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Tag: "health-care"

11
By Erich Vieth on November 11th, 2009

Tear up the health care bill and start over.

I wrote a comment on this same issue last night, but I wanted to make it into a post as well, given the importance.

Marcia Angel, M.D., former editor of the New England Journal of Medicine, is highly critical of the proposed “health care reform.” Although she admits that it accomplishes a few things, it is worse than doing nothing.

It throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it.

Read the full post at Huffpo for Angel’s clear and understandable ideas for meaningful (and not corrupt) health care reform. I agree with Angel that the current bill is an industry-coddling joke and that it is worse than doing nothing, for the reasons she offers. The House bill has a few pieces of low hanging fruit (e.g., portability), but at great unnecessary expense and waste. We need to tear up this celebrated new bill (celebrated by the Democrats, anyway) and start over. For more on Angell’s ideas for reform, also see her recent appearance on Bill Moyer’s show.

Health • Health Care Reform • Politics
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6
By Erich Vieth on November 07th, 2009

Time to go read the House version of the health care reform bill.

It would be irresponsible to take a position on the new House version of the health care bill without reading it, right? Despite the importance and expense of the bill, many national news websites don’t even contain a link to the actual words of the bill. Therefore, go to this link and read the full text of the bill. It’s almost 2,000 pages long and it’s loaded with specialized terminology and ambiguities. To read it, you’ll need to give up many hours of your life.

I’m a lawyer, and I read difficult documents all day at work. I can guarantee that it would take me more than a week to read this bill and to obtain a thorough understanding of its main provisions. How many Americans would be willing to read this bill without being required to read it as part of a special healthcare-related job (much less understand it) prior to taking a position on it? Probably only a handful. Out of almost 300,000,000 Americas, only a few would exert the effort to read the entire thing. In fact, send in a comment if you are not being paid to read this bill, and you’ve nonetheless read it on your own just to be an informed citizen.

This House bill will eventually need to be reconciled with a Senate bill, which will be comparable in length and complexity. Completely responsible people will read both versions and map out the differences. That could take many weeks, even for those of us who are even able to analyze text at this level. To really follow this legislation in real time would require one to give up everything he or she cares about for many weeks. It means giving up time with one’s family, exercising, entertainment and probably burning vacation time at work. I doubt that it is a rare legislator has read more than 1/4 of this bill.

What does it mean when it takes 2,000 words to put an idea into a law containing numerous vague provisions? I have become cynical about this process (as you can probably tell). My presumption is that this bill is representative of many modern pieces of federal legislation (there are many other similarly long and vague federal laws that have been passed over the past couple of decades). My suspicion is that when a bill is written in lengthy prose that is often vague, it means that it is intentionally written this way to discourage ordinary people from understanding it. It is written with lots of bells and whistles that will work to the benefit of private businesses. It is written for those who can afford to hire teams of lawyers who can “work” the law to their advantage in federal courts. Something for everyone who can afford to litigate, it seems, based on the many provisions.

Or would it be more accurate to say that this bill is an attempt to put off for another day the dirty details of who, exactly will be covered, whether those who are being insured by the federal government get the same gold-plated coverage as those who work hard to shell out $1,000/month to insure their families, how much it will really cost to give this kind of coverage to the poor and working poor, who will pay for it in the end and what will we no longer be able to afford as a country given that we are going to be paying a presumably huge sum for health care? These are the kinds of questions that good and decent people want to know before they make a commitment.

I should make it clear that the current system is terrible in many ways, both for people who are insured and those who aren’t. We need a new law to keep purchasers of health insurance from getting ripped off by insurers, but this is low-hanging fruit that could be knocked out with a 10-page bill. We also need to figure out some affordable level of coverage to provide to those who we feel moral compulsions to cover. I suspect that all of this could be done in far less than 2,000 pages.

Like I mentioned, I’m suspicious about this process, which has proven to be opaque in more ways than one.

Seeing this bill makes me realize how daunting it is for most folks to “get involved” in the government process. No wonder so many people, driven by emotions, give up entirely and insist that living locally can take care of national or global problems. These include many of the “free market fundamentalists,” as well as many others who haven’t quite articulated why they are so reluctant to get involved.

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By Erich Vieth on November 06th, 2009

Onion: Children oppose readily available health care

The Onion reports that Children clearly oppose health care:


Study: Most Children Strongly Opposed To Children’s Healthcare

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By Erich Vieth on October 09th, 2009

Alan Grayson still not apologizing

Grayson is a fresh voice I enjoy hearing.

I especially agree with Grayson’s point that we need to do something about 120 needless deaths every day. If 120 people died in a plane crash each day for a week, we’d take action and revamp the aviation system. So why do we allow 120 people die each day due to lack of health insurance?

I’m not suggesting that I’m happy with the proposals that I’ve heard so far. I don’t want a system that shovels lots of tax dollars to for-profit health insurance companies to insure a relatively small number of new people. And I’m frustrated that we aren’t talking clearly in terms of how much reform would cost, who would pay it and how much coverage it would provide. We can’t afford heart transplants for everyone, right? So what level of health coverage should we guarantee and how are we going to pay for it? In plain English, please. Without all of the backroom deals. And not passed 12 hours after the public release of a 2,000 page bill loaded with special favors. Let’s talk out in the open like adults. Or is that not possible anymore?

Health • Health Care Reform • Politics • Psychology Cognition • Social justice
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3
By Erich Vieth on October 06th, 2009

I’m behaving like someone who isn’t getting an answer to his question

This is a wild ride, but a lot was put onto the table. Even Dylan Ratigan’s phrase “corporate communism. Look what happens when you put Dylan Ratigan, Betsy McCaughey and Anthony Weiner into the same room:

Visit msnbc.com for Breaking News, World News, and News about the Economy

Economy • Health • Health Care Reform • Politics
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1
By Erich Vieth on September 30th, 2009

Alan Grayson on “The Republican Health Care Plan”

What is “The Republican Health Care Plan”? Alan Grayson made this presentation yesterday:

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By Erich Vieth on September 29th, 2009

Michael Moore: The current proposals can’t fix health care

Michael Moore gives 13 reasons why the current proposals don’t get to the heart of the problem. His conclusion:

We may be slow learners, but the rest of the industrial world has figured it out: Universal, single-payer or national health care systems. That’s the reason why all those other countries cover everyone, have better patient outcomes, cause no one to declare bankruptcy or lose their homes because of medical bills, and spend less than half per capita on health care than we do. We could do it too, by reducing the starting age for Medicare from 65 to 0. There’s still time to act.

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0
By Erich Vieth on September 15th, 2009

Garrison Keillor describes his stroke

What’s it like to have a stroke, then get really lucky? Garrison Keillor tells it like only Garrison Keillor can tell it:

[A] neurologist shook my hand and said: “I hope you know how lucky you are.” That was pretty clear as I walked down the hall, towing my IV tower, and saw the casualties of serious strokes. Here I was sashaying along, like a survivor of Pickett’s Last Charge who had suffered a sprained wrist.

What’s it like to get world class treatment for your stroke when you have a strong sense of social justice?

Rich or poor, young or old, we all face the injustice of life — it ends too soon, and statistical probability is no comfort. We are all in the same boat, you and me and ex-Gov. Palin and Rep. Joe Wilson, and wealth and social status do not prevail against disease and injury. And now we must reform our health insurance system so that it reflects our common humanity. It is not decent that people avoid seeking help for want of insurance. It is not decent that people go broke trying to get well. You know it and I know it. Time to fix it.

Health • Medicine • Social justice
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4
What KIND of health care?
By Erich Vieth on September 07th, 2009

What KIND of health care?

The raging health care debate “debate” is almost entirely devoid of facts, an issue on which I’ve previously posted. Instead of discussing fact, then, we tend hurl vague accusations, like calling the reformers “communists” (and you’ve GOT to see this).

I “blame” Obama for this lack of specificity, but I realize that the vicious opposition mounted by huge self-interested insurance companies and health care providers might require that he not play all of his cards at this point.

But isn’t it odd that our politicians aren’t at least clarifying the term “health care coverage” when they refer to national health care coverage? Defining this term would make a huge difference to the public reaction to any national plan. Here are two possibilities (though there are others):

A) The national plan will offer gold-plated coverage much like the expensive United Health Care coverage I buy for my family through my employer. For the record, the pre-tax cost of this coverage is about $20,000 per year for my family. Is the Obama proposal to provide every citizen with this kind of coverage? If so, I can see why there is massive resentment to the proposal. Many working people can barely afford health insurance coverage at all, and the coverage many people do purchase is not nearly as comprehensive as the expensive coverage I purchase. Of course people who can can only afford to buy their own rudimentary policies will resent that the government might buy gold-plated policies for everyone else, including many highly irresponsible people.

B) The national plan will offer a rudimentary coverage only. It will cover x-rays and casts for broken arms, but not heart transplants and expensive drugs that only marginally increase one’s chances of surviving an illness. It wouldn’t keep people suffering from terminal illness on life support when there is no reasonable chance that they would ever leave the hospital. It would cover only a small subset of the treatments covered by gold-plated policies. It might be akin to the Oregon Plan.

I believe that there would be massive resistance to the national coverage described in A) but far less resistance to the coverage described in B).

At least Oregon’s legislators had the cajunas to specifically state what was covered under their plan and what was not (Oregon’s prioritized list is available for all to see). Oregon had the fiscal responsibility to make certain that they could afford the level of health care to which they were committing. Oregon dealt head-on with the accusation that they were “rationing” health care; absolutely they were, just like private plans ration health care only to those who pay those high premiums. Both responsible and irresponsible health care plans “ration” health care. Therefore, it is not a criticism of any health care plan that it “rations” health care. Here are the guiding principles to the Oregon Plan:

In 1987, the Oregon Legislature realized that it had no method for allocating resources for health care that was both effective and accountable. Over the next two years, policy objectives were developed to guide the drafting of legislation to address this problem. These policy objectives included:

• Acknowledgment that the goal is health rather than health services or health insurance
• Commitment to a public process with structured public input
• Commitment to meet budget constraints by reducing benefits rather than cutting people
from coverage or reducing payments to levels below the cost of care
• Commitment to use available resources to fund clinically effective treatments of
conditions important to Oregonians
• Development of explicit health service priorities to guide resource allocation decisions.

Our national conversation regarding health care is so dysfunction on so many levels that it’s hard to know where to begin. I’ll make only one more point in this post, however. Opponents of current proposals often make accusations that there will be “death panels,” indicating that some sick people will be allowed to die. As a nation, we need to grow up and deal with the fact that this happens every day in every hospital in the country: we shouldn’t be allocating huge amounts of money to maintain pulses in people who have become living corpses. There are some families who “can’t let go” no matter what (e.g., Terry Schiavo), and our national plan needs to have specific guidelines for these situations. In fact, every private insurance plan should have guidelines for determining when further treatment is likely to be futile and a provision for ending coverage at that point. The alternative is to make policies so horrifically expensive that many people can’t afford policies that cover tratments likely to make an immediate positive impact on their lives.

Only when we put these issues clearly on the table can we begin to have a real conversation.

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By Erich Vieth on September 06th, 2009

Just how dysfunctional are we? Ask Bill Moyers.

Just how dysfunctional are we? Here’s what Bill Moyers has to say:

Bill Maher asked me on his show last week if America is still a great nation. I should have said it’s the greatest show on earth. Forget what you learned in civics about the Founding Fathers — we’re the children of Barnum and Bailey, our founding con men. Their freak show was the forerunner of today’s talk radio.

Speaking of which: we’ve posted on our website an essay by the media scholar Henry Giroux. He describes the growing domination of hate radio as one of the crucial elements in a “culture of cruelty” increasingly marked by overt racism, hostility and disdain for others, coupled with a simmering threat of mob violence toward any political figure who believes health care reform is the most vital of safety nets, especially now that the central issue of life and politics is no longer about working to get ahead, but struggling simply to survive.

So here we are, wallowing in our dysfunction. Governed — if you listen to the rabble rousers — by a black nationalist from Kenya smuggled into the United States to kill Sarah Palin’s baby. And yes, I could almost buy their belief that Saddam Hussein had weapons of mass destruction, only I think he shipped them to Washington, where they’ve been recycled as lobbyists and trained in the alchemy of money laundering, which turns an old-fashioned bribe into a First Amendment right.

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6
By Erich Vieth on September 04th, 2009

How to have a conversation about health care reform

I commend the way that Al Franken engaged with these tea party folks recently:

Watching this video makes me ever more suspicious that the media is driving unnecessary conflict (on health care reform and on everything else) in order to sell ads. It seems much easier to talk when the media isn’t around spewing sound bites and featuring angry extremists, instead of focusing on the many ways we actually agree with those with whom we “disagree.”

I couldn’t take my eyes off of the woman who tried to start the conversation in a contentious way. I kept wondering whether her views on Al Franken were shifting given the impressive way he discussed the issues surrounding health care reform.

Communication • Community • Health • Medicine • Politics
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Government-Hating: An American Value
By Mark Tiedemann on August 27th, 2009

Government-Hating: An American Value

G.O.P. Chairman Michael Steele made a few remarkably in-your-face comments recently about the health care debate. Here, in his own words, is pretty much where he thinks the nation is going, why it shouldn’t go there, and what the Republican Party stands for.

This morning on NPR he tangled with Steve Inskeep, in particular over this.

One quote in particular caught my eye: ” Simply put, we believe that health-care reform must be centered on patients, not government.”

When you listen to the NPR interview it’s clear that we’re hearing another in the now decades-long tirades against the government which has become the hallmark of Right Wing politics in this country.

In this country, in theory, the government is supposed to be us, the people. We elect our representatives, we tell them how we want them to vote, we change our minds, we are supposed to be in charge. In theory. Obviously, the reality is far from that. For one, we are not a full-fledged democracy, we are a republic, and while we elect those who operate the machinery of the republic on our behalf, we do not have a direct say in the running. Nor could we, really. it is simply too complex. We send our representatives to the various points of departure—state capitols, Washington D.C., county seats, city halls—to do that for us because it is a big, complex, often indecipherable melange of conflicting goals, viewpoints, and problems. We do not have the time to pay the necessary attention to do that work ourselves, so we pay people to do it for us.

So why do we distrust it so much?

Well, because we distrust each other.

American Culture • Bigotry • Communication • Community • Culture • Current Events • Featured • History • Medicine • Politics • hypocrisy • ignorance
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Inferred justification: We invaded Iraq, therefore Saddam Hussein caused 9/11
By Erich Vieth on August 25th, 2009

Inferred justification: We invaded Iraq, therefore Saddam Hussein caused 9/11

According to Sharon Begley’s article at Newsweek, “Lies of Mass Destruction,” people are susceptible to upside down reasoning. She cites a large team of researchers who studied the people who believe the lie that Saddam Hussein caused 9/11. The researchers concluded that these believers believed that lie because the U.S. invaded Iraq. They refer to this upside-down process as “inferred justification.” Begley sums it up:

Inferred justification is a sort of backward chain of reasoning. You start with something you believe strongly (the invasion of Iraq was the right move) and work backward to find support for it (Saddam was behind 9/11). “For these voters,” says Hoffman, “the sheer fact that we were engaged in war led to a post-hoc search for a justification for that war.”

The researchers published their findings in a paper entitled “There Must Be a Reason”: Osama, Saddam, and Inferred
Justification.” Here’s an excerpt from Sociological Inquiry.

The primary causal agent for misperception is not the presence or absence of correct information . . . Our explanation draws on a psychological model of information processing that scholars have labeled motivated reasoning. This model envisions respondents as processing and responding to information defensively, accepting and seeking out confirming information, while ignoring, discrediting the source of, or arguing against the

substance of contrary information. Motivated reasoning is a descendant of the social psychological theory of cognitive dissonance, which posits an unconscious impulse to relieve cognitive tension when a respondent is presented with information that contradicts preexisting beliefs or preferences. Recent literature on motivated reasoning builds on cognitive dissonance theory to explain how citizens relieve cognitive dissonance: they avoid inconsistency, ignore challenging information altogether, discredit the information source, or argue substantively against the challenge. The process of substantive counterarguing is especially consequential, as the cognitive exercise of generating counterarguments often has the ironic effect of solidifying and strengthening the original opinion leading to entrenched, OSAMA, SADDAM, AND INFERRED JUSTIFICATION polarized attitudes. This confirmation bias means that people value evidence that confirms their previously held beliefs more highly than evidence that contradicts them, regardless of the source.

In her article, Begley suggests that the current health care debate stems from the same cognitive vulnerabilities.

There are legitimate, fact-based reasons to oppose health-care reform. But some of the loudest opposition is the result of confirmatory bias, cognitive dissonance, and other examples of mental processes that have gone off the rails.

American Culture • Featured • Neuroscience • Psychology Cognition • ignorance
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