanford showed that 36 percent of mentally ill church attendees (and former church attendees) were told their mental illness was a product of their own sin, while 34 percent were told their illness was caused by a demon. Forty-one percent were told they did not really have a mental illness, and 28 percent were instructed to stop taking psychiatric medication.
posted by ogooglebar at 11:46 AM on November 30, 2013 [1 favorite]




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