Cutting Medicaid Means Cutting Care For The Poor, Sick And Elderly
The part of Paul Ryan’s budget that’s going to get the most attention is his proposal to privatize and voucherize Medicare. But the part that worries me the most is his effort to slash Medicaid, with no real theory as to how to make up the cuts.
Ryan’s op-ed introducing his budget lists Medicaid under “welfare reform,” reflecting the widespread belief that Medicaid is a program for the poor. That belief is wrong, or at least incomplete. A full two-thirds of Medicaid’s spending goes to seniors and people with disabilities — even though seniors and the disabled are only a quarter of Medicaid’s members. Sharply cutting Medicaid means sharply cutting their benefits, as that’s where the bulk of Medicaid’s money goes. This is not just about the free health care given to some hypothetical class of undeserving and unemployed Medicaid queens.
But perhaps cutting it wouldn’t be so bad if there were a lot of waste in Medicaid. But there isn’t. Medicaid is cheap. Arguably too cheap. Its reimbursements are so low many doctors won’t accept Medicaid patients. Its costs grew less quickly than those of private insurance over the past decade, and at this point, a Medicaid plan is about 20 percent cheaper than an equivalent private-insurance plan. As it happens, I don’t think Medicaid is a great program, and I’d be perfectly happy to see it moved onto the exchanges once health-care reform is up and running. But the reason that’s unlikely to happen isn’t ideology. It’s money. Giving Medicaid members private insurance would cost many billions of dollars.
That’s why it’s well understood that converting Medicaid into block grants means cutting people off from using it, or limiting what they can use it for. You can see CBO director Doug Elmendorf say exactly the same thing here. There’s just not another way to cut costs in the program. You can, of course, work to cut costs outside of the program, either by helping people avoid becoming disabled or making it cheaper to treat patients once they become disabled or sick, but those sorts of health-system reforms are beyond the ambitions of Ryan’s budget.
To get around some of this, Ryan’s op-ed talks about state flexibility, with the implication being that states have some secret Medicaid policies they’ve been dying to try but that the federal government simply hasn’t let them attempt. But the truth is there’s been a tremendous amount of experimentation in Medicaid over recent decades. Indiana converted its Medicaid program into health savings accounts. Tennessee based its program around managed care. Massachusetts folded its Medicaid money into Mitt Romney’s health-care reforms. Oregon tried to rank treatments by value. Some of these reforms have worked well and some haven’t worked at all, but none have solved the basic problem that covering the sick and disabled costs money, and you can’t get around that by trying to redesign their insurance packages. For that reason, block-granting Medicaid ultimately means cutting health-care coverage to the poor, the elderly and the disabled, even as it doesn’t actually address the factors driving costs throughout the health-care system.
By: Ezra Klein, The Washington Post, April 5, 2011
GOP Wants To Pay For Health Care After All
Well, well, well.
Remember how Republicans have been whining that using federal tax dollars to pay for health care is some kind of evil Hitlerian Kenyan socialism that has all our Founding Fathers spinning in their graves? Turns out it’s bullshit.
Kate Sheppard at Mother Jones reports:
A bill that Rep. Cliff Stearns (R-Fla.) introduced in January would provide federal funds for the purchase of sonogram machines at organizations that counsel women against having an abortion (the American Independent reported on this bill last week). These crisis pregnancy outfits, sometimes called “pregnancy resource centers,” are often run by religious groups; many have been found to provide women with false and misleading information to dissuade them from having an abortion.
The bill, H.R. 165, laughably called the Informed Choice Act, appears quite simple:
To authorize the Secretary of Health and Human Services to make grants to nonprofit tax-exempt organizations for the purchase of ultrasound equipment to provide free examinations to pregnant women needing such services, and for other purposes.
But of course it doesn’t allow all organizations to apply for funding. There are a few restrictions, according to Mother Jones.
To be eligible for this grant, a facility would have to show every woman seeking services the ultrasound image and describe to them the “general anatomical and physiological description of the characteristics of the fetus.” The facility would be required to provide women with “alternatives to abortion such as childbirth and adoption and information concerning public and private agencies that will assist in those alternatives.” It also must offer its services free of charge. That last condition would disqualify abortion providers, such as Planned Parenthood, which charges on a sliding scale based on a woman’s income.
Crisis pregnancy centers are nothing more than religious centers that try to dissuade women from obtaining abortions by using false and misleading information.To review:
Such centers have repeatedly been found to give women false medical information for the explicit purpose of preventing them from obtaining, or even learning about, abortions.A 2006 Congressional report, False and Misleading Health Information Provided by Federally Funded Pregnancy Resource Centers, concluded:
Pregnant teenagers and women turn to federally funded pregnancy resource centers for advice and counseling at a difficult time in their lives. These centers, however, frequently fail to provide medically accurate information. The vast majority of pregnancy centers contacted in this investigation misrepresented the medical consequences of abortion, often grossly exaggerating the risks. This tactic may be effective in frightening pregnant teenagers and women and discouraging abortion. But it denies the teenagers and women vital health information, prevents them from making an informed decision, and is not an accepted public health practice.
The bill’s sponsor is the same Cliff Stearns who wanted to investigate Planned Parenthood over the O’Keefe-style sting videos that tried to show Planned Parenthood covering up a prostitution ring. That would be the same Cliff Stearns who last month said that “defunding Planned Parenthood should be a fiscal and moral priority for Congress, and for the American people.” Why?
Our national debt exceeds $14 trillion and after running a federal deficit of $1.3 trillion last year, we will see a $1.5 trillion deficit this year. I get one clear message in talking with the American people – promote job growth and control government spending.The federal government funds thousands of programs and projects, and Congress must look at all federal expenditures and reduce or eliminate those that do not meet the needs of the American people.
So while Rep. Stearns and his fellow Republicans think there’s just no room in our budget for the nation’s largest women’s reproductive health care provider, there is, apparently, $5 million a year to fund fake health care clinics run by religious zealots.
No word yet from Stearns on how this will “promote job growth and control government spending.”
By: Kaili Joy Gray, Daily Kos, March 29, 2011
Precautions Should Limit Health Problems From Nuclear Plant’s Radiation
Worsening conditions at the Fukushima Daiichi nuclear power plant in Japan have raised fears that people will be harmed by radiation. But experts say that in terms of public health, the Japanese have already taken precautions that should prevent the accident from becoming another Chernobyl, even if additional radiation is released.
The Japanese government has evacuated people closest to the plant, told others to stay indoors and distributed the drug potassium iodide to protect the thyroid gland from radioactive iodine.
The great tragedy of Chernobyl was an epidemic of thyroid cancer among people exposed to the radiation as children — more than 6,000 cases so far, with more expected for many years to come. There is no reason for it to be repeated in Japan.
The epidemic in Chernobyl was preventable and would probably not have happened if people had been told to stop drinking locally produced milk, which was by far the most important source of radiation. Cows ate grass contaminated by fallout from the reactors and secreted radioactive iodine in their milk.
The thyroid gland needs iodine and readily takes in the radioactive form, which can cause cancer. Children are especially vulnerable. Potassium iodide pills are meant to flood the thyroid with ordinary iodine in the hope that it will prevent the gland from taking in the radioactive type. The drug may be unnecessary if people avoid drinking the milk, but for most people, there is no harm in taking it. And if radioactive iodine has already started building up in the thyroid, the pills can help get rid of it, said Dr. Richard J. Vetter, a professor emeritus of biophysics at the Mayo Clinic in Rochester, Minn.
“It will always help if you’re within a month or so of the exposure,” Dr. Vetter said. “The later it is, the less it helps.”
If the pills are in short supply and have to be rationed, he said, they should go first to children and pregnant women. But taking the drug does not make it safe to stay near a reactor that is emitting radiation, he said. People still must evacuate.
Apart from the increase in thyroid cancer, “there is no evidence of a major public health impact attributable to radiation exposure two decades after the accident” at Chernobyl, in part because of the evacuation efforts, according to a recent United Nations report.
There are several ways to tell if someone has been exposed to radiation. A Geiger counter will detect radioactivity outside the body, on clothing, hair and skin. People found to be contaminated should be advised to undress and take a shower, and their clothing should be discarded as hazardous waste, Dr. Vetter said.
Another device, a sodium iodide detector, can be held an inch or so from the neck to check for radioactive iodine in the thyroid gland; if it detects any, the person may be given iodide pills.
In photographs from Japan, health workers appear to be screening members of the public with both Geiger counters and sodium iodide detectors.
If there is a suspicion that someone has been exposed to a large dose of radiation, the first test that doctors are likely to perform is a complete blood count, Dr. Vetter said. Abnormalities in the count — fewer white cells than would be expected, for example — can show up within a day or so, and give a ballpark estimate of how bad the exposure was.
“In Japan, it’s very unlikely that a member of the public would get a dose of radiation that would result in a decrease in any blood cells,” Dr. Vetter said. “If anyone got that kind of dose, it’s likely people who are working in the nuclear plants themselves.”
People with significantly lowered blood counts from radiation can be given drugs to stimulate their bone marrow to make more blood cells. Those drugs were not available in 1986, when a nuclear power plant in Chernobyl, Ukraine, blew up. Other drugs can be used to help rid the body of certain radioactive isotopes. But if the exposure was so high that the drugs do not help, people may need to be treated in the hospital — put into isolation and given antibiotics to protect them from infection, and possibly blood transfusions as well. A bone marrow transplant may be a last resort, but, Dr. Vetter said, “the patient is in real trouble at that point.”
Crops can be contaminated by fallout, which can cling to surface of plants at first and later be taken up by their roots.
Radioactive iodine has a half-life of only eight days — the time it takes for half of it to decay or disappear — so most of it is gone within about two months. But radioactive forms of the particulate cesium persist much longer, and in the regions affected by Chernobyl, they are still the main threats to human health and will be for decades.
Wild mushrooms, berries and animals have been found to be contaminated with cesium in areas contaminated by Chernobyl, and that is expected to last for decades. Lakes and freshwater fish may also be contaminated, but experts say ocean fish are less of a worry because the contaminants are more dispersed and diluted in the ocean than in lakes.
By: Denise Grady, The New York Times, March 15, 2011
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