Health Care

How Is AHCA Doing?

Depending on which news organization you look at, if the Republicans lose 22 or 23 votes, the AHCA is dead in the House. The voting is taking place today, and the bill is changing with little giftees for certain districts.  Here is a wrap-up of where we are so far on the vote count, but pay close attention to the times below.  This is a VERY fluid thing.

And this just got tweeted:

I went to bed thinking they would make deals and get the votes.  But they failed to satisfy the Freedom Caucus last night, and I’ve seen a few confirmed no’s this morning.

On the other hand, there’s still more hours ahead. The Freedom Caucus is meeting with the President at 11:30 am today.

Ohhhhh…. if I had to guess, I would say it won’t pass the House.

UPDATE: Earlier today, the Freedom Caucus left the White House unmoved to change their NO vote.  And just now… this:

Speed Read: The House Obamacare Replacement Bill

From Axios:

The House Republican Obamacare replacement package is finally out, and the two main health care committees — Ways and Means, and Energy and Commerce — are scheduled to start working on the bills on Wednesday. Here’s your speed read on what’s in them — summaries are available here and here:

In:

  • Pre-existing condition coverage
  • Continuous coverage — 30 percent penalty if people don’t keep themselves insured
  • Special fund to help states set up “high-risk” pools, fix their insurance markets, or help low-income patients
  • Enrollment in expanded Medicaid will be frozen
  • Current enrollees can stay until 2020, and keep getting extra federal funds, until they leave the program on their own
  • Medicaid will change to “per capita caps” (funding limits for each person) in fiscal year 2020
  • A new, refundable tax credit will be available in 2020 to help people buy health insurance
  • Covers five age groups — starts at $2,000 for people in their 20s, increases to $4,000 for people in their 60s
  • It’s not means tested, but phased out for upper-income people (starting at $75,000 for individuals, $150,000 for families)
  • Insurers can charge older customers five times as much as young adults

Out:

  • All Obamacare taxes
  • All Obamacare subsidies, including its premium tax credit
  • Individual, employer mandate penalties
  • “Cadillac tax” (until 2025)
  • No longer will limit the tax break for employer-sponsored health coverage
  • No payments to insurers for cost-sharing reductions
  • Selling insurance across state lines (can’t be done in the “reconciliation” bill)
  • Medical malpractice reform (can’t be done in the “reconciliation” bill)

There’s also a little sugar in there for insurance company CEOs. Under Obamacare, insurance companies could not deduct an employee’s pay that exceeded $500,000 per year.  This limited incentives to give excessive salaries to CEOs and officers.  That limitation is gone now.

Look, if this is complicated for you (and no shame in that — it’s hard stuff) consider this: the House did not send this to the Congressional Budget Office for “scoring”. In other words, we would normally get an estimate as to (1) how much this will cost or save (will it add to the deficit?); (2) how many people will get lose coverage; and (3) how much insurance costs will go up (or down) as a result for the average consumer.  The House did not get the bill “scored” because — let’s face it — they didn’t think the numbers would look good.

AND they are trying to get this passed without debate.

My prediction? Even if they succeed in passing the bill, it is DOA in the Senate.

Draft Republican Plan Leaked

Politico has obtained a draft bill from House Republicans for Obamacare repeal. The draft closely follows proposals put forward by House Speaker Paul Ryan and the proposal Tom Price introduced last year. He’s now popular vote loser Donald Trump’s Secretary of Health and Human Services. It defunds Planned Parenthood completely. For everybody. No matter what they visit PP for. But more than that, it scraps Medicaid expansion and by allowing insurance companies to charge older people much more for insurance.

The Republican plan would also eliminate Obamacare’s Medicaid expansion in 2020. States could still cover those people if they chose but they’d get a lot less federal money to do so. And instead of the current open-ended federal entitlement, states would get capped payments to states based on the number of Medicaid enrollees.

Capped payments is basically the same idea as a block grant. The state would get a set amount of money—less than currently under Obamacare’s Medicaid expansion—depending on the current Medicaid population size. If for some reason the Medicaid-eligible population increased in a state, it would have to do that thing Republicans falsely screamed bloody murder about with Obamacare: ration care. It would have to decide whether to keep covering children, or the disabled, or the elderly in long-term care. Which means, fewer people covered.

The draft bill is two weeks old, so maybe there have been changes, but if this is the end result, GOPCare will suck.  And they will get an earful.

NOW They Are Asking What Would Happen If Obamacare Is Repealed

Winning is easy; governing is hard.

It is easy to get people – especially Republicans — to hate Obamacare.  For one thing, it has the name of the 44th President attached to it.  That alone gets many people to dislike it.

On top of that, it DOES have many problems.  Rates this past year jumped bigly, and many plans now have high deductibles.  (To be fair, the health-care premium increased 31% from 2006-2011, pre-Obamacare, and only 20% with Obamacare over the 5 year period of 2011-2016 — but some states have been hit hard.)

Also, in many counties now, there is only one choice of healthcare plan.

But the Affordable Care Act (see, it’s not Obamacare now!) is not the “total disaster” that Trump says it is. About 16.6 million people now have health insurance — people who wouldn’t have it otherwise.  Denial of insurance because of pre-existing conditions is a thing of the past.

The ACA also allows states to expand Medicaid eligibility, with the federal government paying most of the cost for new beneficiaries.

Finally, the ACA also prohibits insurers from charging different premiums to individuals based on their health. Everyone is in one big insurance pool, sharing in the average cost. Tax credits to help people buy private insurance.

The problems hit because more sick people enrolled than insurers expected when they initially set their premiums in 2014. That’s a big reason why premiums are rising more quickly for 2017 — with benchmarks increasing 22% on average nationally and 8% in California. Some insurers have exited the market, and Obamacare consumers face fewer choices. But the hope is that these higher premiums represent a one-time market correction rather than a sign of worsening trends to come.

But Republicans want to repeal.  They think it is what the people want.  Even some of the people think it is what they want.  It’s the most unpopular popular law.

The problem is, what happens when the GOP tries to change the ACA?

That, of course, depends on HOW they do it, and what they replace it with.  All indications are that they want to keep the popular parts of the ACA (the ban on pre-existing conditions, and the part where you can be on your parents’ plan if under age 26), but remove other parts (the individual mandate which penalizes people who don’t buy health insurance).

And how will they do this? It looks like they may use a budget maneuver known as a reconciliation bill, and through this, repeal parts of the ACA. The advantage of such a bill is that it cannot be filibustered in the Senate, meaning it can be passed with 51 votes instead of 60. The disadvantage is that it can be used only to make changes that have a direct effect on federal spending or taxes. So, for example, a reconciliation bill cannot repeal the ACA’s insurance market regulations, including protections for people with pre-existing conditions. But it can repeal the law’s premium subsidies and the individual mandate.

Unfortunately, this is going to wreak havoc and produce a death spiral in the individual health insurance market. With guaranteed insurance for people with pre-existing conditions but no subsidies or individual mandate, premiums could skyrocket. Or, more likely, insurers simply would exit the market. Why risk losses when the whole law is getting repealed anyway? The upshot would be canceled coverage with no other options for people buying in the ACA’s marketplaces (like healthcare.gov or Covered California), as well as those buying directly from insurers, where the same rules apply.

So what Republicans MUST do is hold off on the reconciliation bill until they have a replacement in mind for the ACA.  That presents a political problem though, because repealing Obamacare was designated a first priority.

In short, here’s the dilemma for Republicans: YOU HAVE TO HAVE THE INDIVIDUAL MANDATE IF YOU WANT TO KEEP THE BAN ON PRE-EXISTING CONDITIONS.  Period.  It’s that simple.  If you don’t, then premiums will go through the roof, since people will drop their insurance and insurance companies won’t have the money to cover all the people with pre-existing conditions.

The only other alternative?  Single payer.  But the GOP won’t touch that.

So the GOP is in a bit of a bind.  Maybe that’s why this happened:

In a Tuesday letter to congressional leaders, the American Medical Association (AMA) came out against plans floated by Republicans to quickly repeal Obamacare but delay fully replacing the law.

The AMA told congressional leaders that they must reveal their plans to replace the Affordable Care Act before repealing the legislation.

“[W]e believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,” James L. Madara, the CEO of the AMA wrote in the letter.

The GOP, no doubt, wants to dismantle Obamacare but doesn’t want to get the blame.  The ball is definitely in their court.  They’re like the dog that caught the bus by the bumper — not sure what to do.

But it ain’t looking good for the dog.

SCOTUS Strikes Down Oppressive Abortion Restrictions

This morning, the Supreme Court struck down parts of a restrictive Texas law that could have reduced the number of abortion clinics in the state to about 10 from what was once a high of roughly 40.

The 5-to-3 decision was the court’s most sweeping statement on abortion rights since Planned Parenthood v. Casey in 1992. It applied a skeptical and exacting version of that decision’s “undue burden” standard to find that the restrictions in Texas went too far.

The decision on Monday means that similar restrictions in other states are most likely also unconstitutional, and it imperils many other kinds of restrictions on abortion.

Justice Stephen G. Breyer wrote the majority opinion, joined by Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. Chief Justice John G. Roberts Jr. and Justices Clarence Thomas and Samuel A. Alito Jr. dissented.

The decision concerned two parts of a Texas law that imposed strict requirements on abortion providers. It was passed by the Republican-dominated Texas Legislature and signed into law in July 2013 by Rick Perry, the governor at the time.

One part of the law requires all clinics in the state to meet the standards for ambulatory surgical centers, including regulations concerning buildings, equipment and staffing. The other requires doctors performing abortions to have admitting privileges at a nearby hospital.

“We conclude,” Justice Breyer wrote, “that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes. Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the federal Constitution.”

I’m not surprised by the outcome, nor am I surprised by swing justice Kennedy joining the “liberals” on the court.  Frankly, the Texas restrictions were NOT intended to support women’s health.  If you saw who proposed those restrictions (longtime Texas anti-abortion legislators) and listened to their rhetoric, “health of women” was a sham rationale.  Their real objective was to make abortion clinics so regulated that they could not afford to make the required changes, and eventually close down.  In fact, to date, twenty abortion clinics have closed down under those regulations.

So, yes, a victory, and it would have been a victory even if Scalia was alive and on the court.  But it does underscore the importance of the election and who gets to pick the next justices.

Two Million Pregnant Women At Risk For Zika Virus

So far, the GOP-controlled House has offered a mere $622 million in Zika funding — far less than what will be needed to meaningfully combat the virus. It’s unclear when Congress may reach an agreement on this issue before its long summer recess. And according to an analysis by the Center For American Progress, this delay could be putting about 2 million pregnant American women at risk.

Using data from the Centers for Disease Control and Prevention (CDC), here’s the think tank’s prediction for the number of pregnant women who might be affected by Zika this summer and fall, broken down by state:

Zika-webtable-620x804

We’ve known for months that Zika, which has been ravaging our neighbors to the south, was headed for the United States as warmer weather approached. In fact, it’s already here — there are currently 472 confirmed cases of Zika in the continental US, though so far they are all travel-related. Including U.S. territories such as Puerto Rico, which is already being overwhelmed by the virus, so far 279 pregnant women have tested positive for the virus.

These new numbers, however, show just how great the risk is if the United States hits mosquito season unprepared. Preparation takes funding — which is necessary for basic research on the virus, to help develop a vaccine, and take preventative measures like providing mosquito nets and education campaigns about how to avoid getting bitten. Yet despite the clear and present danger, conservatives on Capitol Hill have dragged their feet, haggling over the finances.

Josh Earnest, White House Press Secretary, said, “The House of Representatives is three months late and more than a billion short of doing what’s necessary to protect the American people.”

This is typical of a Republican-led Congress.  They fail to do enough until it is too late, and then things get really expensive.

Disease Of The Week

It’s called dementia with Lewy’s Bodies, and Robin Williams.  So says his widow, citing the cause of his suicide.  It wasn’t depression that caused the suicide, so much as the dementia with Lewy’s Bodies which caused the depressions which caused the suicide.

I have to be honest here: Is attribution to a physical illness merely a way to make a mental illness more palatable?  Given the stigma against mental illness (which includes depression), you have to wonder if the family is trying to revive some honor to Mr. Williams.

Uninsured State By State

From tomorrow’s New York Times, this remarkable map shows the percent uninsured in each state under Obamacare.  The states which elected to expand Medicare coverage are outlined in bold, and you can see the difference.  Compare, say, Arkansas in 2015 to its southern neighbors which did not expand Medicare coverage.

ocarestatesbig

First Human Trials On An HIV Vaccine Start Today

Researchers may be one step closer to creating an HIV vaccine.

This month, the Institute for Human Virology at the University of Maryland School of Medicine in Baltimore launched the first phase of clinical trials for a new treatment. The immunogen, known as the Full-Length Single Chain (FLSR), could potentially induce protective antibody responses to HIV-1 strains, going where previous trial vaccines have fallen short.

And it only took three decades and millions of deaths.

Tales Of The One Percenters

Honestly.  What is it going to take for the people and/or the government to throw these rich bastards in jail?  No, not for being rich, but for, you know, breaking laws and regulations that effect the lives of actual people…. when?!?

Case Study Number One:

Volkswagen chief executive Martin Winterkorn resigned Wednesday as a growing scandal over falsified emissions tests rocked the world’s biggest carmaker.

“I am doing this in the interests of the company even though I am not aware of any wrongdoing on my part,” Winterkorn said after an emergency meeting with Volkswagen directors.

Winterkorn, 68, was Volkswagen (VLKAY) CEO for eight years. The German company, which also owns the Audi and Porsche brands, had just achieved his long-standing goal of overtaking Toyota (TM) to become the biggest automaker three years ahead of target.

But his position had looked increasingly precarious since the scandal broke Friday, when U.S. regulators said the company had deliberately programmed some 500,000 diesel-powered vehicles to emit lower levels of harmful gases in official tests than on the roads.

The crisis escalated Tuesday when Volkswagen revealed it had found significant emissions discrepancies in 11 million diesel vehicles worldwide.

Winterkorn, an engineer and former head of Audi, said he was stunned by the scale of the misconduct, and was accepting responsibility to clear the way for a “fresh start” for the company.

Stunned, my ass.  You don’t intentionally program an entire line of cars to “cheat” emissions tests without the CEO knowing about it.  So this guy straps on a golden parachute, and leaves Volkswagon.  But people die when these things are avoided:

Volkswagen has admitted that 11 million of its cars worldwide were designed to cheat emissions testing, in an escalating scandal that has loaded pressure on the wider motor industry.

Campaigners have long claimed engine emissions figures under laboratory tests are far exceeded in real-life conditions, and experts have said thousands of premature deaths could be averted by ensuring cars meet their legal limits.

Emphasis mine.

Case Study Number Two:

Hedge fund manager Martin Shkreli is 32 years old but he’s acting half that age on Twitter today after news broke that his company, Turing Pharmaceuticals, had raised the price of the life-saving drug Daraprim from $13.50 to $750 per pill.

That’s not a typo — $13.50 to $750.00 per pill.

Daraprim is used to treat toxoplasmosis, a condition caused by a parasite that exists in nearly a quarter of the U.S. population over age 12, but which can prove deadly for the unborn children of pregnant women and for immunocompromised individuals like AIDS patients. These vulnerable populations will now have to pay over 5,000 percent more for their treatment.

Due to the sudden price hike, Shkreli, whose company only acquired Daraprim last month, has already dethroned the dentist who killed Cecil the Lion as the most-hated man in America.

***

Shkreli did a news show circuit as well, beginning with Bloomberg, where he attempted to argue that Daraprim had been underpriced before Turing swept in.

“The price per course of treatment to save your life was only $1,000 and we know these days, [with] modern pharmaceuticals, cancer drugs can cost $100,000 or more, rare-disease drugs can cost half a million dollars,” Shkreli said, as if it should be shocking that cheap, life-saving medicine could cost less than a laptop.

When confronted by the reporter with the low cost of producing Daraprim—about $1 per pill by her estimate—Shkreli claimed that the price hike was necessary for Turing Pharmaceuticals to increase revenue, and that some of the profits would be funneled into research and development costs for a Daraprim alternative. But as Emory University infectious disease professor Dr. Wendy Armstrong told RawStory, “I certainly don’t think this is one of those diseases where we have been clamoring for better therapies.”

Why do one percenters get away with this?  Because they can:

But as reprehensible as Shkreli’s actions might appear, what is even more harrowing is that they are not illegal. With his social media swagger, Shkreli makes an easy target for a problem that extends far beyond the confines of his ego: the rampant overpricing of life-saving medicine. As USA Today reported, many new cancer drugs cost over $100,000 per year—a fact that Shkreli, ironically, sees as justification for raising the cost of Daraprim. And technically, there’s no way to stop him.

As a spokesperson for the Food and Drug Administration told The Daily Beast’s Ben Collins on Twitter in response to Shkreli’s actions, their power in this situation is, well, nonexistent.

An FAQ page on the FDA’s website asks, “What can the FDA do about the cost of drugs?” and the answer is, essentially, nothing: “We understand that drug prices have a direct impact on the ability of people to cope with their illnesses as well as meet other expenses. However, FDA has no legal authority to investigate or control the prices charged for marketed drugs.”

Martin_Shkreli__3449094bThis is true, but states have laws against gouging.  An industrious state Attorney General could make a name for himself on this.

In any event, Shkreli’s media blitz cast him in an even worse light — he came off as slimy and greasy as a used car salesman.  Just .look at his picture.  The latest news today is that Shkreli has agreed to reduce the price, although he will not say by how much.

He’s not the first person to corner the market on a drug and hike the price.  But he’s one of the most frequent offenders.  Fortunately, Bernie Sanders and Hillary Clinton have weighed in, and this could become a political hot potato.  Any chance for reform?  We’ll see.

 

Planned Parenthood, the Abortion Debate, and 2016 Elections

There is very little to recommend being over the age of 50, but one of the nice things is that it gives perspective and wisdom — the kind of experience that can’t be taught, but can only come from having lived several decades.

There is one thing I have learned – abortion rights are not going away.

notdifficultThat wasn’t always a certainty.  Roe v Wade was seriously challenged in the 1980s and 1990s, not only in the political arena, but also in the courts.  But that nadir of the conservative anti-abortion movement came in 1992, with the case of Casey vs. Planned Parenthood.  The Supreme Court was, like today, leaning conservative.  You had Scalia, you had Thomas, you had Alito, you had Rehnquist for crying out loud.  And they were handed, on a silver platter, a case in which Roe v Wade could have been overturned, or at least seriously curtailed.  The result was 5-4, with the conservatives losing.  The Casey case actually strengthened abortion rights.

Having lost in the legal arena, the anti-choice forces spent the next two decades challenging abortion in the political arena.  They have had some success there.  There was the Hyde Amendment, a legislative provision barring the use of certain federal funds to pay for abortion unless the pregnancy arises from incest, rape, or to save the life of the mother.  That was signed into law by Bill Clinton in 1993.  At the state and local levels, a hodgepodge of laws have restricted access to abortion through laws requiring waiting periods, mandatory ultrasounds, and over-regulation of abortion clinics (like requiring wide hallways).  But abortion itself remains legal.

The recent attempt to defund Planned Parenthood is probably the strongest national push against abortion since the Hyde Amendment.  It is quite obviously punitive in nature — since the Hyde Amendment already restricts federal funds to go to Planned Parenthood for abortions, the current legislative push seeks to defund Planned Parenthood of federal funds for everything else they do (cancer screening, etc.).  And why?  Because they sell “baby parts”, which of course is a crass and not-altogether-honest way of saying that Planned Parenthood provides fetal tissue to medical research facilities in the hopes of curing disease.  Conservatives want to kill Planned Parenthood (the largest abortion provider) even if it means killing women’s health.

Of course, this dovetails nicely into the “war on women” meme.  And Hillary Clinton is right to pound Republicans on this.  This issue was a gift to her — she was sagging in the polls and Bernie Sanders has been making a serious play for the nomination (coming within 8 points of Hillary in New Hampshire).  Now she can talk about women’s health, and the Republican efforts to kill it.

I am perplexed as to why Republicans want this debate.  They seems to care more about two-celled zygotes than million-celled actual women.  After they lost the 2012 Presidential elections, they performed an autopsy of their failures, which included statements like this:

When it comes to social issues, the Party must in fact and deed be inclusive and welcoming.

If we are not, we will limit our ability to attract young people and others, including many women, who agree with us on some but not all issues…

The RNC must improve its efforts to include female voters and promote women to leadership ranks within the committee. Additionally, when developing our Party’s message, women need to be part of this process to represent some of the unique concerns that female voters may have. There is growing unrest within the community of Republican women frustrated by the Party’s negative image among women, and the women who participated in our listening sessions contributed many constructive ideas of ways to improve our brand with women throughout the country and grow the ranks of influential female voices in the Republican Party.

But rather than do that, they seem to be doubling down on losing the women vote — going so far as to threaten a government shutdown.  At first I thought the talk of government shutdown was an empty threat, but maybe I am wrong.  Stan Collender at Forbes puts the odds of a government shutdown at 60% (up from his previous prediction of 40% ). Here’s his wonderfully descriptive way of saying what happened.

But the biggest change from last week in the odds of a government shutdown is because of the emergence of the one big thing that has been missing so far from the appropriations debate: a highly emotional, politically toxic and take-no-prisoners issue.

Even the front-runner in that contest right now – Donald Trump – declared his support for a government shutdown over Planned Parenthood. Any candidate who had doubts about whether or not a government shutdown would be good for their campaign will now have to weigh in with that in mind.  Also, we’ve already seen one example of a candidate making a mess of that when, in commenting about Planned Parenthood funding, Jeb Bush said yesterday that he was “not sure we need half a billion dollars for women’s health issues.” His campaign pretty immediately tried to walk that one back. Overall it’s very likely that, in order to win the GOP primary, these candidates will all wind up taking positions that their own autopsy suggested were one of the causes of their defeat in 2012.

The craziness of the high rhetoric of this 2016 election campaign is causing Republicans to shoot themselves in the face.  It is interesting to watch.

This Says It All

Obama Derangement Syndrome:

Atlanta resident Ted Souris, 62, describes himself as an “arch-conservative” who initially opposed the health law. He said he had mixed feelings about the ruling. He receives what he calls “a pretty hefty subsidy” to buy insurance — he gets $460 and pays $115 a month for insurance.

“I’m so against Obama, and I hate that he has any kind of victory,” Souris said, “but it’s nice that I don’t have to worry” about affording health coverage.

He said that he doesn’t like getting what he calls “a government handout” but that the law — and the subsidy — allowed him to retire early and still have coverage. “I am glad I have the Affordable Care Act, and I appreciate that I got the subsidy.”

These people just hate.  Hate Obama.  Even when Obama does things that are good for them.

I’m not saying it is racism, but whatever it is, it is a very strange pathology.

Obamacare Subsidies Upheld By SCOTUS

I’m actually not that surprised at the outcome.  The surprising thing was that the Supreme Court ever took this case in the first place.

But the US Supreme Court upheld the challenge to Obamacare.  The opinion is here.

In layman’s terms, the issue surrounded some (arguably) vague language in the Affordable Care Act relating to the federal government providing financial assistance to people who get Obamacare through their state exchange.  If you interpret the language one way, the federal government cannot provide financial assistance.  If you interpret it the way Congress intended it, then the federal government can provide financial assistance.  Without the federal government assistance, however, health insurance will become far too expensive for millions of people who buy it through their state exchange, and so they won’t buy it.  (In North Carolina, it would increase healthcare costs by over $300 per month).   In effect, it would end Obamacare.

So the question was actually quite simple…. did Congress intend to write a healthcare law that wouldn’t work?

Chief Justice Roberts wrote the opinion and the short answer to that question is….

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Chief Justice Roberts did note that the ACA was a badly written piece of legislation.  (There are, he notes, three separate Section 1563s).

Scalia’s dissent is pure Scalia.  It refers to “interpretive jiggery-pokery” and calls the majority opinion “pure applesauce”.

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Elsewhere, he writes: “Impossible possibility, thy name is an opinion on the Affordable Care Act!”

He writes that the court “rewrites the law to make tax credits available everywhere… We should start calling this law SCOTUScare.” (that’s the first time “SCOTUS” has ever been used in a SCOTUS opinion).

He says: “Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”

And similarly: “[T]he cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”

Talk about projection.  Scalia is the one with the obvious agenda and “favorites”.  That last comment is a pretty harsh attack on his colleagues, including the Chief Justice.

We should remember that Scalia didn’t give a rat’s ass about the clear language OR the legislative intent of the Voting Rights Act when he and his conservative colleagues gutted it, deciding unilaterally that it didn’t apply to today’s world, now that there isn’t racism any longer.

Roberts, by the way, took Scalia’s own dissent from the last major Obamacare case, and used it against Scalia.  It was buried in a footnote and amounted to a small dart lobbed Scalia’s way.  To defend making the subsidies available to consumers everywhere, Roberts cited a line the dissent to the 2012 decision in favor of Obamacare, in which Scalia said, “Without the federal subsidies . . . the exchanges would not operate as Congress intended and may not operate at all.”

Roberts used the line to argue that it “is implausible that Congress meant the Act to operate” in a manner to limit the subsidies only to those states with state-operated exchanges, as the challengers in King v. Burwell argued.

Other reax below the fold

Will America’s Uninsured Rate Go To Single Digits?

No major survey has ever found that the uninsured rate in America has hit single digits.  Ever.

But a new survey from the Urban Institute’s Health Reform Monitoring Survey, a quarterly survey of non-elderly Americans, says that 10.0% of nonelderly adults were uninsured.  That’s down from 17.8% in September 2013, before the Affordable Care Act’s insurance exchanges first launched.

And in fact, that data is only as recent as March 2015, so we are probably in the single digits now.

Let’s hope SCOTUS doesn’t screw things up now.

I Feel Bad For The Guy, But….

There are many angles about the story I am about to convey.

One might say it is a story about a guy out on his luck.  Another might say it is a story about the crappy healthcare system we have.  Or maybe it is about how Republicans talk about personal responsibility but then complain when they don’t get government handouts when they want it.  For me though, this is a story about a guy so entrenched in his Obama hatred that he screwed himself over (and yet he still blames Obama).  Anyway, you be the judge. From the Charlotte Observer:

Lang, a 49-year-old resident of Fort Mill, S.C., has bleeding in his eyes and a partially detached retina caused by diabetes.

“He will lose his eyesight if he doesn’t get care. He will go blind,” said Dr. Malcolm Edwards, the Lancaster, S.C., ophthalmologist who examined Lang.

Lang is a self-employed handyman who works with banks and the federal government on maintaining foreclosed properties. He has done well enough that his wife, Mary, hasn’t had to work. They live in a 3,300-square-foot home in the Legacy Park subdivision valued at more than $300,000.

But he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills.

That worked while he and his wife were relatively healthy. But after 10 days of an unrelenting headache, Lang went to the emergency room on Feb. 25. He says he was told he’d suffered several mini-strokes. He ran up $9,000 in bills and exhausted his savings. Meanwhile, his vision worsened and he can’t work, he says.

That’s when he turned to the Affordable Care Act exchange. Lang learned two things: First, 2015 enrollment had closed earlier that month. And second, because his income has dried up, he earns too little to get a federal subsidy to buy a private policy.

Lang, a Republican, says he knew the act required him to get coverage but he chose not to do so. But he thought help would be available in an emergency. He and his wife blame President Obama and Congressional Democrats for passing a complex and flawed bill.

Since Lang now has no income, he should be eligible for the ACA’s expanded Medicaid coverage, for which the federal government picks up tab. But Lang lives in Fort Mill, South Carolina. And South Carolina refused to accept Medicaid expansion. So he’s out of luck on that front too.

He now has a gofundme page to help raise some money for his medical expenses.

Okay.

That’s the story.  Now, he and his wife have decided to lay blame at ACA’s feet, so let’s play the blame game:

Let’s go through this point by point:

(1) Lang broke the law by refusing to get health insurance coverage because he prided himself on being able to pay his bills out of pocket.  ACA’s fault?  Verdict: No.

(2) He lost the health lottery and got sick.  That’s when he realized he actually had too little savings to cover even relatively small health care bills.  ACA’s fault?  Verdict: No

(3) By now open enrollment has closed. But he figured he’d be able to buy in if he got in a jam or wait till he got sick to buy coverage. Luckily the ACA’s Medicaid expansion covers him regardless. But the state of South Carolina refused to accept Medicaid expansion even though the federal government would pay for it. ACA’s fault?  Verdict: No (The US Supreme Court ruled that it could not be made compulsory on states to accept the Medicaid expansion, i.e., states had to opt in.  Most states did choose to opt in but the Republican legislature and governor of South Carolina said “no”.).

When all is said and done, Lang is left in precisely the situation that would exist if the ACA (aka Obamacare) had never been passed. So he blames… Obama?  It takes quite a lot of chutzpah to blame the Affordable Care Act for not covering him when he disdains government programs and never carried health insurance in the first place. If he thinks he should be covered now then he’s really asking for single payer, which he would probably call “socialist”.  Lang’s case shows the exceptional power of myths reinforced by Fox News-like partisanship and ideology.

Lead Paint And Inner City Violence

I’m just going to point to this comprehensive and insightful Washington Post article which talks about Freddie Gray (whose death while in Baltimore police hands sparked the recent riots there) and lead paint.  Like many inner city kids, Gray lived in sub-standard housing with peeling lead paint, and in his case, it specifically was blamed for ADHD and other problems.

It wasn’t long after that he was given the first of many blood tests, court records show. The test came in May of 1990, when the family was living in a home on Fulton Avenue in West Baltimore. Even at such a young age, his blood contained more than 10 micrograms of lead per deciliter of blood — double the level at which the Center for Disease Control urges additional testing. Three months later, his blood had nearly 30 micrograms. In June 1991, when Gray was 22 months old, his blood carried 37 micrograms.

“Jesus,” Dan Levy, an assistant professor of pediatrics at Johns Hopkins University who has studied the effects of lead poisoning on youths, gasped when told of Gray’s levels. “The fact that Mr. Gray had these high levels of lead in all likelihood affected his ability to think and to self-regulate and profoundly affected his cognitive ability to process information.”

Levy added, “And the real tragedy of lead is that the damage it does is irreparable.”

This isn’t unusual, and any discussion of violence in the inner cities needs to consider this as a factor.

NAMI On the Germanwings Air Crash

Reprinted in full:

NAMI shares the grief of the rest of the world over the crash of Germanwings Flight 9525.  We extend our condolences to the families of those who lost their lives in this senseless tragedy.

As often happens in tragedies, information emerges first through an immediate frenzy of reporting in news media and then through more careful analysis. It is always best not to speculate on causes, but to wait until all facts are confirmed and assessed.

In this case, as news cycles have progressed, we’ve been told that the co-pilot who crashed the plane had some history of depression. Most recently, a German prosecutor has reported that he had “received psychotherapy for an extended period of time, during which suicidal tendencies had been noted,” while the airline has reported in 2009 he had disclosed to them a previous episode of severe depression. Treatment apparently occurred before he received his pilot’s license.

He also apparently was being seen for one or more other medical issues. How relevant those factors actually are remains to be seen.

We know that by crashing the plane, the co-pilot killed himself, along with 149 other people.

We know that most suicides involve mental illness.

In the United States, approximately 40,000 people die from suicide each year.  Obviously, we are falling far too short in suicide prevention.

Typically, suicide involves a struggle between a person and his or her own psychological problem. Murder-suicides are very rare. Murder-suicides conducted by commercial airline pilots are even rarer—extremely rare—although that of course is no consolation to the victims of Flight 9525, their families and friends.

People living with mental illness are rarely violent. Usually, mental illness is only one factor, among several, if not many, that set the stage for violent tragedies.

In the case of Flight 9252’s co-pilot, the fact is that we don’t know his full history yet. We may never know every relevant fact. His precise history of depression, whatever it may have been, may ultimately be seen as unimportant compared to other issues in his life.

Please keep that point in mind as the global conversation now turns to whether anyone who experiences mental illness should be allowed to serve in certain occupations or professions. Mental illness is treatable. People do recover.

Senseless tragedies must not be allowed to resurrect or perpetuate stigmatizing stereotypes that associate anyone with a history of mental illness with a propensity to violence. It will be an additional tragedy if the crash of Flight 9525 leads to “witch hunts” in which people who have sought help for mental illness become unfairly discriminated against.

Sixteen million American adults—almost 7 percent of the population—had at least one major depressive episode in the past year.  When depressive symptoms occur, people need to see a doctor for a comprehensive examination. Underlying medical issues that can mimic a depressive episode, side effects from medications or any other medical causes must first be ruled out, before a treatment plan is chosen.

As a society, we need to create a cultural environment in which people are encouraged to seek help when they need it—regardless of whether it is a mental illness or any other illness.  No one should have to hide out of fear of negative consequences or reprisals such as loss of employment or social ridicule.

We want a society that affirms the worth of every individual—the same kind of affirmation that causes us to mourn the loss of so many precious lives on Flight 9525.

Today Is World Bipolar Day

wbdAccording to the World Health Organization (WHO), there are 450 million people globally with mental illness; of that number, 5 percent are labeled bipolar, which is three times all cases of diabetes and 10 times all the cases of cancer. Bipolar is the sixth leading cause of disability, according to WHO.

“Bipolar Disorder is a mental illness that represents a significant challenge to patients, health care workers, family members and our communities,” according to a press release from World Bipolar Day organizers. “While growing acceptance of bipolar disorder as a medical condition, like diabetes and heart disease, has taken hold in some parts of the world, unfortunately the stigma associated with the illness is a barrier to care and continues to impede early diagnosis and effective treatment.”

So how do we break down barriers and dispel myths and mistruths? Enter World Bipolar Day.

March 30 is the birthday of Vincent Van Gogh, the famous painter who cut off his own ear and was posthumously diagnosed with probable bipolar disorder, also known as manic depression. Dr. Pichet Udomratn, a member of the Asian Network of Bipolar Disorder (ANBD) who worked with with International Bipolar Foundation (IBPF) and International Society for Bipolar Disorders (ISBD) to create World Bipolar Day, thought March 30 would be a fitting day to bring the world information about a highly stigmatized and feared mental illness.

For more information on World Bipolar Day and how you can get involved, visit the cause’s Facebook page or follow the event on Twitter @WorldBipolarDay.

Don’t Blame Depression

This is in Forbes, so I don’t have to write it:

You saw a depressed person today. Probably dozens or hundreds of them.

They drive cars. They perform surgery.

They fly planes — and safely land them.

Of course, that’s been frequently forgotten since last week’s devastating Germanwings tragedy.

Many pundits quickly blamed the horrific plane crash on depression, noting that co-pilot Andreas Lubitz — who took control of the Germanwings airliner and steadily, deliberately flew it and his 149 fellow passengers into the Alps — was reportedly treated for depression and possessed a supply of antidepressants.

The argument came from know-nothing pundits like Piers Morgan. “Depressed pilots on medication for mental illness should not be flying passenger planes,” he declared. If they’re not pulled from the skies, he added, “it could be any one of us next.”

The supposed link was blared across European newspaper headlines, too.

Even the experts weren’t sure.

“Should a depressed pilot be allowed to fly?” wrote Dr. John Grohol, the founder & CEO of Psych Central.

“I’m not sure someone who has a lot of responsibility should be going into work on days where they’re dealing with this kind of emotional upset or sadness.”

On one count, Grohol’s right: there do need to be some basic protections. (That’s a key reason why the FAA has been incredibly restrictive when letting pilots return from treatment for depression, as Forbes writer David Kroll notes.)

And there is a possible link between depression and violence, at least in some cases.

For example, a recent Oxford University study reviewed 50,000 Swedish citizens diagnosed with depression, concluding that people who were diagnosed with depression tended to commit more violent crimes too.

“Our findings suggest that the odds of violent crime are elevated two to three fold after adjustment for familial, socioeconomic, and individual factors,” the researchers wrote in TheLancet Psychiatry in February.

But blaming a person’s depression for his evil acts is ridiculous.

For instance, the Oxford researchers noted that when accounting for other factors — like a previous history of violence, substance abuse, or psychosis — the elevated rate of violence among depressed was notably smaller. And it’s possible that “depression” was over-diagnosed in these people, too.

Mental health experts further stress: Depressed people may be suicidal, but almost never homicidal. The suicide rate in the United States is roughly double that of the homicide rate.

That’s why one of the most important public health efforts of the past few decades has been the effort to de-stigmatize depression — especially because it’s so widespread. Depression strikes up to 20% of Americans across their lifetimes, the Anxiety Disorders Association of America has found.

For the moment, depression is seen as a debilitating, but not disabling condition. “Depression made me do it” isn’t an acceptable excuse for doing a poor job at work, and can’t get you out of a legal bind.

And it doesn’t explain what happened in the case of Germanwings, as Lubitz horribly plunged a plane of screaming passengers into the Alps, acting with chilling evil.

If you believe the tale told by an alleged ex-girlfriend, the plane crash was chillingly planned for months; Lubitz supposedly wanted the world to know his name.

“I don’t know what that is,” psychiatrist Anne Skomorowsky wrote at Slate, “but it’s not depression.”

Ask one of the 10 million-plus Americans who are seriously depressed at any given time. The bravest among them will admit: Depression is devastating. It makes you self-loathing, and lays you low.

But it doesn’t make you a murderer.

See also: “Would We Be ‘Blaming’ Cancer for the Deaths of Those People Who Perished in the Alps?” at HuffPo

I would add that we shouldn’t blame bipolar disorder either.  That is being bandied about as the culprit because he was prescribed strong SSRIs and anti-psychotic medicine.

Don’t get me wrong… I think it is clear that he suffered from some mental illness.  He may have had bipolar disorder or depression, but these would only explain the suicide, not the 149 homicides.  Some have suggested narcissistic personality disorder, which is characterized by (among other things) indifference toward others and grandiosity (Lubitz reportedly said he wanted to “change the system”).  Perhaps that is true.

But the danger here is linking his illness to the tragedy.  I know people who have struggle with depression.  I know people who have been diagnosed bipolar.  And people who have NPD/borderline.  None of them are likely to become homicidal.  This tragic event, like some school shootings, could become a good teaching moment for mental illness — to explain both the frequency and severity and the wide range of problems it causes (homicide being extremely rare)  But instead, the media focus will merely add to the already-existing stigma of mental illness, causing fewer people to seek treatment, or deny their illness altogether.  And that would add to the tragedy.

Stigmatization Of Mental Illness Begins

It’s an explanation, not an excuse.

By the way, it bears mentioning that if there were no stigmatization of mental illness, the copilot would not have felt the need to hide his condition, and could have gotten the help he needed, thus saving 150 lives. But you can bet the media won’t take that angle.

The Cheap Wine You’ve Been Drinking May Contain Too Much Arsenic

That’s the allegation in a lawsuit (read the complaint here — PDF) filed in California this week.  The origins of the lawsuit draw back to Kevin Hicks, a former wine distributor who started BeverageGrades, a Denver-based lab that analyzes wine. The lab tested 1,300 bottles of California wine, and found that about a quarter of them had higher levels of arsenic than the maximum limit that the Environmental Protection Agency allows in water.

Now, it is important to keep in mind that this is a lawsuit, and it is entirely possible that this is essentially a nuisance lawsuit — one contrived by ambulance-chasing lawyers in order to get a quick shakedown of the wine companies involved, hoping that the companies would rather see this go away quickly than have to put up with years of bad publicity (even if they are vindicated in the end).  So take that into account. But in the meantime, below the fold is a list of wines that are included in the lawsuit. (Note: Any wines without a specific year listed mean that the grapes don’t come from a single year.)

Taking Anti-Vaxxing To The Next Level

It’s one thing to say that measles vaccinations are harmful (they’re not), but it is entirely different to say that measles don’t exist at all.  Yet, one German pseudoscientist did, going so far as to put his money on it.  He lost:

This is something I thought would probably never happen – a science denier, in this case German virologist Stefan Lanka, was ordered by a court to pay 100,000 Euros to German doctor David Barden for meeting his challenge to prove that the measles virus exists.

Lanka is clearly, in my opinion, a crank, which is a specific flavor of pseudoscientist who makes sophisticated arguments to support a hilariously wrong conclusion. There is some major malfunction in their scientific reasoning. Typically, in my experience, they have an oversized ego and think they know better than the rest of the scientific community. For some reason an extreme narrative gets stuck in their brain, and they spend their career marshaling evidence and arguments to support a nonsensical idea. I find cranks endlessly fascinating because I think they are extreme cases that reveal major weaknesses in the operation of the human brain.

One favorite tactic of cranks and deniers is to issue an open challenge to prove what they deny exists. I think this strategy is inspired by the Randi Million Dollar Challenge, which is a legitimate challenge for anyone to prove a paranormal phenomenon. Randi has a specific process spelled out, with concrete criteria for success.

Hoax challenges are pure publicity stunts – they sound grandiose but typically are framed in such a way that the one issuing the challenge can wiggle out of ever having to pay. They are rigged from the beginning, mainly by not spelling out what kind of evidence would meet the challenge.

I guess Lanka got a little sloppy. He issued a 100,000 Euro challenge to anyone who could prove the measles virus exists. That’s right – the measles virus. Lanka is an HIV denier from back in the 1990s (and still denying HIV). HIV denial is the claim that AIDS does not exist as a discrete medical illness, or at least is not caused by a specific virus, and in fact the human immunodeficiency virus does not really exist.

***

That a court has now demanded that Lanka pay Barden the reward for meeting his challenge is an interesting twist. Barden pulled together published scientific evidence that together proves beyond a reasonable scientific doubt that measles is real. Lanka, of course, denied the evidence. That is what he does. You will never meet his burden of evidence to prove the thing that he denies, which is what makes such challenges from deniers a hoax.

However, Barden went to the courts to settle their dispute. The court, unlike Lanka, has apparently applied a reasonable standard for scientific proof and determined that Barden did indeed meet the burden of proof to demonstrate that measles is real. Lanka, of course, will appeal, and there is always the possibility that he will wiggle out of the judgment on legal grounds (rather than the merits of the case).

Study: Selfish Anti-Vaxxing Parents Facilitated Measles Outbreak

L.A. Times:

Although epidemiologists have not yet identified the person who brought measles to Disneyland, a new analysis shows that the highly contagious disease has spread to seven states and two other countries thanks to parents who declined to vaccinate their children.

Using some simple math, a team of infectious disease experts calculated that the vaccination rate among people who were exposed to the measles during the outbreak was no higher than 86%, and it might have been as low as 50%.

In order to establish herd immunity, between 96% and 99% of the population must be vaccinated, experts say.

“Even the highest estimated vaccination rates from our model fall well below this threshold,” the researchers reported Monday in the journal JAMA Pediatrics.

… In other words, the only way to explain how the measles spread from a single person at Disneyland to 145 people in the U.S. and about a dozen others in Canada and Mexico is that a substantial number of parents have not had their children fully immunized with the measles, mumps and rubella vaccine.

“Clearly, MMR vaccination rates in many of the communities that have been affected by this outbreak fall well below the necessary threshold to sustain herd immunity, thus placing the greater population at risk as well,” the researchers concluded.

Fortunately, there are bills in the California legislature (and hopefully in other states as well) to make it harder for parents to “opt-out” their kids.

Why My Plans To Retire In Costa Rica Are Looking Better

Because of this:

Exactly five years ago this week, as the Congressional debate over the Affordable Care Act was coming to its eventual conclusion, Rush Limbaugh made a bold statement about his future as a resident of the United State of America.

Speaking to a caller who expressed concerns about the impact of Obamacare on the U.S. healthcare system, Limbaugh said, “If this passes and it’s five years from now and all that stuff gets implemented, I am leaving the country. I’ll go to Costa Rica.”

He’s still here in the U.S.  Maybe he was just saying stuff.

Whew!

Do We Have A Contender For Michelle Bachman’s Replacement?

MichelleFioreNevada Republican assemblywoman Michelle Fiore made a bit of name for herself when she was quoted in the New York Times saying that “hot little girls” on campus need guns to protect themselves against rapists.  She did not say what ugly large girls should carry.  This was all in connection with a bill she sponsored that would allow firearms onto college campuses (because what could possibly go wrong with that?)

Now she is telling her constituents that cancer is a fungus that can be flushed out with salt water and baking soda.

Yes, she really said that.

Gonna keep an eye on this one…..

P.S.  The more you know….

The Vaccination Debate Makes For An Interesting Political Wedge Issue

Of the potential 2016 presidential candidates on the GOP side, we have Christie and Rand Paul cuddling up with the anti-vaxxers (spouting “freedom” in their answers when asked about whether parents should vax)

And then we have one of the most conservative Christian candidates out there, Dr. Ben Carson, who seems to be the voice of reason on this issue:

“Although I strongly believe in individual rights and the rights of parents to raise their children as they see fit, I also recognize that public health and public safety are extremely important in our society,” Carson said in a statement to BuzzFeed News.

Carson said diseases of the past should not be allowed to return because of people avoiding vaccines on religious or philosophical grounds.

“Certain communicable diseases have been largely eradicated by immunization policies in this country and we should not allow those diseases to return by foregoing safe immunization programs, for philosophical, religious, or other reasons when we have the means to eradicate them,” Carson said in the statement.

Well, duh.

[UPDATE 2/4/15 — Looks like I gave Carson too much credit.  He stands by his statement, but he blames “undocumented people” for outbreaks (despite the fact that countries in Central and Southern America are better about vaccinations than we are.]

This isn’t a battle the Republicans want to have. This shouldn’t be one of those issues where you have to reflexively oppose whatever Obama or Clinton says, and the potential Republican candidates do this at their peril. The GOP is already thought of as the anti-science party. If Republican leaders are questioning the efficacy of vaccines, they’re going to double down on that label, alienating many of the moderates they need in 2016.

By the way, there is some interesting data on who supports/opposes vaccinations.  According to a YouGov survey, support for mandatory vaccinations for “childhood diseases like measles, mumps, whooping cough” is inversely correlated with age. Under-30s actually oppose it by a 42/43 margin, while those 30-44 support it 50/37; 45-64-year-olds support it 64/26, and seniors support it 73/21.

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I think the reason for this is quite simple: younger people are…. well, not stupid…. but ignorant.  They simply grew up in a time when these diseases had been eradicated for the most part.  They are going from their own blind lack of experience and firsthand knowledge.  They think of things like pro-choice and freedom, and apply it to this situation, without really knowing the history or facts.

The Problem With Libertarianism

Libertarianism (Latin: liber, “free”) is a political philosophy that upholds liberty as its principal objective. Libertarians seek to maximize autonomy and freedom of choice, emphasizing political freedom, voluntary association and the primacy of individual judgement.

For months, nay, years, I have been wanting to write about the shortfalls of libertarianism.  It’s been difficult because who in America, other than outright fascists, would argue with liberty and freedom of choice?

But finally FINALLY we have an illustrative example come to the fore.  And I’ve been blogging about it recently (a lot) and now I can make a simple tie-in without expending too many words.

Let’s go to the money quote from libertarian extraordinaire and 2012 Presidential candidate, Ron Paul:

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On Monday, Rand Paul, the son, hedged a little:

Paul was asked to weigh in on vaccines, after New Jersey Gov. Chris Christie (R), a likely rival for the GOP nomination in 2016, said Monday morning that there should be “some measure of choice” for parents leery of vaccinating their children.  “I’m not anti-vaccine at all, but most of them ought to be voluntary,” Paul, an ophthalmologist, said Monday on the “Laura Ingraham Show,” in a segment circulated by the Democratic National Committee along with criticism of Paul’s views.

UPDATE:  Later that day, Rand Paul was asked a follow-up, and said this with respect to vaccines:

I think they’re a good thing but I think the parent should have some input. The state doesn’t own your children; parents own the children and it is an issue of freedom.

Huh. So parents own their children (that’s libertarian?!?) and not only have the “freedom” to expose their property to deadly illnesses, they have the freedom to expose your kids to deadly illnesses.

The thing is — and I certainly can see why the anti-vaxxers hate this — IT TAKES A VILLAGE to get rid of some of these diseases.  All or most children had to be vaccinated before measles made its disappearance and the beginning of this century.  The same can be said for many more diseases.

The same holds true for other areas of human endeavor — the economy for example.  Libertarians think the self-interest and the invisible hand of Adam Smith will take care of everything.  Nope:

Neighborhoods, communities, villages, cities, societies — depending on the situation — can succeed and improve the quality of life where “individual freedom” cannot.  Does that mean socialism and communism is the way to go?  Of course not.  But libertarianism — the polar opposite of socialism and communism — is just as ineffectual for most things.

There is a balance between individual rights and the common good. This should be obvious, but hardcore libertarians seem to believe that the mere assertion of a right is sufficient to end a public argument. It is not, when the exercise of that right has unacceptable public consequences, or when the sum of likely choices is dangerous to a community.

Turning to the issue at hand, vaccines provide protection through two means.  The first is direct protection.  I get a shot for something and the probability of me getting that particular disease declines dramatically as my immune system now knows how to fight that type of invader.  The second is indirect protection via herd immunity.   If I get a shot, I go from being a possible vector and transmitter of a disease to another unvaccinated person to a very low probability of passing the disease along.  Herd immunity only works when the vast majority of the population already is immune to a disease as the probabilities of a current carrier bumping into a receptive individual is fairly low if the general population is overwhelmingly vaccinated.

So the point of vaccinations is to protect not merely ourselves, but the community. To not vaccinate is to threaten the array of trillions of antibodies and T cells that decades of vaccination have built up in our bodies/  We drape a web of germ-fighting agents not just in ourselves, but around our most vulnerable neighbors. To not vaccinate is to affirm an overweening individuality. It’s a form of selfishness.

community_immunity.0

The best results come when everybody does what is best for themselves and for the group.  Adam Smith was wrong.  So are Ron and Rand Paul.  And the anti-vaxxers.

World’s Worst Doctor

There’s always one.  No matter what hair-brained position you take, you can always find an “expert” to add alleged credibility.

This time the “expert” is Jack Wolfson.  He’s being embraced by the loons because he’s a doctor AND an anti-vaxxer.  Here’s the thing to keep in mind — he’s a cardiologist.  That means he knows as much about vaccines as a proctologist knows about muscle degeneration.  Weigh his medical views against literally tens of thousands of academics and doctors who actually study and practice in this field.

Anyway, here’s a little of his drivel:

“Measles isn’t a big deal”, he said, though the CDC definitely disagrees. “This quote-unquote ‘outbreak’ has infected 70 people who are quote-unquote ‘infected,’ ” he said. “This is a country of 300 million people, and no one has died, and no one is sick as far as I know. We are all worried, and we are all getting crazy, and what we’re talking about is really just a fever and a rash.”

Uh, Mr. quote-unquote doctor?  It IS an outbreak. There have been over 80 102 people identified as of two days ago.  And what’s more, as the same article notes, that in YOUR state (Arizona), as many as 1,000 people, including 200 children, have potentially been exposed to the disease, and seven are infected.

No, it isn’t that black plague, but there was a point in history when there were only 80 people infected with the black plague.  That wasn’t a big deal at the time either.

What’s interesting/scary about the guy is that he doesn’t deny that vaccines prevent measles, mumps, rubella, chicken pox, etc.  He just thinks children have the “right” to contract these potentially life-threatening illnesses.  He says:

“I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years…. That’s the best way to protect.”

Except it is not.  It is just another fad diet, one that nutritionists reject.  In fact, in 2012, a panel of experts reviewed 36 different diets for their weight loss and health (nutrition) value.  Guess what came in last?  The paleo diet, mostly because it was unsafe.

But morons will be morons.  Even with a DR in front of their name.

*******

Also, this:

Video of Kristiana Coignard’s Summary Execution

As I posted a few days ago, police in Longview, Texas, tragically shot and killed a 17-year-old girl last week.  Her name was Kristiana Coignard.

In the newly released video, it’s clear that her shooting death was completely and totally avoidable.

After speaking with officers and roaming around the lobby of the police station for ten minutes, Kristiana, who was struggling with mental illness, was subdued by an officer in the lobby until two additional officers entered.

After Kristiana clumsily charges at the original officer, he shoots and kills her instantly.  We’ve been told she was “brandishing” a knife.  I don’t see it, but (for now) we’ll take the officers word on that.

Even then, a lot of questions come to mind: Why did he not handcuff her earlier in the minutes he had her subdued? Why did he not search her for weapons earlier? Why did he not Taser her with a stun gun? Why did he not use pepper spray? Why did he not simply grab her and subdue her again? Why did he not throw a chair at her, run from her, ANYTHING?

This cannot and should not be the best practice for police officers.  Firing your weapon should be the LAST RESORT.  I’m pretty sure it used to be. If this is all our officers are trained to do, it’s insufficient.

What Is Grubergate And Why You Shouldn’t Care

Republicans think they’ve just happened upon a major moment in the never-ending political debate over Obamacare: Newly discovered video of White House consultant Jonathan Gruber’s controversial comments about the passage of the law.

In the video, from 2013, Gruber suggests the details of the law were obscured in order to assure its passage. He says the bill relied on the “stupidity of the American voter” and a “lack of transparency.” Pretty damning stuff.

Republicans, naturally, think they just might have this goose cooked now, with the Post’s Robert Costa quoting Rep. Jim Jordan (R-Ohio) calling Gruber’s comments a potential (for lack of a better term) game-changer — one that could finally help turn public sentiment against Obamacare for good and assist the GOP’s efforts to dismantle it.

“We may want to have hearings on this,” Jordan told Costa. “We shouldn’t be surprised they were misleading us.”

But while it’s clear this is hardly Obamacare’s proudest moment, the idea that Gruber’s comments will suddenly swing public sentiment against Obamacare is wishful thinking.  That’s because any damage Gruber did — ultimately — was to himself, and nobody knew who he was before last week.

What did Gruber actually do?  In The West Wing terms, it is the classic Washington scandal — get into trouble for telling the truth.  In a city where it is a cliche not to show how the sausage is made, Gruber was exposing something sordid yet completely commonplace about how Congress makes policy of all types: Legislators frequently game policy to fit the sometimes arbitrary conventions by which the Congressional Budget Office evaluates laws and the public debates them.

Indeed, when Gruber discusses the ignorance of American voters in the video clips, no political scientist who knows even smidgen about American public opinion would have raised an eyebrow. This isn’t because political scientists look down on voters; it’s because they have surveyed voters repeatedly and discovered that rational ignorance is this is just the way it is.

But stating that most voters are uninformed about most things is one of those rude utterances that one just does not say in polite political company. People can say it behind closed doors, or at academic settings, but never on camera.

Gruber, unknowingly, said it on camera. That’s his sin. And I suspect it’s a sin that countless social scientists have committed at myriad conferences over the years.

But Obama didn’t say it, and it doesn’t change what Obamacare is, or how we, as a country, are benefiting from it.

Nor will it lead to Obamacare’s downfall, despite the zeal of many conservative pundits who think this is THE “smoking gun”.  That’s because Gruber’s comments, while damning, aren’t exactly the most fertile political territory. While “stupidity of the American voter” is a pretty strong soundbite, Gruber’s connection to the law takes some explaining. And most people — apart from those who already decided the efficacy of the law years ago — are really keen on the latest Obamacare debate a week after the 2014 election.

Changing public opinion on something like this, five years hence, takes a lot — especially when the support and opposition have been baked in for so long at pretty constant levels.

If anything can change that, it is far more likely to be something that has a personal impact on lots of Americans — like large premium increases or canceled plans. And if Obamacare is dismantled, it will be because the GOP has Congressional majorities and a president who wants to do it.  That means no earlier than 2017.

Suicide – Brave Or Cowardly?

A person from my past had issues.  She was diagnosed with Bipolar I, which they don't diagnose unless you have psychotic episodes, which she claimed to have had.  I never witnessed any (I don't think); in fact, what I witnessed mostly was the depressive side of her bipolarity, which included a suicide attempt or two.

In that depressive state, we would often talk about her situation (sometimes, it seemed like that was all we talked about), and she would occasionally talk matter-of-factly about killing herself, listing the people who would be "better off" if she wasn't alive (including her daughter).  Her rationale made no sense, but… that's the nature of the being bipolar: the perceptions of a bipolar person are usually wrong, even when (especially when) they feel so so right to the bipolar person.  When you are bipolar, you can't trust how you feel.  Which must be very difficult.

One of arguments she liked to make was that committing suicide was a very brave thing to do.  I didn't take a contrary position, although I know what she was responding to — that old chestnut you often hear that people who commit suicide are "cowardly".  They are afraid to face their difficulties, the myth goes, so they do the "cowardly" thing by ending it all.  My ex's point was just the opposite: it takes chutzpah, gonads, bravery to end it all.

i am reminded of those conversations now that question had been raised again in the public conscience, in light of the recent and tragic Robin Williams suicide.  Was Robin Williams cowardly for "checking out"?  

My answer is the same as always.  Of course he wasn't cowardly.  But I wouldn't agree to call him brave.  Not everything that happens falls on that scale.  He was sick.  His depression had control over him.  He couldn't help it.  So the answer is "neither" and the debate itself is silly.

The same goes for the question of whether suicide is "selfish".  Yes, of course suicide is selfish, but not in the perjorative sense that we usually mean when we say "selfish". After all, depression is selfish — is there ever a time when a person is more self-indulgent and self-involved than when he or she is depressed?  So of COURSE a person attempting suicide is selfish — he/she is in pain.  Just as much pain as if shot with a bullet.  

But all you can say is that they were "selfish", then you are missing the larger point.  What MADE them selfish?  It's NOT a character flaw, but more likely (and certainly in the case of Robin Williams), a mental illness known as depression or bipolar disorder or something along those lines.  The selfishness is incidental to the illness.  Calling them selfish, even if it happens to be true, only serves to malign and stigmatize those with a mental disorder.  It's turning a sickness into a callous act of blaming the victim.

Why do that?

The Cost Of Obamacare Repeal

The GOP wants to run on repealing Obamacare in the upcoming elections?  How will that play at the state level?  A new Department of Health and Human Services report documents the impact federal subsidies under Obamacare are having on the insurance costs of people receiving them, and the Plum Line gives the bottom line:

But if subsidies were repealed, people would not lose coverage, instead seeing premiums jump from loss of the tax credit.

– In North Carolina, 357,584 people are paying an average monthly premium of $81 — and repeal would result in an average monthly loss of subsidies/cost increase of $300.

– In Michigan, 272,539 people are paying an average monthly premium of $97 — and repeal would result in an average monthly loss of subsidies/cost increase of $246.

– In New Hampshire, 40,262 people are paying an average monthly premium of $100 — and repeal would result in an average monthly loss of subsidies/cost increase of $290.

– In Louisiana, 101,778 people are paying an average monthly premium of $83 — and repeal would result in an average monthly loss of subsides/cost increase of $314.

– In Iowa, 29,163 people are paying an average monthly premium of $108 — and repeal would result in an average monthly loss of subsidies/cost increase of $243.

– In Alaska, 12,890 people are paying an average monthly premium of $94 — and repeal would result in an average monthly loss of subsidies/cost increase of $413.

– In Georgia, 316,543 people are paying an average monthly premium of $54 — and repeal would result in an average monthly loss of subsidies/cost increase in premiums of $287.

Let that be known.

UPDATE: Apparently, the courts are doing it for the GOP.  This morning, the D.C. Circuit court (the most conservative of the circuit courts) ruled in a case called Halbig v. Burwell.  Here is the D.C. Circuit Halbig ruling:

A federal appeals court dealt a huge blow to Obamacare on Tuesday, banning 
the federal exchange from providing subsidies to residents of the 36 states it serves.

A divided three-judge panel on the D.C. Circuit Court of Appeals ruled that the text of the Affordable Care Act restricts the provision of premium tax credits to state-run exchanges. The two Republican appointees on the panel ruled against Obamacare while the one Democratic appointee ruled for the law.

"We conclude that appellants have the better of the argument: a federal Exchange is not an 'Exchange established by the State,' and section 36B does not authorize the IRS to provide tax credits for insurance purchased on federal Exchanges," Judge Thomas B. Griffith wrote for the court in Halbig v. Burwell.

His ruling was joined in a concurring opinion by George H. W. Bush-appointed Judge A. Raymond Randolph, who said it would be a "distortion" to let the federal exchange provide subsidies. "Only further legislation could accomplish the expansion the government seeks," he wrote.

Carter-appointed Judge Harry T. Edwards voted to uphold the subsidies.

"This case is about Appellants’ not-so-veiled attempt to gut the Patient Protection and Affordable Care Act," Edwards wrote in his dissenting opinion.

The ruling is very troubling for the Obama administration because the subsidies are critical to the success of Obamacare. The law encourages states to build their own exchange, but if they don't the federal government operates one on their behalf. The subsidies, or premium tax credits, exist to help Americans between 133 percent and 400 percent of the poverty line buy insurance. That imperils the practicality of the individual mandate to get covered and the market regulations to protect sick people.

UPDATE #2:  Fourth Circuit to the rescue.  A few hours after this morning's D.C. Circuit case, the also-conservative Fourth Circuit comes out with an opinion in King v. Burwell, which goes in the other direction and upholds the subsidies in Obamacare.  The opinion is here.

Money quote:

No case stands for the proposition that literal readings should take place in a vacuum, acontextually, and untethered from other parts of the operative text; indeed, the case law indicates the opposite. National Association of Home Builders v. Defenders of Wildlife, 551 U.S. 644, 666 (2007). So does common sense: If I ask for pizza from Pizza Hut for lunch but clarify that I would be fine with a pizza from Domino’s, and I then specify that Iwant ham and pepperoni on my pizza from Pizza Hut, my friend who returns from Domino’s with a ham and pepperoni pizza has still complied with a literal construction of my lunch order. That is this case: Congress specified that Exchanges should be established and run by the states, but the contingency provision permits federal officials to act in place of the state when it fails to establish an Exchange. The premium tax credit calculation subprovision later specifies certain conditions regarding state-run Exchanges, but that does not mean that a literal reading of that provision somehow precludes its applicability to substitute federally-run Exchanges or erases the contingency provision out of the statute.

UPDATE #3:  I didn't realize this before, but the DC Circuit opinion was en banc.  It was not the full circuit.  Therefore, the 4th Circuit "wins" out for now.  The Obama administration is appealing the DC Circuit opinion to the full DC Circuit.

Ripple Effect

Among the dead in the Malaysian Air shootdown — about 100 people from the World Health Organization going to an AIDS conference.  According to the Associated Press, the exact number of individuals who were killed on their way to the conference is unconfirmed. However, Australian officials have noted that “there is no doubt it’s a substantial number” that includes “medical scientists, doctors, people who’ve been to the forefront of dealing with AIDS across the world.”

Go On Offense

Just a week ago, things looked bleak for Democrats and Obama for 2014. But then thePaul Ryan Vanity Project collided with 7 million new signups under the Affordable Care Act, and now the Democrats have the makings of a winning ticket for this year:

Go on offense.

One of Karl Rove’s basic tenets of politics was to attack from your area of weakness. In the same vein, Congressional Democrats and Barack Obama need to treat the next seven months as a sprint, an all-out attack campaign against their GOP opponents, day in and day out to push the GOP on defense for having no solutions except to throw millions off their health insurancehurt the vulnerable, and protect corporations and the wealthy. Democrats and the White House should aggressively push the ACA, attack the Ryan budget, and tar the GOP as whores for the Koch Brothers, end of story. Hammer the message every day without apology.

And watch these poll numbers go even higher. Go for broke and double down, instead of crawling into a hole.

The Hobby Lobby Case

Justice Anthony Kennedy, on whose vote the Hobby Lobby SCOTUS case rests, seems very concerned about the government forcing corporations to cover abortion:

WASHINGTON, DC — Justice Anthony Kennedy thinks gay people are fabulous. All three of the Supreme Court’s most important gay rights decisions were written by Justice Kennedy. So advocates for birth control had a simple task today: convince Kennedy that allowing religious employers to exempt themselves from a federal law expanding birth control access would lead to all kinds of horrible consequences in future cases — including potentially allowing religious business owners to discriminate against gay people.

Kennedy, however, also hates abortion. Although Kennedy cast the key vote in Planned Parenthood v. Casey upholding what he called the “essential holding of Roe v. Wade,” he’s left no doubt that he cast that vote very grudgingly. Casey significantly rolled back the constitutional right to choose an abortion. And Kennedy hasn’t cast a single pro-choice vote in an abortion case in the last 22 years.

So Hobby Lobby and Conestoga Wood, the two companies claiming that they should be exempt from the birth control rules had an ace in their pocket as well. Their path to victory involved convincing Kennedy that their cases are really about abortion — and it looks like Kennedy convinced himself of that point on his own.

It was clear from the get go that the Court’s liberals understood that their best course involved highlighting the dangerous consequences of a victory for Hobby Lobby. Paul Clement, the de facto Solicitor General of the Republican Party who argued the case on Hobby Lobby’s behalf, barely uttered his first sentence before Justice Sonia Sotomayor cut him off to ask what other medical procedures religious employers could refuse to cover in their employee health plans. Justice Elena Kagan quickly joined the party. If Hobby Lobby can deny birth control coverage, Kagan asked, what about employers who object to vaccinations? Or blood transfusions?

When Clement tried to deflect this list, Kagan came armed with an even bigger what. What of religious employers who object to gender equality, or the minimum wage, or family medical leave, or child labor laws? If the Supreme Court agrees with Hobby Lobby’s brief, which argues that laws burdening a corporation’s purported religious faith must survive the “most demanding test known to constitutional law,” then there would be few laws corporations could not exempt themselves from following.

Clement’s argument time then took a number of detours, with the Court’s three women dominating the questioning. Justice Kagan pointed out that religious liberty cases have never applied the same strict constitutional rule applied in race cases. Justice Ruth Bader Ginsburg wondered how the federal religious liberty law at issue in this case — the Religious Freedom Restoration Act (RFRA) — could have passed almost unanimously if it lead to the deeply controversial results advocated by Clement. Justice Sotomayor wondered how it is possible for a corporation to exercise religion.

The justices also spent a good amount of time discussing whether Hobby Lobby faces any real burden at all, since they could always simply stop offering health benefits and pay a tax — a position first articulated in a blog post written by Professor Marty Lederman.

At the end of Clement’s first turn at the podium, Kennedy asked the question that will probably give most hope to Team Birth Control. What about the rights of employees who may be hurt by their employer’s decision not to follow the law? For the moment, it appeared that Kennedy was worried about the parade of horribles that could follow a decision for Hobby Lobby.

Indeed, not long after Solicitor General Don Verrilli took the podium to argue the government’s case, it appeared that he may ultimately emerge victorious. Clement spent much of his argument on his heels. The three women on the bench appeared quite confident in their questioning. Kennedy was silent for much of Verilli’s argument.

But then he made a statement that will likely doom the government’s case. “Your reasoning would permit” Congress to force corporations to pay for abortions, Kennedy told Verrilli. This was not the Anthony Kennedy that worried about conservatives imposing their anti-gay “animus” on others, this was the Anthony Kennedy that views abortion as a grave moral wrong. Shortly after Kennedy made this statement, Justice Kagan’s face dropped. It appeared that she’d just figured out that she would be joining a dissenting opinion.

It’s worth noting that Kennedy expressed a different concern than one offered shortly thereafter by Chief Justice John Roberts. Hobby Lobby objects to four forms of contraception on the mistaken ground that these contraceptive methods are actually forms of abortion — a brief filed by numerous medical organizations explains that they are not. Roberts, however, suggested that someone’s mere belief that something is an abortion is enough to trigger an religious exemption to federal law.

This is insane.

Suppose I had the "mere belief" — religiously held — that black people evolved from mud and white people were descendents of Adam and Eve, and had a rightful place in heaven and on Earth?  And in my place of employment?

Of course, you don't have to go that far.  No Muslim or Jewish employer gets to demand that their employees not get coverage for, say, illnesses resulting from eating pork. No Hindu employer gets to restrict health coverage for people who eat beef or were born to the wrong caste.  Why do Christians get a pass?

We have actually addressed this issue before, in 1990, in Employment Division, Oregon Department of Human Resources vs. Smith.  In that case,  Smith and Black were fired by a private drug rehabilitation organization because they ingested peyote, a hallucinogenic drug, for sacramental purposes at a ceremony of their Native American Church. Their applications for unemployment compensation were denied by the State of Oregon under a state law disqualifying employees discharged for work-related "misconduct."

That case involved the same question: what happens when one's religious belief runs up against a generally-applicable law?

And the answer was: Tough.  Here's what Scalia — yes, Scalia — wrote:

We have never held that an individual's religious beliefs excuse him from compliance with an otherwise valid law prohibiting conduct that the State is free to regulate. On the contrary, the record of more than a century of our free exercise jurisprudence contradicts that proposition. As described succinctly by Justice Frankfurter in Minersville School Dist. Bd. of Ed. v. Gobitis, 310 U.S. 586, 594 -595 (1940): "Conscientious scruples have not, in the course of the long struggle for religious toleration, relieved the individual from obedience to a general law not aimed at the promotion or restriction of religious beliefs. The mere possession of religious convictions which contradict the relevant concerns of a political society does not relieve the citizen from the discharge of political responsibilities (footnote omitted)." We first had occasion to assert that principle in Reynolds v. United States, 98 U.S. 145(1879), where we rejected the claim that criminal laws against polygamy could not be constitutionally applied to those whose religion commanded the practice. "Laws," we said, "are made for the government of actions, and while they cannot interfere with mere religious belief and opinions, they may with practices. . . . Can a man excuse his practices to the contrary because of his religious belief? To permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself." Id., at 166-167.

Emphasis mine.

There simply is no reason why abortion is entitled to some special category of religious exemption, where peyote and polygamy were not.

But it looks like this is where the Supreme Court is headed, and as Scalia notes, it will be throwing aside centuries of jurisprudence in doing so (Scalia is likely to be one of the justices contraditing himself).

Very sad.  And a very dangerous precedent.

 

Be Wary Of Obamacare “Losers” You See On TV

From HealthInsurance.org:

For months, health reform’s opponents have been feasting on tales of Obamacare’s innocent victims – Americans who lost their insurance because it doesn’t comply with the ACA’s regulations, and now have to shell out more than they can afford – or go without coverage.

Trouble is, many of those stories just aren’t true.

Yesterday I posted about a Fort Worth Star Telegram article that leads with the tale of Whitney Johnson, a 26-year-old new mother who suffers from multiple sclerosis (MS). Her insurer just cancelled her policy, and according to Johnson, new insurance would cost her over $1,000 a month.

That claim stopped me in my tracks. Under the ACA, no 26-year-old could be charged $1,000 monthly – even if she has MS.

Obamacare prohibits insurers from charging more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.

At that point, I knew that something was wrong.

When I checked the exchange – plugging in Johnson’s county and her age – I soon found a Blue Choice Gold PPO plan priced at $332 monthly (just $7 more than she had been paying for the plan that was cancelled). Co-pays to see a primary care doctor would run just $10 ($50 to visit a specialist) and she would not have to pay down the $1,500 deductible before the insurance kicked in.

My radar went up. Recently, I have been reading more and more reports regarding “fake Obamacare victims.”

Now I couldn’t help but wonder: Who are these folks in the Star-Telegram story? The paper profiled four people who supposedly had been hurt by Obamacare. When I Googled their names, I soon discovered that three (including Johnson) were Tea Party members.

The paper describes them as among Obamacare’s “losers,” but the truth is that they didn’t want to be winners. Two hadn’t even attempted to check prices in the exchanges.

Meanwhile, it appeared that no one at the Star-Telegram even attempted to run a background check on the sources, or fact check their stories. I couldn’t help but wonder: “Why?”

The answer will surprise you.

You should read the whole story.  Meanwhile, the Johnson lady makes the rounds…

 

Prediction

There are many many many things wrong with our healthcare system, including things that drive up costs.  None of this is the fault of Obamacare.  But you can be sure that these problems will come to light, and it will be blamed on Obamacare, even if those problems have been around for decades.

Dumbest Comparison Ever

On Mandela:

“He was fighting against some great injustice, and I would make the argument that we have a great injustice going on right now in this country with an ever-increasing size of government that is taking over and controlling people’s lives — and Obamacare is front and center in that."

Folks, if you try to compare affordable health care to apartheid, you've already lost

Rand Paul And Doughnuts

Rand is all up in arms over the jack-booted doughnut snatchers:

Sen. Rand Paul warned Americans that the federal government is targeting doughnuts, the latest example of the oppressive nanny state in America.

"They're coming after your doughnuts!" the Kentucky Republican said, referring to the Food and Drug Administration decision to ban trans fats.

Paul added that if the FDA was banning trans fats, the employees of the agency should be forced to get healthy themselves.

"I say we should line every one of them up. I want to see how skinny or how fat the FDA agents are that are making the rules on this," Paul said…

"Because if we're going to have a nanny state and everybody's got to eat the right thing, and you can't eat a doughnut, maybe we just ought to enforce it on the government workers first," he said.

Apparently he thinks you can't make doughnuts without trans fats. I think that's going to come as a surprise to Krispy Kreme. Or anyone who's ever eaten real doughnuts made with real ingredients.

He's all upset about the nanny state in this piece, but keep in mind who he sees as the truly aggrieved party: the major food industry manufacturers who want to keep poisoning people with cheap, chemical ingredients that are killing them.

Sarah Palin’s Word Salad

Sarah Palin is on a media tour to promote her silly book about a nonexistent "War on Christmas," and appeared on the Today show with a tasty new right wing word salad, achieving (not for the first time) total incoherence:

The plan is to allow those things that had been proposed over many years to reform a health-care system in America that certainly does need more help so that there's more competition, there's less tort reform threat, there's less, um, trajectory of the cost increases, and those plans have been proposed over and over again. And what thwarts those plans, it's the far left, it's President Obama and his supporters who will not allow the Republicans to usher in free market, patient-centered, doctor patient relationship links to reform health care.

[…]

Uh, you know, when you stand in the middle of the road you're gonna get hit on both sides of the road. We need to take a stand especially on this Obamacare, and support those who are just fulfilling their campaign promises, SO many politicians ran for reelection and for election saying they will do anything in their power to defund the status [sic] socialized medicine program called Obamacare. Ted Cruz, Mike Lee, some of these guys actually were fulfilling their campaign promises and they asked for debate. That's why they stood up, they took the stand, fought for us, to debate the issue of Obamacare.

Wha?

Republican Alternatives To Obamacare

As the White House struggles with the rollout of Obamacare’s online health insurance marketplace, pressure has mounted within the Republican Party to begin offering conservative alternatives that address the nation’s health care crisis.

Here are some of the plans the GOP is considering:

  • Repeating the phrase “you can keep your current doctor” over and over until something happens
  • Loosening regulations to allow Americans to ship ill and injured family members to cheaper doctors overseas
  • Whatever the opposite of tyranny is
  • Allowing sick Americans to choose how they exhaust their life savings on a single medical bill, even if it’s out of plan
  • A true market-based solution—perhaps a convenient website—where uninsured people would pay for their own health insurance from private providers
  • $2,500 cash incentive to the first person who cures cancer
  • A health care law that won’t allow the disgrace of another Benghazi
  • Unsettling language and several ominous-looking graphs labeled “Obamacare” followed by a breezy smile and soothing, unspecific words

Yeah, that's from The Onion.  But it's not that far from reality.

Red State Leads In Obamacare

It's true — the federal government websites for signing up for the Affordable Care Act are glitchy.  And an embarrassment to the Obama Administration.  And Obama will suffer repercussions for that.

But when Obama says that websites are glitchy, and the Affordable Care Act isn't, he's right.  Obamacare isn't the websites.  Not even close.

And the other thing is, the glitchy websites are only for those states (like North Carolina) that decided not to set up their own health exchage.  If you live and work in Kentucky, and you want to sign up for health care, the Kentucky website is hunky-dory, thank you very much.  That's right, Kentucky — the home state of Senators Mitch McConnell and Rand Paul.

The Deal

Looks like the House is getting ready to vote to end the government shutdown and raise the debt ceiling in return for…. stripping members of Congress, their staff and White House appointees and employees of their Obamacare subsidies.

Sounds good to me.

What Obamacare Will Cost You

Okay, it's arrived (despite Ted Cruz's embarrassing attempt to kill it).

Obamacare is here.

For most of us who are employed, it'll probably mean some kind of change in our health coverage.  But of course, Obamacare wasn't meant for people who already had coverage; it was meant for those who didn't.  And when we are all covered, that works to everyone's benefit.

So, for those without coverage, you have to go to your state exchange and see what your state offers.

But 36 states (including North Carolina) have opted to go with the federal exchange.  And now we have the numbers for the federal exchange.  The cost of a healthcare plan under the federal exchange depends on, well, your age and where you live, as well as what plan you choose.  

And it's pretty good:

Table 1: Premiums and Qualified Health Plan Choices, 36 States (Weighted average across entire state)

 

State

 

Average Number of QHPs

27-Year-Old, Before Tax Credits

27-Year-Old with an Income of $25,000

Family of Four with an Income of $50,000

Lowest Bronze

Lowest Silver

Lowest Gold

Lowest Catastrophic

Second Lowest Silver Before Tax Credit

Second Lowest Silver After Tax Credit

Lowest Bronze After Tax Credit

Second Lowest Silver Before Tax Credit

Second Lowest Silver After Tax Credit

Lowest Bronze After Tax Credit

AK

34

$254

$312

$401

$236

$312

$107

$48

$1,131

$205

$0

AL

7

$162

$200

$248

$138

$209

$145

$98

$757

$282

$112

AR

28

$181

$231

$263

$135

$241

$145

$85

$873

$282

$64

AZ

106

$141

$164

$187

$107

$166

$145

$120

$600

$282

$192

DE

19

$203

$234

$282

$137

$237

$145

$111

$859

$282

$158

FL

102

$169

$200

$229

$132

$218

$145

$96

$789

$282

$104

GA

50

$179

$208

$242

$142

$221

$145

$103

$800

$282

$132

IA

39

$139

$175

$203

$95

$189

$145

$96

$683

$282

$103

ID

42

$150

$182

$211

$134

$188

$145

$107

$680

$282

$144

IL

58

$134

$180

$210

$134

$188

$145

$90

$682

$282

$84

IN

34

$200

$258

$332

$168

$265

$145

$80

$961

$282

$46

KS

37

$130

$171

$192

$87

$171

$145

$104

$619

$282

$133

LA

40

$175

$235

$253

$142

$249

$145

$71

$902

$282

$15

ME

20

$216

$255

$336

$182

$265

$145

$96

$961

$282

$104

MI

43

$146

$178

$218

$118

$202

$145

$89

$731

$282

$80

MO

17

$162

$211

$242

$110

$220

$145

$87

$798

$282

$72

MS

22

$225

$265

$321

N/A

$295

$145

$75

$1,069

$282

$28

MT

26

$165

$204

$222

$149

$208

$145

$102

$753

$282

$126

NC

22

$186

$237

$283

$123

$243

$145

$88

$880

$282

$74

ND

24

$185

$230

$259

$142

$232

$145

$98

$841

$282

$111

NE

40

$159

$196

$232

$122

$206

$145

$98

$744

$282

$113

NH

12

$186

$236

$281

$157

$237

$145

$94

$859

$282

$96

NJ

29

$219

$253

$303

$186

$260

$145

$103

$943

$282

$131

NM

52

$143

$181

$204

$120

$186

$145

$102

$672

$282

$128

OH

46

$177

$200

$243

$131

$212

$145

$110

$768

$282

$156

OK

53

$114

$169

$203

$105

$175

$145

$84

$634

$282

$63

PA

56

$151

$170

$205

$125

$187

$145

$109

$675

$282

$152

SC

26

$176

$219

$259

$146

$223

$145

$97

$809

$282

$109

SD

32

$196

$225

$272

$169

$235

$145

$106

$852

$282

$141

TN

59

$119

$155

$205

N/A

$161

$145

$103

$584

$282

$128

TX

54

$139

$189

$225

$139

$201

$145

$83

$727

$282

$57

UT

82

$153

$183

$212

$116

$203

$145

$95

$656

$282

$122

VA

47

$156

$213

$253

$118

$221

$145

$80

$799

$282

$48

WI

97

$189

$227

$280

$150

$238

$145

$96

$861

$282

$106

WV

12

$185

$218

$266

$169

$218

$145

$112

$789

$282

$161

WY

16

$286

$324

$365

$259

$342

$145

$90

$1,237

$282

$81

Average,

36 States

53

$163

$203

$240

$129

$214

$145

$93

$774

$282

$95

NOTE: Premiums shown above are a weighted average of the lowest cost plans in each rating area within a state. Weights are derived from county-level population under the age of 65, projected by the Census Bureau. The average across all 36 states is based on the number of uninsured eligible for the Marketplaces.

So, say you're 27 years old, making $25,000 a year, and live in North Carolina (under 27, you can remain on your parents' plan, thanks to Obamacare).  The lowest plan (the Bronze Plan) will cost you $186 per month, which isn't too bad.  When you factor in the tax credit you get, it will only be $88 per month.

Not bad.

Death Of A Talking Point

The main takeaway from an exhaustive new study of premiums on the Obamacare health insurance marketplaces by nonprofit, nonpartisan Kaiser Family Foundation: They’re generally going to be lower than expected.

KFF on Obamacare Premiums

I know.  You're not going to read it.  But here's the bottom line:  Marketplaces premiums are coming in below initial estimates.

The expected monthly premium for a 40-year-old adult purchasing a silver-level plan (the baseline, which covers 70 percent of costs) on a marketplace had been $320, according to previous projections from the Congressional Budget Office. But in 15 of the 18 regions studied by Kaiser, the average premium will be below that — thus the study’s conclusion that the prices are going to be lower than anticipated.

“While premiums will vary significantly across the country, they are generally lower than expected,” the authors wrote.

If Kaiser’s estimates bear out, it could be a big blow to one of the main conservative talking points against the Affordable Care Act: rate shock. Everybody from House Republicans to think tank types like the Manhattan Institute’s Avik Roy and the Heritage Foundation have been warning that consumers would see skyrocketing prices under the law.

And to be sure, premiums are going to go up.  But this was known.  That's why health care reform was needed in the first place.  Doing nothing would have made premiums so high that they simply could not be attained.

So much for the "rate shock" Republicans warned us about.

Actions Have Consequences, Part XXVIII

Q.  The senior pastor at a Texas megachurch often speaks from the pulpit against vaccines.  The church's position is that one should seek guidence from God, the Word.   What is the result?

(a)  God, the Word, takes care of everybody.
(b)  The senior pastor gets a Ph.D. in medicine
(c)  There is an outbreak of measles which not only affects members of the church, but the entire community.

The answer, of course, is C. 

And this happens quite often — more than you may think.

Quote of the day goes to William Schaffner, an infectious disease expert and professor at the Vanderbilt University School of Medicine in Nashville, who says:  "This is a sadly misinformed religious leader."

And the church?  Looks like they know they stepped in it.

It Turns Out That People Like The Alternative to Obamacare, Known As “Obamacare”

This anecdote, reported by Jason Cherkis after attending an event in Louisville, speaks to a fascinating larger phenomenon.

A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state's health benefit exchange established by Obamacare.

The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers.

"Do I burst his bubble?" wonders Reina Diaz-Dempsey, overseeing the operation. She doesn't. If he signs up, it's a win-win, whether he knows he's been ensnared by Obamacare or not.

Yep, that guy in Kentucky has been told so many times to hate Obamacare that he genuinely believes it's awful. But in Kentucky, a red state with a Democratic governor, implementation of the Affordable Care Act is continuing apace with the creation of "Kynect" — the state's new health care marketplace. Indeed, as Cherkis explained, "The state had spent millions establishing the exchange, staffing up outreach, and conducting market research that included holding a dozen focus groups in Louisville, Paducah and London."

And as the anecdote helps demonstrate, it's having some success. People don't necessarily realize that new benefits available in Kentucky have anything to do with the federal law they've been conditioned to reject. It's why they're impressed when they hear the pitch from policy experts like Reina Diaz-Dempsey — the benefits sound like a pretty good deal for folks.

If they think those benefits "beat Obamacare," so be it.

Better People Than Me

Caleb Howe is a writer for the rightwing blog RedState.  And he's one of those bloggers — a pure hater.

Take, for example, how he laid into Roger Ebert for no apparent reason other than he disagreed with Ebert.

500x_howetweets_0b21e

That's only a small sample.

Howe loves being that way.  He prides himself being that way.

True, he did eventually apologize (sort of) for his Ebert tweets.  But the incident was noted.  In Esquire magazine, writer Chris Jones noted:

Yes, Caleb Howe is more famous than he was last week, but he's famous for being a person who doesn't know whether he should introduce himself to strangers at parties, just in case, and he's famous for his allegiance to the very thing that Roger has already stomped again and again: Caleb Howe, for whatever unfathomable reason, has sided with cancer.

That was all back in May 2010.

Why am I writing about this?

Because Caleb Howe has liver cancer.  And he needs your help.

Cancer's not so funny now is it Caleb?

RedState put out a call for help — Caleb has no health insurance and is facing huge medical bills.  To their credit, the big lefty sites joined in: Daily Kos and Think Progress among them.  If so inclined, you might want to help as well.

But while I hope for Caleb and his family that he recovers fully, I'm not above inserting politics into this matter.  Hopefully Caleb, a strong opponent of Obamacare, will realize that the only reason he can hope to pay his bills is because he is a minor celebrity in the blogosphere, and from that celebrity he can get charitable donations.  However, most people aren't celebrities of any sort, and nobody should have to hold a bake sale to pay their hospital bills.  

End of story.

Sabotaging Obamacare

Look, you can't intentionally derail a train, and then say that the train didn't work.

But that's just what Republicans and Tea Party leaders are planning to do with Obamacare:

"The Republican strategy is to focus on messages that this is not working in states where the law is still unpopular with voters and where there are really going to be competitive races," said Robert Blendon of the Harvard School of Public Health.

FreedomWorks and Americans for Prosperity, a conservative issue group financed by billionaire brothers David and Charles Koch, known for funding conservative causes, are planning separate media and grassroots campaigns aimed at adults in their 20s and 30s – the very people Obama needs to have sign up for healthcare coverage in new online insurance exchanges if his reforms are to succeed.

"We're trying to make it socially acceptable to skip the exchange," said Dean Clancy, vice president for public policy at FreedomWorks, which boasts 6 million supporters. The group is designing a symbolic "Obamacare card" that college students can burn during campus protests.

Right. So you urge your people not to get healthcare coverage, and when they get leukemia, you think they will blame Obamacare??

Noting that it is unprecedented in American history that politicians would try to undercut a law, Norm Ornstein has a few words:

When a law is enacted, representatives who opposed it have some choices (which are not mutually exclusive). They can try to repeal it, which is perfectly acceptable – unless it becomes an effort at grandstanding so overdone that it detracts from other basic responsibilities of governing. They can try to amend it to make it work better – not just perfectly acceptable but desirable, if the goal is to improve a cumbersome law to work better for the betterment of the society and its people. They can strive to make sure that the law does the most for Americans it is intended to serve, including their own constituents, while doing the least damage to the society and the economy. Or they can step aside and leave the burden of implementation to those who supported the law and got it enacted in the first place.

But to do everything possible to undercut and destroy its implementation – which in this case means finding ways to deny coverage to many who lack any health insurance; to keep millions who might be able to get better and cheaper coverage in the dark about their new options; to create disruption for the health providers who are trying to implement the law, including insurers, hospitals, and physicians; to threaten the even greater disruption via a government shutdown or breach of the debt limit in order to blackmail the president into abandoning the law; and to hope to benefit politically from all the resulting turmoil – is simply unacceptable, even contemptible. One might expect this kind of behavior from a few grenade-throwing firebrands. That the effort is spearheaded by the Republican leaders of the House and Senate – even if Speaker John Boehner is motivated by fear of his caucus, and McConnell and Cornyn by fear of Kentucky and Texas Republican activists – takes one's breath away.

Indeed.

Tom-toles-obamacare

House Republicans Will Vote Tomorrow — For The 43rd Time — To Unsuccessfully Repeal Obamacare

They know it is an exercise in futility, because even if (for some reason) the House Republicans manage to pass a vote to repeal Obamacare, the Senate won't take it up OR pass it, and even if THAT happened, Obama will never sign the repeal into law.

So it's a symbolic thing.

That's okay.  Symbolism has its place.  But this is ridiculous.  They want to be able to go home and say, "I voted 17 times against Obamacare" or (for members who have been there longer), "I voted 43 times against Obamacare."

That makes it dumb.

And unfortunately, these repeal votes might become a stain.  Why?  Read this from the New York Times:

The repeal vote, which is likely to occur Thursday, will be at least the 43rd day since Republicans took over the House that they have devoted time to voting on the issue.

 To put that in perspective, they have held votes on only 281 days since taking power in January 2011. (The House and Senate have pretty light legislative loads these days, typically voting only three or four days a week.)

 That means that since 2011, Republicans have spent no less than 15 percent of their time on the House floor on repeal in some way.

That's right.  With a dicey economy, terrorism, etc., the Republicans spent almost one-fifth of their time on the House floor voting for repeal.

Waste of time.  Waste of House seats.

UPDATE: Last year, CBS News calculated that the number of hours spent on 33 repeal votes — then roughly 80 hours, or two full work weeks — cost taxpayers an estimated $48 million. Since then, Republicans have held three more votes (another $4.5 million) to repeal ALL of Obamacare and will add another $1.5 million with their latest.

Epidemic

CDC says 7.3% of all deaths in US last week were from pneumonia, flu, which is above epidemic threshold of 7.2%. 47 US states have reported widespread flu activity; 24 states, New York City had 'high activity' in flu-like illnesses last week.

Papa John’s Takes A HIt

HuffPo:

The opinion of Papa John's among recent casual diners dropped precipitously after CEO John Schnatter's public comments about Obamacare, according to a new study from YouGov BrandIndex, which researches brand perception for marketing directors, brand managers and PR reps. The site conducts thousands of interviews a day, providing real-time info that shows trends and responses to different marketing techniques or in this case, public gaffes.

The national pizza chain's YouGov BrandIndex Buzz score — which the site uses as an indication of brand favorability — dropped to four at the end of November, down from 32 on election day.

Papa John's isn't the only one:

Applebee's score dropped more than 25 points after Zane Tankel — who owns 40 Applebee's in the New York area – appeared on the Fox Business Network and expressed reluctance to expand because of the health care overhaul.

Romney: Can’t Afford Health Care? Go To ER!

Republican presidential candidate Mitt Romney says, what's the big deal about universal health care anyway? You people who can't afford car elevators can just go to the emergency room.

WASHINGTON — Downplaying the need for the government to ensure that every person has health insurance, Mitt Romney on Sunday suggested that emergency room care suffices as a substitute for the uninsured. "Well, we do provide care for people who don't have insurance," he said in an interview with Scott Pelley of CBS's "60 Minutes" that aired Sunday night. "If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."

UPDATE: Obama turns around a quick ad: