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“Medically Unnecessary”: Scott Walker Doesn’t Get Why His ‘Cool’ Ultrasound Remark Was So Offensive — And That’s The Problem

Gov. Scott Walker was chatting recently with right-wing radio host Dana Loesch about his efforts to set up regulatory hurdles to abortion access in Wisconsin, when he offered this defense of a law he signed that would require a woman to undergo a medically unnecessary ultrasound before exercising her constitutionally protected right to an abortion:

I’m pro-life. I’ve passed pro-life legislation. We defunded Planned Parenthood, we signed a law that requires an ultrasound. Which, the thing about that, the media tried to make that sound like that was a crazy idea. You know, most people I talked to, whether they’re pro-life or not, I find people all the time that pull out their iPhone and show me a picture of their grandkids’ ultrasound and how excited they are, so that’s a lovely thing. I think about my sons are 19 and 20, we still have their first ultrasounds. It’s just a cool thing out there.

Right Wing Watch, a project of People For the American Way, was listening to the show and brought attention to Walker’s comments, and they understandably hit a nerve.

Sure, an ultrasound could be “cool” if you are a woman carrying a healthy child, surrounded by family, love and support and making your own medical choices along with your doctor. Or you are excited grandparents looking forward to years of joy with a child. What’s not “cool” is if the state mandates that you undergo a medically unnecessary procedure in an effort to prevent you from making a choice that you, an adult woman whose circumstances your politicians have no right to know or judge, have already made and are unlikely to change.

Even less “cool” is the fact that the ultrasound bill was passed as part of an explicit effort to undermine women’s access to health care. Its companion bill was an “admitting privileges” requirement, a common anti-choice tactic, that threatened to close two abortion clinics in the state. Since then, Walker has boasted to anti-choice leaders of using deceptive rhetoric about the ultrasound bill in order to downplay its true intentions.

Unlike the ultrasounds of the Walkers’ children, forced ultrasounds like these aren’t the kind that anyone wants to show off. What’s astonishing is that Walker doesn’t seem to get this. Instead, he’s accusing the “gotcha” media of being “biased” and “lazy” and twisting the meaning of his comments. Unfortunately, some of the media are taking him at his word.

Walker’s remarks weren’t twisted. You can listen to his whole answer to the question here. The problem is that Walker just doesn’t seem to get why what he said was so offensive. For someone who wants to be president, that’s deeply troubling.

 

By: Michael B, Keegan, President, People For the American Way; The Blog, The Huffington Post, June 1, 2015

June 2, 2015 Posted by | Scott Walker, War On Women, Women's Health | , , , , , | Leave a comment

“Wildly Misleading Pernicious Ads”: Sabotaging Health Care, One Lie At A Time

A Koch-brothers funded conservative group, Generation Opportunity, is out with a wildly misleading, pernicious set of ads aimed at sabotaging the Affordable Care Act by discouraging young people from signing up for health insurance exchanges.

One’s aimed at young men, the other at young women. In the “for him” version, an actor tells his doctor that he saw an ad for the Affordable Care Act and “figured, why not?” The doctor tells him to take his pants off, “hop up here, lay down and bend your knees to your chest.” He leaves the room. Then a man wearing an Uncle Sam mask snaps on a blue glove. As if the message weren’t perfectly clear, the ad states: “Don’t let government play doctor.”

The “for her” version is much the same, except in that case Uncle Sam’s performing a gynecological exam.

The ads are as offensive as they are derivative.

During the 2012 campaign, the reproductive rights site Lady Parts Justice released a web video attacking laws requiring women to undergo medically unnecessary ultrasounds before receiving abortions. In that spot, a woman with her feet in stirrups explains that she wants an abortion because she’s “just not emotionally or financially ready to have kids right now.” The doctor, sitting between her legs, responds, “OK, well, just so you know, the law says that before I can do that, I need to do some things to you that you need to pay extra for. You know, just some things that will help you better understand what it is you really want.” These “things” include inserting a camera into her vagina and looking at pictures of what’s inside her uterus.

But that video made sense—states actually did pass laws interfering with the doctor-patient relationship—whereas the Generation Opportunity ads perpetuate outright lies. Young people who sign up for exchanges won’t be getting access to government-run healthcare (if only they were!), but to privately run insurance. Nor does the A.C.A. force doctors to ask patients about their sex lives or perform unwanted exams—as Politifact explained recently. Under the A.C.A., government doesn’t “play doctor,” it merely enables access to doctors who then decide, using their professional judgment, the best course of action.

Signing up for an exchange isn’t an act of political (or sexual) submission. It’s just a way to get insurance if you don’t have a job or your employer doesn’t provide it. The Generation Opportunity crowd surely knows that and obviously doesn’t care because its priority now, as ever, is bringing down President Obama’s signature domestic accomplishment. The group also doesn’t care about the possibility that some number of young people, scared by its ads, will forego access to affordable care, get sick, and go bankrupt paying their medical bills.

 

By: Julie Lapidos, Opinion Pages Editor’s Blog, The New York Times, September 23, 2013

September 24, 2013 Posted by | Affordable Care Act, Koch Brothers | , , , , , , , | Leave a comment

“Promoting Untrue Choice”: Paul Ryan’s Health Care Proposal Would Shrink The Medicare Doctor Pool

The federal budget proposed by Representative Paul Ryan, the Republican vice-presidential nominee, extols the benefits of “promoting true choice” for Medicare beneficiaries.

In truth, though, the Ryan plan would substantially reduce choice for many people on Medicare — by cutting them off from their current doctors.

Doctors see Medicare patients, despite the relatively low payments they receive for doing so, partly because Medicare represents such a large share of the health-care market.

If a substantial number of beneficiaries moved out of Medicare and into private plans, as Ryan proposes, doctors would have much less incentive to see Medicare patients. And the elderly who want to remain in traditional Medicare would risk being stranded.

The evidence suggests that, in time, this problem could well affect a large share of Medicare beneficiaries. To put that evidence in context, though, it helps to first review the history of the Ryan plan.

The proposal has changed since it was presented in 2011. In the original version, traditional Medicare was eventually to be replaced in its entirety by private plans. The Congressional Budget Office found that this shift would raise health-care costs drastically because the private plans wouldn’t be large enough to enjoy Medicare’s leverage in negotiating prices with hospitals and other large providers. The savings that private plans could achieve because beneficiaries would share more of the costs, and therefore economize more, would be more than offset by that loss of leverage — and by the private plans’ higher overhead and need to turn a profit.

Ryan Revision

In response to the devastating CBO report, Ryan revised his proposal. Under Ryan 2.0, private plans would co-exist with traditional Medicare. (The CBO hasn’t fully evaluated the revised plan yet.)

Many supporters argue that the new plan can’t be as big a problem as the old one, since beneficiaries could always choose to remain in traditional Medicare. In health care, however, choice isn’t always innocuous — and can sometimes be harmful.

I have previously described two downsides to expanding private plans in Medicare. First, it would undercut Medicare’s ability to help move the payment system away from fee-for- service reimbursement and toward payments based on value, because no private plan is large enough to accomplish that shift by itself. Second, the mechanism for adjusting premiums to even out the health risks of individual beneficiaries is far from perfect, so plans can easily game the system, raising total costs. In effect, the plans would end up being overpaid.

The reduced choice of doctors for those who remain in traditional Medicare is a third adverse consequence of moving beneficiaries out of the program.

Currently, Medicare beneficiaries almost universally enjoy excellent access to doctors. And the great majority of beneficiaries never have to wait long for a routine appointment, the Medicare Payment Advisory Commission has found. Roughly 90 percent of doctors accept new Medicare patients.

Doctors provide this access even though they are reimbursed by Medicare at rates that are only about 80 percent of commercial rates — partly because Medicare is such a large share of the market. Which brings us to the concern about the Ryan plan.

Medicare Doctors

How important is Medicare’s market share in influencing physician participation? The evidence is limited, but the best study to date suggests it is significant. In the 1990s, Peter Damiano, Elizabeth Momany, Jean Willard and Gerald Jogerst, all associated with the University of Iowa, surveyed Iowa physicians and examined variation among counties. They found that for each percentage-point increase in the share of Medicare beneficiaries in a county’s population, doctors were 16 percent more likely to accept patients on Medicare. The only other study I know of on this topic, an unpublished analysis by Matthew Eisenberg of Carnegie Mellon University, also found an effect from Medicare’s market share, albeit one that was substantially smaller than the one Damiano and his colleagues found.

About 10 percent of the U.S. population is now enrolled in traditional Medicare, and an additional 5 percent has private Medicare plans. Let’s assume, for the sake of argument, that the Ryan plan would cause another 5 percent of the population to shift, and to be conservative let’s cut in half the Damiano estimate of the impact from that reduction in Medicare’s market share. Then the chance that a doctor is willing to see traditional Medicare patients would be expected to decline by a whopping 40 percent. The share of doctors accepting Medicare would fall from about 90 percent to 54 percent.

To be even more conservative, let’s average the reduced Damiano estimate (already been cut in half and applied only to today’s market share rather than the higher one that will exist in the future when more people are on Medicare) with the Eisenberg estimate. Still, about 20 percent of doctors would be expected to stop accepting Medicare patients.

Supporters of the Ryan approach might argue that fewer people would shift into the private plans, so the impact would not be that great. After all, the existing Medicare program already offers Medicare Advantage plans, so perhaps anyone who wants private insurance already has it. But then, what is the point of Ryan’s Medicare reform?

Another defense might be that the government could simply raise doctor-reimbursement rates to encourage providers to continue treating a shrinking population of traditional Medicare patients. And that’s true. However, Ryan has not included the extra cost in his budget.

So, which is it, Mr. Ryan? Will your plan cause Medicare beneficiaries to lose access to their doctors, or are your budget numbers too rosy because you haven’t counted the extra payments needed to keep doctors in the program?

 

By: Peter Orszag, Council on Foreign Policy, Business Insider, September 24, 2012

September 25, 2012 Posted by | Health Reform | , , , , , , , , | Leave a comment

“Not All Facts Are Created Equal”: The Right To Know Versus The Right To Withhold

In the debates over pre-abortion ultrasound bills, advocates often say such measures are vital to ensuring that women have all the relevant information. The argument is often based in part on the idea that abortion providers make money off of the procedures—and therefore may try to trick women into terminating their pregnancies. The reasoning also assumes that when deciding to have an abortion, a woman should know the physical details of the fetus, like how many fingers and toes have developed. That’s why—in a messaging win for social conservatives—the pre-abortion sonogram requirement is often called a “Woman’s Right to Know” legislation.

But, Kansas Republicans may spoil all the fun. The state House is working on legislation that would allow doctors to withold information if it will help prevent an abortion, as well as requiring doctors to tell women that abortions increase odds of getting breast cancer—a theory many public health organizations reject. Forget right to know—the proposal promotes misinformation and distrust between doctors and patients. And that’s hardly the only disturbing part of the bill, which ostensibly is meant to cut back access to abortions.

Huffington Post’s John Celock has more details on the measure:

The latest bill — which is scheduled to be discussed by a legislative committee for a second time on Wednesday — contains a number of provisions which would give the state one of the most sweeping anti-abortion laws in the nation. Among the provisions is one which would exempt doctors from malpractice suits if they withhold information — in order to prevent an abortion — that could have prevented a health problem for the mother or child. A wrongful death suit could be filed in the event of the death of the mother.

Other provisions include requiring women to hear the fetal heartbeat prior to an abortion, taking away tax credits for abortion providers and removing tax deductions for abortion-related insurance. The bill also requires that women be told that abortions would increase the risk of breast cancer, a controversial theory that the World Health Organization, the National Cancer Institute and gynecological groups in the United States and the United Kingdom have said is incorrect.

The bill was scheduled for discussion on Wednesday, but it looks like technical amendments have it stuck in committee a bit longer. But, Kansas’ state House is among the most far right in the country and will likely pass the measure—the Senate, on the other hand, is up in the air. In the meantime, Celock reports that Kansas Governor Sam Brownback—a vehement social conservative—is friendly towards the bill.

If passed, the bill would make it much harder to make the already dubious claim that the pro-life movement is all about giving women “the facts.”

 

By: Abby Rapoport, The American Prospect, March 1, 2012

March 2, 2012 Posted by | Abortion, Women's Health | , , , , , , | Leave a comment

   

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