“Ideology Standing In The Way”: How To Get Sicker, Die Sooner, And Pay More For It
It is painful that five years after passage of the Affordable Care Act, 19 states still have not taken advantage of its option to expand Medicaid. It becomes more so with each new report on the deeply flawed U.S. health system.
The latest, from the National Academy of Sciences, finds that rich people live about 13 years longer than poor people. The researchers note that consequently, rich people end up getting the lion’s share of Social Security benefits. Such inequity should be attacked at its root. At the very least, we could use available tools to help low-income people get health insurance.
The NAS report is far from the first to highlight problems in our approach and results. The Commonwealth Fund last year examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average of $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain’s socialized National Health Service was No. 1 at less than half the U.S. cost.
That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Cooperation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.
The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 “peer” countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty, and more neighborhoods designed to require automobiles.
We have gained a few new tools since some of those studies were done. Some, such as Michelle Obama’s “Let’s Move” initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are the ACA’s new marketplaces (where individuals can buy insurance regardless of their health status) and the law’s expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).
The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, nearly 4 million people are stuck in an absurd coverage gap. That’s even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.
If we’re already spending a huge amount on health care, why should we sink more into it? It’s a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, a typical example from a study of nine countries released last year by the International Federation of Health Plans. Just this month, The New York Times reported on a 62-year-old drug that went from $13.50 to $750 per tablet overnight.
How can we get a grip on costs? In part by getting a grip on politics. Medicare, overcoming “death panels” alarmism, recently announced it will reimburse doctors for discussing end-of-life choices with patients. That may lead to a decline in expensive, painful and futile treatments. Next, we should lift bans on research into gun violence, the better to reduce shootings and their public health costs.
Ideology is standing in the way on guns, as it is in the 19 states refusing so far to expand Medicaid. The struggles of purple-state Virginia have been among the most epic. Democratic Gov. Terry McAuliffe has been repeatedly thwarted by Republican lawmakers in his push to expand Medicaid. Last year, a disloyal Democratic lawmaker resigned and threw the state Senate into GOP hands. This year Democrats are trying to win back the chamber and, along with it, the slim chance of a Medicaid deal. In the meantime, some 350,000 Virginians are stranded in the coverage gap.
And this, dear readers, is how you get to be last place in the developed world.
By: Jill Lawrence, The National Memo, September 24, 2015
“American Exceptionalism In A Nutshell”: We Think “Freedom” Is Just Another Word For “Packing Heat”
Well, Donald Trump finally said something I agree with 100%:
Donald Trump: “We are the only country in the world that has a Second Amendment.”
— Ben Jacobs (@Bencjacobs) September 18, 2015
Here’s what I said about gun rights and American Exceptionalism back in July when the president told the BBC that his inability to enact reasonable gun regulations was his greatest frustration:
Any British audience would be puzzled by this phenomenon, but then the Brits aren’t exactly freedom-loving, are they?
Well, actually they are, as are people in a lot of other advanced countries where there’s no expectation of any right to set oneself up as a private army.
And that gets to one of the roots of the ideology of “American exceptionalism.” If you compare the U.S. to other nations where there are reasonably solid traditions of self-government, respect for law, and democratic accountability, in what respect do we enjoy more “liberty?” When people tearfully sing along with Lee Greenwood’s “I’m proud to be an American,” what do they mean when they say “at least I know I’m free,” as compared, say, to a Canadian? The only thing readily identifiable is our unique freedom to pack heat. And so long as that is thought to be integral to American identity, and protected by powerful and wealthy interest groups, including maybe one-and-a-half major political parties, then efforts to take the most reasonable steps to keep guns out of the hands of potential shooters will continue to be “frustrated.”
I love my country, and I don’t want to live anywhere else. But I sure wish fewer of us thought of “freedom” as just another word for packing heat, and even fewer thought they had the right to stockpile weapons in case they decide it’s necessary to overthrow the government and impose their will on the rest of us.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, September 18, 2015
“Racism, Violence And The Politics Of Resentment”: It Shouldn’t Be Hard To Recognize Two Truths
We have a choice to make.
We can look at violence and racism as scourges that all of us must join together to fight. Or we can turn the issues of crime and policing into fodder for racial and political division.
In principle, it shouldn’t be hard to recognize two truths.
Too many young African Americans have been killed in confrontations with police when lethal force should not have been used. We should mourn their deaths and demand justice. Black Lives Matter turned into a social movement because there is legitimate anger over the reality that — to be very personal about it — I do not have to worry about my son being shot by the police in the way an African American parent does.
At the same time, too many of our police officers are killed while doing their jobs. According to the National Law Enforcement Officers Memorial Fund, 1,466 men and women in law enforcement died in the line of duty over the past decade. We should mourn their deaths, appreciate the dangers they face and honor their courage.
Now I’ll admit: It’s easy for me to type these words on a computer screen. Circumstances are more complicated for those on either side of confrontations over the obligations of our police officers. Things get said (or, often, shouted) that call forth a reaction from the other side. A few demonstrators can scream vile slogans that can be used to taint a whole movement. Rage escalates.
Moreover, there are substantive disagreements over what needs to be done. Those trying to stop unjust police killings want to establish new rules and practices that many rank-and-file officers resist, arguing that the various measures could prevent them from doing their jobs. This resistance, in turn, only heightens mistrust of the police among their critics.
But politicians and, yes, even political commentators have an obligation: to try to make things better, not worse. There is always a choice between the politics of resentment and the politics of remedy. Resentment is easier.
And so it was this week that the murder of Texas Sheriff’s Deputy Darren Goforth inspired Sen. Ted Cruz (R-Tex.) to say on Monday: “Whether it’s in Ferguson or Baltimore, the response of senior officials of the president, of the attorney general, is to vilify law enforcement. That is fundamentally wrong, and it is endangering the safety and security of us all.” For good measure, the next day, Cruz condemned President Obama’s “silence” on Goforth’s murder.
The problem? For starters, Obama was not silent. He called the slain officer’s widow on Monday and issued a statement saying he had told Kathleen Goforth “that Michelle and I would keep her and her family in our prayers. I also promised that I would continue to highlight the uncommon bravery that the police show in our communities every single day. They put their lives on the line for our safety.” Obama has made statements of this sort over and over. Vilification this is not.
Over at Fox News, the campaign against Black Lives Matter has become fierce. Bill O’Reilly called the organization a “hate group” and declared: “I’m going to put them out of business.”
Let’s take five steps back. The movement for police reform was not the invention of some leftist claque. It was a response to real and genuinely tragic events. Silencing protesters won’t make anything better.
And some potential solutions don’t even make the political agenda. The easy availability of guns on U.S. streets is a threat to the police and to African Americans in our most violent neighborhoods. Why are those who seek reasonable gun regulations regularly blocked by interests far more powerful than those who demonstrate in our streets?
On April 5, 1968, the day after Martin Luther King Jr. was assassinated, Robert F. Kennedy — who himself would be fatally shot exactly two months later — said this to the Cleveland City Club:
“Whenever any American’s life is taken by another American unnecessarily — whether it is done in the name of the law or in defiance of the law, by one man or by a gang, in cold blood or in passion, in an attack of violence or in response to violence — whenever we tear at the fabric of our lives which another man has painfully and clumsily woven for himself and his children, whenever we do this, then the whole nation is degraded.”
How much more pain must we endure before we recognize that these words are still true?
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, September 2, 2015
“Police Abuse Is A Form Of Terror”: State Violence Versus Community Violence
Writing about the wave of deadly encounters — many caught on video — between unarmed black people and police officers often draws a particular criticism from a particular subset of readers.
It is some variation of this:
“Why are you not writing about the real problem — black-on-black crime? Young black men are far more likely to be killed by another young black man than by the police. Why do people not seem to protest when those young people are killed? Where is the media coverage of those deaths?”
This to me has always felt like a deflection, a juxtaposition meant to use one problem to drown out another.
Statistically, the sentiment is correct: Black people are more likely to be killed by other black people. But white people are also more likely to be killed by other white people. The truth is that murders and other violent crimes are often crimes of intimacy and access. People tend to kill people they know.
The argument suggests that police killings are relatively rare and therefore exotic, and distract from more mundane and widespread community violence. I view it differently: as state violence versus community violence.
People are often able to understand and contextualize community violence and, therefore, better understand how to avoid it. A parent can say to a child: Don’t run with that crowd, or hang out on that corner or get involved with that set of activities.
A recent study by scholars at the Institution for Social and Policy Studies at Yale found that homicides cluster and overwhelmingly involve a tiny group of people who not only share social connections but are also already involved in the criminal justice system.
We as adults can decide whether or not to have guns in the home. According to a study in the Annals of Internal Medicine, having a gun may increase the chances of being the victim of homicide. We can report violent family members.
And people with the means and inclination can decide to move away from high-poverty, high-crime neighborhoods.
These measures are not 100 percent effective, but they can produce some measure of protection and provide individual citizens with some degree of personal agency.
State violence, as epitomized in these cases by what people view as police abuses, conversely, has produced a specific feeling of terror, one that is inescapable and unavoidable.
The difference in people’s reactions to these different kinds of killings isn’t about an exaltation — or exploitation — of some deaths above others for political purposes, but rather a collective outrage that the people charged with protecting your life could become a threat to it. It is a reaction to the puncturing of an illusion, the implosion of an idea. How can I be safe in America if I can’t be safe in my body? It is a confrontation with a most discomforting concept: that there is no amount of righteous behavior, no neighborhood right enough, to produce sufficient security.
It produces a particular kind of terror, a feeling of nakedness and vulnerability, a fear that makes people furious at the very idea of having to be afraid.
The reaction to police killings is to my mind not completely dissimilar to people’s reaction to other forms of terrorism.
The very ubiquity of police officers and the power they possess means that the questionable killing in which they are involved creates a terror that rolls in like a fog, filling every low place. It produces ambient, radiant fear. It is the lurking unpredictability of it. It is the any- and everywhere-ness of it.
The black community’s response to this form of domestic terror has not been so different from America’s reaction to foreign terror.
The think tank New America found in June that 26 people were killed by jihadist attacks in the United States since 9/11 — compared with 48 deaths from “right wing attacks.” And yet, we have spent unending blood and treasure to combat Islamist terrorism in those years. Furthermore, according to Gallup, half of all Americans still feel somewhat or very worried that they or someone in their family will become a victim of terrorism.
In one of the two Republican debates last week, Senator Lindsey Graham of South Carolina seemed to be itching for yet another antiterrorism war, saying at one point: “I would take the fight to these guys, whatever it took, as long as it took.”
Whatever, however, long. This is not only Graham’s position, it’s the position of a large segment of the population.
Responding to New America’s tally, Fareed Zakaria wrote in The Washington Post in July:
“Americans have accepted an unprecedented expansion of government powers and invasions of their privacy to prevent such attacks. Since 9/11, 74 people have been killed in the United States by terrorists, according to the think tank New America. In that same period, more than 150,000 Americans have been killed in gun homicides, and we have done … nothing.”
And yet, we don’t ask “Why aren’t you, America, focusing on the real problem: Americans killing other Americans?”
Is the “real problem” question reserved only for the black people? Are black people not allowed to begin a righteous crusade?
One could argue that America’s overwhelming response to the terror threat is precisely what has kept the number of people killed in this country as a result of terror so low. But, if so, shouldn’t black Americans, similarly, have the right to exercise tremendous resistance to reduce the number of black people killed after interactions with the police?
How is it that we can understand an extreme reaction by Americans as a whole to a threat of terror but demonstrate a staggering lack of that understanding when black people in America do the same?
By: Charles M. Blow, Op-Ed Columnist, The New York Times, August 12, 2015
“I’ll See Your Chainsaw And Raise You A Semi Automatic”: GOP Candidates Are Finding It Difficult To Capture The Spotlight
Two weeks ago, Sen. Rand Paul’s (R-Ky.) presidential campaign, eager to generate some interest in its message, released an unfortunate video. The 51-second clip showed Paul, looking and sounding a bit like a used-car salesman, setting fire to large stacks of paper, putting the paper through a wood-chipper, and literally using the chainsaw.
It was supposed to have something to do with federal tax policy.
That, of course, set a fairly high bar for presidential candidates doing silly things to generate attention for themselves. Sen. Ted Cruz (R-Texas), do you have a rebuttal?
“There are few things I enjoy more than on weekends cooking breakfast with the family,” Cruz opens the video. Raw bacon and aluminum foil are then wrapped around the barrel of a machine gun at a firing range.
“Of course in Texas, we cook bacon a little differently than most folks,” Cruz says.
The far-right senator appears to have partnered with IJReivew, a conservative site, for the video called, “Making Machine-Gun Bacon with Ted Cruz.” The minute-long clip is online here.
The video proceeds roughly as one might expect: the raw bacon “cooks” as Cruz fires the gun. When he’s done with target practice, the senator removes the foil, takes a bite with a fork, and laughs. “Mmm, machine-gun bacon,” he says.
For the record, I’m not entirely sure if this actually is a “machine gun.” More knowledgeable sources can (and should) check me on this, but I was under the impression that machine guns are fully automatic, firing bullets quickly. The far-right senator appears to be firing one bullet with each pull of the trigger. It seems like a relevant detail – if Cruz doesn’t know what a machine gun is, this video may prove to be more embarrassing than intended.
Regardless, whether or not this video is better than Cruz’s tryout for “The Simpsons” is a matter of taste.
As for the larger context, this is apparently what it means to run for the Republican presidential nomination in 2015.
In a massive field of 17 candidates, which is currently led by a former reality-show host who has never sought or held public office, GOP candidates are finding it increasingly difficult to capture the spotlight. Looking “presidential” is nice, but it’s also evidently dull.
And so we’ve reached the curious combination of candidates, chainsaws, and raw meat on gun barrels.
What’s more, it’s only early August. What the YouTube clips will look like in, say, November, is anybody’s guess.
By: Steve Benen, The Maddow Blog, August 3, 2015
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