Aaron Jamison

the verbiage at CNN reads:
Added On April 29, 2010

An Oregon man holds onto his sense of humor even though he has been diagnosed with terminal cancer. KATU reports.

I note that the public health policy dimension, the fact that this man's widow-to-be would be unlikely to face crushing debts in most industrialized countries as a consequence of her husband's health problems, goes unmentioned. Maybe the reporter realizes that in 2014 people will still have these problems, even after Obamacare is fully implemented.

cross-posted at Dead Horse.

Nixon and the HMO debate

via Ed Richey and Sean O'Neill.

Regarding Hillary's 2008 plan, and individual mandates

I posted this at Dead Horse, in response to Buzzcook, a commenter who encouraged me to read a blog post(referenced below):

OK Buzzcook, I read the lengthy(4,000+ wd) post you referred to in the comments,
"An analysis of Clinton's [2008]Health Plan Proposal"

Robert Laszewski talks about how H. Clinton's 2008 healthcare plan(hereafter I'll just call it HRC-08)says that there will be a public option allowing regular people to buy a plan that's the equivalent of the "Federal Employee Health Benefit Program", something a lot of pols talk about.

Yes, the healthcare plan for federal employees is pretty good, but SO WHAT? If you've ever actually looked at buying health insurance on your own, you'd see that the major companies don't offer a one-size-fits-all plan for everybody, but rather a pretty wide array of plans, with the economy plans offering negligible coverage with high deductibles, and the top of the line plans offering at least as much coverage at the "FEHBP" plan, sometimes more. If you're curious, go to www.ehealthinsurance.com and plug in your personal data and see what's available to you. Blue Cross and Humana, for example, offer an especially wide range of plans, but the prime ones are well out of my reach.

(incidentally, the reason I recommend you look at ehealthinsurance is because they don't ask you, as of this writing, for an email or home phone number, which many of the other online comparison services do, presumably so agents in your area can subsequently pester you. For the record I have not purchased anything from them, just window-shopped.)

Laszewski also discusses the HRC-08 approach to individual mandates,

"Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans."

OK, the devil in her plan finally shows itself. Tax credits are all well and good, but what if they're not enough to purchase decent coverage? Then you have to purchase sub-standard coverage(I guess that's where "consumer price consciousness in choosing health plans" comes in.)

I'm a male in my 40s, and from what I've looked at, it would cost me at least 250/month to purchase meaningful coverage, as opposed to plans with 3,000/yr or 5,000/yr deductibles* that don't cover dr's visits until the deductible is satisfied, which are often more "reasonable."

Except they're not. The canard that individual mandate proponents often trot out is that individual mandates will force healthy people to buy coverage when they're well, and quit gaming the system by waiting until they're sick, implicitly suggesting that is what the bulk of the nation's 45 million plus uninsured are doing.

I don't believe that for a moment. If I had a spare 250 dollars a month I would buy a policy, but I'm really poor. I'll wager that most people who don't have health insurance just can't afford it, and some have looked at the bargain-basement policies and figured out they're essentially worthless. And of course some had insurance and were bumped by their insurance companies, and can't find anybody who'll cover them, except at exorbitant rates.

Let's say you are a cashier or a short-order cook, earning 8.50 or 9 bucks an hour. (Let's also assume you have no dependents and no pre-existing conditions.)

Sure, maybe you could, with some difficulty, afford to enroll in a plan that only costs 80 or 90 bucks a month, assuming you can stay healthy and don't actually need that 80 or 90 bucks that month, should you actually need to see a doctor and buy some medication, something the economy plans generally wont help you with, or will only help you a spitting-in-your-poor-face, token amount.

Let's see. You're paying 80 bucks a month, 960 dollars a year, the doctor charges 80 bucks for a visit, and the 80 bucks a month plan reduces your out-of-pocket expense to 45 bucks? Wow! But you don't have 125 bucks to spare on healthcare for the month, not if you want food, and some electricity? You're a bum.

And since you're making, say,18,000 dollars/yr, that 960 bucks a year is still too little to deduct off your income tax, because even if it's more than 7.5% of your taxable income, you still don't make enough to be able to itemize.

My point, buzzcook, is that plans with individual mandates are eminently gameable-- they're designed so the politicians can take credit for dramatically reducing the number of uninsured folks while forcing a large segment of society to buy junk policies, by defunding vouchers so they only pay for worthless coverage, or by making eligibilty for tax credits that phases out below a certain point, in the same way that making something tax-deductible means only people who make enough money to itemize may benefit.

Do I know HRC created a plan with this aspect designed to be a deliberate gimmick? No, but I don't have to. It's not about her, any more than it's about Obama now that he's president. It isn't even about the democrats. It's a systemic vulnerability that's built into individual mandates and that's why it's foul public policy, period. I'm sure you've heard of unfunded mandates in other contexts.

They won't call it cutting the plan off at its knees;

they'll call it "reaching a bipartisan solution" or

"allowing the private sector breathing room to innovate"

and when a New York Times story about some Duke or University of Michigan study questioning the effectiveness of individual mandates comes out 3 or 4 years later, it will studiously avoid connecting the dots, to prove that the democrats deliberately created legislation to "allow" themselves to be played by the other guys, as they both wink at each other from across the aisle.

That's why I think my criticism of HRC-08(and BHO-09) is legitimate.

Later this week I'll post about my thought on how to fix healthcare. Maybe my ideas will be just as flawed, just differently flawed. We'll see.

(*I've even seen some companies offer 7,500/yr deductible plans, although they're still rare.)

from MSNBC: heckling the handicapped

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

Why I mistrust Obamacare, pt 2

A reminder(above). This is from a speech Obama gave in Chicago in 2003. I guess that was then.

See also:

San Francisco Chronicle/AP, July 3rd:
"Under Senate health care plan, either way you pay"



John Dickerson, Slate, Tuesday, July 7, 2009:
"Going Public, Quietly: Why Obama wants to be as vague as possible about health care reform"



Michael Lind, Salon, July 21st: "Healthcare reform: More raw deal than New Deal"
We need universal, citizen-based healthcare. It doesn't look like Obama and Congress are ready to give it to us



Bruce A. Dixon, Black Agenda Report,Weds, 07/22/2009:
"Is the Obama Health Care Plan Really Better Than Nothing?"

(via Skookum)


Lambert at Corrente, 7/21:
'How the Dems and "progressives" are selling you the "bait and switch" of public option'



and finally, Wikepedia's US healthcare reform article, which keeps growing. More later.


cross-posted at Dead Horse.

Saturday 25 July 09

Gawker's headline read:
"John Yoo Briefly Disturbed By Consequences of His Actions"

(via xymphora)

Salon commenter "mary_steyr" refers to that portal as
"the Parade Magazine of the Volvo and latte set"


not all lefty bloggers are bowled over by Obama's presumptive charm and agenda. Here's Avedon Carol:

people are starting to notice that Obama is just more of the same, only with better syntax. Maybe it's true that his ego made him think "bold" and decide to get a healthcare package this year, even if it's a crap package - but I doubt it. I think his desire to be seen as "respectable" by a bunch of right-wingers led him to shy away from presenting a plan that really works and making the case for it. He hasn't been bold at all - he's backed way off of single-payer, of ending the war, of transparency, of basically every promise he made or implied he was making. He knows perfectly well no one voted him in to give their money to Goldman Sachs and force them to buy crappy health insurance that still doesn't deliver healthcare. He's blown it because he didn't have the guts to do the business.

I wish I knew how to embed this very brief and very droll animation by Ann Telnaes.


Humana has an animation up as well, designed to explain health care reform, or to avoid explaining while seeming to, depending on your point of view. To be fair it's no worse than what various pols like Obama or Charles Grasley have been saying by way of explanations. It includes that by now familiar insinuation about how people who don't have insurance are primarily healthy people who just don't want to get insurance until they need it. The greedy uninsured, driving costs up for everyone. How many people actually believe this?

cross-posted at Dead Horse.

Why I mistrust Obamacare, pt 1

This is what I wrote in response to dday's "Whitling Down to Nothing" at Digby's Hullabaloo earlier this month.

First, I quoted another commenter, "pataphysician":

"I'm worried that a Health Care "reform" bill will be passed and signed that will include mandates, and taxing of Employer health benefits, with no public option and only subsidies for those who rank among the poor. Obama ran against many of these ideas, only to say now that he is Ok with them. That he says that now, makes me worried that they will happen. This would be much, much worse than our current system, as we will all be paying taxes essentially to private insurance companies for some of the crappiest care possible."

[incidentally, the comment thread led me to believe that Digby's commenters, by and large, seem to "get it" more than the people who write the blog. The bloggers are undoubtedly decent and well-meaning, but their perspective seems compromised by their apparent need to carry water for supposedly mainstream congressional democrats.-JV]

I wrote:

As Digby said earlier, if any sort of healthcare reform bill passes, the democrats will own it. Mandates and extra taxes will stoke class resentment while essentially helping nobody-- apart from the private insurance companies and people eager to paint democrats as being the stuff of the worst republican stereotypes: intrusive government(mandates), and more taxes for negligible benefits that only accrue to the very poor.


I am poor, and I don't want the democrat's plan. It's not because I'm stupid, but because it will likely cause me harm and make me poorer still. Consider: if a plan with mandates forcing employers to provide health insurance for their workers or for individuals to buy their own insurance passes, poor people like me will just have to hand over a certain portion of our very meager incomes to insurance companies for worthless insurance plans just so we can "stay legal."

Oh, but what about your employer? If your subsistence job as a cashier used to offer no benefits, now it will have to...

I doubt it. Far more likely I will lose my job and be reoffered the same job, only reclassified as an "independent contractor," doing the same work after agreeing to the new job(shh! employment contract) description in which I "voluntarily" surrender my benefits. Maybe my employer will even provide a handy toll-free number to call where I can have a call center rep offer me advice on how to score government benefits, or choose between private plans.

well, if that happens, you would get assistance paying for your insurance from the government...



I doubt this too. The 1st TNR article you quote says that subsidies presently taper off at around 88 thou for a family of four. How much do you want to bet this will be adjusted downward in the negotiation towards a final bill, and that if I get a job that pays as little as ten bucks an hour I will suddenly find myself making too much for the subsidy? (And besides, why should I be humbled into accepting a subsidy because I'm suddenly obligated to by insurance? Screw paternalistic politicians of all stripes, on both the left and the right, who want me to beg.)

Well, at least you'll have insurance...

Will I? Digby and dday, I invite you to go to some online price-comparison service that offers health insurance quotes. If you do go to such a site(they often have ads on Yahoo and other mass portals), you'll see that many of the larger insurance companies offer multiple insurance products, that range from over 500 bucks a month to less than 100/month.

If I'm making 10 or even 11 an hour, even if single and without dependents like me, the bells-and-whistles policies are essentially out of reach, and all I might hope to afford is a sub-100/month policy.

They usually have a 5,000/yr dollar deductible. I saw one company that also offered a max deductible of 7500/yr. Generally these policies only pay once you've met the deductible, period. No payment for a routine dr's visit, or even to go to the emergency room, and no prescription drug benefit.(I've also seen slightly more "expensive" plans that do offer prescription drug coverage, usually paying 50% of the cash cost, usually with a 500 or 1,000/yr limit.

So, if it plays out as I've suggested, and if I'm making 10 bucks an hour(I wish!)and don't qualify for a subsidy, maybe I'll have to shell out 600,700,800 or more bucks a year for phoney-baloney coverage, even though I'm poor, just so the government doesn't fine me and pays me my tax refund.(Money I could be otherwise spending, on say, actual healthcare, like when I need to fill a prescription.)

No thanks.


If this kind of twisted "health care reform" passes, it'll be worse than if nothing passes for the working poor.

In fact it will also make subsequent fixing of the bad law substantially harder, because the private insurance companies will fight like hell to hold on to the subsidy they gained under Obama in 2009.

cross-posted at Dead Horse.

Insecurity State

artist: Amanda Moeckel


Steve Gimbel in Philosopher's Playground, a new blog(well, new to me), notes that the World Health Organization recently assessed the healthcare systems of most member countries and ranked the US 37th. Behind virtually all Western European countries, but also behind Costa Rica, behind Chile, even behind Morocco and war-torn Colombia.

From his essay:

...insecurity is the most important force in shaping American society. It manifests itself in two ways. In the middle class, it is class insecurity. There is the sense that our kids will not only fail to have more than we have, but that they may fall from being middle class. This is why schools are simultaneously turned into prisons providing environments that are not conducive to learning and overburdening our kids with too much homework. If they don't get into the right pre-school they won't get into the right college and then they might not end up with a good job. The kids are so risk averse that they refuse to think interesting thoughts. Just get the B, just don't screw up. It is there in the way we create gated communities both in terms of actual gates and in terms of infrastructure. We can't build public transportation because then the wrong kind would have easy access to our homes and our stuff. It's all fear of losing our stuff and our kids not being able to get it for themselves. Look at our drug laws, look at the way we pay for schools through property taxes, look at the discussions around affirmative action. The group of voters who went for Reagan and Clinton are governed by class insecurity and both of them knew it and played them like a fiddle.

The middle class doesn't want health care reform, not because they think ours is the best system in the world, but because it is good enough for them and they are afraid that helping someone else would be a zero sum game and thereby cost them. It works for me and mine so don't mess with it. Insecurity leads to malicious, selfish inaction.

I think there's a bit more to it than that, since this is, to an extent, one of those "people are so X because of Y" arguments, when in fact our society is increasingly less homogeneous and that argument, irrespective of the particulars you replace X and Y with, gets increasingly harder to make. Maybe, as a sort of corollary to Gimbel's thesis, it would be interesting to explore the ways that popular media reinforces our more reactionary traits and deliberately avoids discussing contrasting qualities we have.


Nevertheless his blog looks like a fascinating place to visit and the essay is worth reading in full. Go read the rest here, "Insecurity as an American Social Force"

(via Helmut at Phroneisisaical.)

cross-posted at Dead Horse.

losing coverage

via Christy Hardin Smith, and Avedon Carol, who writes:

It's not just the uninsured; it's the outrageous fraud that people who think they have health insurance are faced with: companies that take your money knowing they will do their damnedest not to give you what you think you are paying for.

cross-posted at Dead Horse.

a reminder:when abortion was illegal

Watch When Abortion Was Illegal: Untold Stories in Entertainment | View More Free Videos Online at Veoh.com

I saw this at the internet archive(here), but I find their embed protocol is a bit buggy when you re-write the html to prevent it from going into auto-play, so here it is via Veoh instead. Then again it may just be my html skills are the problem.

Anyway, the disgusting murder of George Tiller (while attending church) barely two weeks ago reminded me that I've been meaning to post this.

[cross-posted at Dead Horse.]

the politics of lyme disease

Sara Robinson of Orcinus has an exceptional essay on Lyme disease and the politics of restricting treatment, apropos of a recent shooting at a Baptist church in Illinois. It's a lengthy article, well worth reading in full. Here's an excerpt:

The shooter, Terry Sedlacek, had struggled for years with long-term, chronic Lyme disease, contracted after being bitten by a tick some years ago. Though this description of his symptoms seems extreme even among Lyme patients, his struggle to get treatment is an infuriatingly common one. The media debate over the role this disease may have played in the shooting has tapped into one of the most furious and tragic medical debates in modern medicine. On one hand: there are doctors on TV claiming that it's entirely possible that Lyme can create the kind of psychiatric problems that would lead to this kind of catastrophe. On the other are doctors saying that it's impossible -- Lyme is a relatively benign bacterial infection that's easily treated with a few weeks of antibiotics.

Infectious disease specialists-- represented by the Infectious Disease Society of American (ISDA) -- have for decades held to the firm position that Lyme is a spirochete that can be killed with a 28-day course of doxycycline. If you're still sick when the month is over, whatever you have isn't Lyme (and, in practice, is generally assumed to be psychosomatic). And this is true, as far as it goes: if you're lucky enough to catch the disease in the first few months after you're bit -- or you've got one of the many strains that's amenable to this treatment -- a short course of doxy usually does do the trick.


However, once some strains of Lyme get dispersed and embedded in the body's tissues, the standard treatment won't touch them. Worse: the standard Lyme tests won't, either, so the results will likely come back negative. The shady politics of how the approved Lyme tests were developed would take a whole separate post to explain; but suffice to say that they're only 70% accurate on their best day, which would make them patently unacceptable as a diagnostic tool were it any other disease. Far more accurate and sensitive tests are available, but insurance companies won't cover the $400 fee.

That's because the IDSA panel doesn't approve of these tests (even though the "controversial" proteins it tests for -- the only ones common to all Lyme strains -- are the same proteins some of these same doctors once tried to build a Lyme vaccine on). It also doesn't accept Lyme's shapeshifting nature; the existence of a chronic form of resistant Lyme that requires long-term treatment; the importance of seeking out and treating co-infections; or the neurological and cognitive issues it can cause. All of these facts are well-documented by the peer-reviewed science; but IDSA's Lyme panel has actually purged new members who brought these studies up for consideration.

All this is part of the background for the dueling doctor interviews we're seeing on TV this week.

The Great Divide
Why would ostensibly caring doctors be so resistant to accepting new and better data? As always, follow the money. The IDSA's minimalist view of Lyme is greatly favored by insurance companies, who really don't want to be on the hook for expensive testing or more than a month of treatment. On a broader note: they're absolutely terrified (with good reason) that Lyme could turn out to be another huge budget-busting epidemic like AIDS, and want to do everything they can to make sure they're not stuck with the bills for it. To that end, they've made sure that the ISDA's Lyme experts have been richly rewarded with grants, consulting fees, and so on for aggressively defending the narrowest possible case definition and the most limited treatment standards. For their part, IDSA's Lyme group has held up their end of the deal so reliably that last May, they became the first medical standards board in the history of American medicine to be successfully sued (by the attorney general of Connecticut, no less) for corruption.

I don't normally make a habit of quoting so extensively, but I want to encourage you to go read her essay in its entirety, here.

Cross-posted at Dead Horse.

portable health care 2.0

via Mark Kleiman and Ron Wyden.