Blog: Political Jostling Post King v. Burwell

Democrats may be overly optimistic in their hopes that a Supreme Court ruling against Obamacare subsidies in King v. Burwell would be an unambiguous political disaster for Republicans.

The absurd, widely ridiculed claim tweeted by Senator John Thune – which suggested that the Affordable Care Act was to blame for the (potential) loss of health insurance premiums subsidies for six million Americans – was admittedly far too crude to gain traction:

tweet

At the same time, as reported yesterday by Politico and the Associated Press, Congressional Republicans are already readying proposals that would provide for the temporary extension of insurance subsidies in case of a victory of the plaintiffs in King.  Such proposals, however, would simultaneously gut key Affordable Care provisions, like the individual and employer mandates.

These proposals would be unacceptable for Democrats, and indeed would presumably be vetoed by Obama if passed.  However, as noted by Greg Sargent at the Washington Post in May, this would then provide Republicans with a potentially potent political line: “Claim they offered a reasonable “compromise” designed to spare all those millions of people from getting thrown off of insurance, while lamenting that Obama refused to go along with it …”

All in all, some rather sordid scheming, given all the lives on the line.  From the perspective of the progressive health care agenda, however, strategizing how to move beyond the ACA in the months and years ahead is far more important than the post King political jostling.

Jacobin: Lessons From Vermont

Has the tide of health care justice turned — in the wrong direction? Last month, Vermont Governor Peter Shumlin announced that he could no longer “responsibly support” a funding plan for his long-awaited “single-payer” plan for the state. It wasn’t long before some on the Right claimed a historic victory … The article here, at Jacobin.

Salon: The Obamacare “private option”

Imagine you’re a conservative state politician ideologically opposed to government-provided health insurance for those with low incomes, but you nonetheless recognize the folly in forgoing billions of dollars in federal funds available to states that expand Medicaid simply to prove a Dickensian point (of questionable popularity) … Read the article at Salon here.

 

Blog Post: Asking About Costs Is Not Enough

In a recent piece in the New York Times (“Can You Afford Your Medicine? Doctors Don’t Ask”), Allison Bond – a medical student in Boston – poignantly tells the heartbreaking stories of patients who lack the money to afford copayments for prescriptions or doctors visits.  She describes, for instance, a mother and two daughters – recent immigrants from East Asia – who she meets at an appointment with their pediatrician.  The children have signs of growth retardation from malnutrition, evidence of the family’s poverty.  When the mother is told of the $20 copayment, she breaks into tears, knowing she will be unable to afford a return visit.

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Blog Post: The Price vs. the Cost of Health Care

Increasingly, the problem of health care “prices” is replacing the problem of health care “costs.”  That may sound like a meaningless distinction, but consider the opening sentence of the “Cost of Treatment May Influence Doctors,” an article in todays New York Times:

“Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.”

The focus, in other words, is not only society-wide health care costs as a percentage of GDP, but the price of particular interventions for particular patients.  The very premise of this lead, however, is both entirely unremarkable and extraordinarily concerning.

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Jacobin: The Neoliberal Turn in American Health Care

Last year’s three-ring Congressional shutdown circus — for many little more than a desperate rearguard action by an isolated rightwing fringe to undo the fait accompli of Barack Obama’s health care reform — reinforced with each passing day the gaudy dysfunction of the American political system. But we miss something crucial if we construe the perseverance of Barack Obama’s 2010 Affordable Care Act (ACA) as nothing more than the overdue victory of commonsense health care reform over an irrelevant and intransigent right, or, even more, as the glorious culmination of a progressive dream for American universal health care long deferred.  In Jacobin here.

Salon: A pro- single payer doctor’s concerns about Obamacare

As a single-payer advocate who is also a doctor, I was concerned after the Affordable Care Act was passed that it didn’t do enough to combat rising underinsurance. A recent study by the Commonwealth Fund, which used new data to demonstrate that in 2012 some 31.7 million Americans were underinsured (i.e. insured, but still with heavy additional out-of-pocket health care expenses), argued that the burden of underinsurance will likely lessen as the ACA fully unfolds. But is there really reason for such optimism?  See the article here in Salon.

Dissent: The Twilight of the British Public Health System?

Less than two years after the fall of Nazi Germany, a bankrupt Britain—reeling from the most destructive war in history and living under conditions of stark austerity—elected to create an extraordinary system of universal health care, the National Health Service (NHS) …

My article on the ongoing assault in the Spring 2014 issue of Dissent is available here.