30 Governors Open Health Care Ghettos: October 1, 2013

Featured

The governors from over half of the 50 states have or are considering refusing to establish Health Care Exchanges and to participate in Medicaid as provided for by the Affordable Care Act, (ACA) cynically known as “Obamacare.”  My assessment is that the consequences of this decision by the Chief Elected Officers of these states is going to in actuality create a third-tier, low quality health care environment.  Simply put, those states that offer to their residents full participation in the rights and privileges provided by the ACA, which is the law of the land, will develop in a few short years, into first-tier, high quality health care systems.  The states  that don’t, however, will within a similar number of a years see their health care, both private and public, degenerate into a ghetto of medical inferiority.

I call it…Read More

Sunrise: Health Care For All Rises Above the Horizon

The Sun has Risen for Health Care in America. Photo Courtesy: Bolte Medical

.

Now is the time for health care to be added to those moments of sublime national change, to join those great reforms, cast as the finest, hardest steel into our Nation of Laws as an inalienable right and an eternal Blessing of Liberty.  D. Waggoner, Phd, 2009.

.

 

Oregon Health & Science University: Oregon's Premier Medical School and Research University. Photo Courtesy OregonLive.com

.

President Barack Obama:  Our presence here today is remarkable and improbable.  With all the punditry, all of the lobbying, all of the game-playing that passes for governing in Washington, it’s been easy at times to doubt our ability to do such a big thing, such a complicated thing; to wonder if there are limits to what we, as a people, can still achieve.  It’s easy to succumb to the sense of cynicism about what’s possible in this country.

But today, we are affirming that essential truth -– a truth every generation is called to rediscover for itself –- that we are not a nation that scales back its aspirations. We are not a nation that falls prey to doubt or mistrust.  We don’t fall prey to fear.  We are not a nation that does what’s easy.  That’s not who we are.  That’s not how we got here.

.

Pres. Obama Signs Health Care Reform Act into Law. Photo Courtesy: Saul Loeb, AFP/Getty Images.

.

We are a nation that faces its challenges and accepts its responsibilities.  We are a nation that does what is hard.  What is necessary.  What is right.  Here, in this country, we shape our own destiny.  That is what we do.  That is who we are.  That is what makes us the United States of America.

And we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.  And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country.

.

A Promise Fulfilled.

.

Professor Obama: The Presidential School of Bipartisan Education.

You may have thought the summit President Obama presided over today was all about health care reform.  It wasn’t.  Health Care Reform was the topic, but the subject was a six-plus hour seminar in front of a national audience on how to  be bipartisan led by the professor-in-chief, Barack Obama, J.D.   The pundits and bloggers, well, like, me are pounding away at their computers trying to wring every bit of meaning and nuance from the day’s-long exchange.

Health Care Reform was the topic, but the subject was a six-plus hour seminar in front of a national audience on how to  be bipartisan led by the professor-in-chief, Barack Obama, J.D.

Let’s get one thing out of the way.  How do I grade the debate on health care reform?  I give the Democrats a C, and that’s generous.  Their acting like they are close to the Republicans in the substance of the bill was stretching credulity nearly to the breaking point.  But I give the Republicans a D- and that is because they went out of their way to avoid any semblance comprehension what the summit was really about.  Just a whole day of props and talking points without as much as a single original thought.

Sorry, Mitch, John, Lamar and Eric, starting over isn’t an option.  It wasn’t about how many minutes each side gets to speak, Mitch (that has to be one of the most sophomoric gaffs of your career). You know as well as I do that it is empty rhetoric.  It’s impossible to start with a clean sheet.  The sheets in the health care debate are not paper.  They are hospital bed sheets and have over a half a century of political grime ground into them.  There are no clean sheets.  You can’t rewind history.  The perpetuation and dissemination of ideas follows the one-way arrow of time.  Health care reform does not exist in a bubble undisturbed by the flow of reality in the present environment of human medical needs.

Republicans: It’s time for you to step out of the way and let we Americans have access to medical care that meets our needs, covers us without regard for preexisting conditions, and sets the stage for a era of wellness through preventing those medical conditions that can be prevented.  Your ideas won’t work because your plan has an inherent stinginess to it that is, well, just incomprehensible in a nation  that thrives on being generous.

Republicans: Your ideas won’t work because your plan has an inherent stinginess to it that is, well, just incomprehensible in a nation  that thrives on being generous.

Now, on to the real subject of the summit today.  Prof. Obama led the seminar in bipartisanship.  Neither political party really figured that out, however.  They have over the past year (two? three? twenty?) been overwhelmed by the drumbeat of talking points drilling themselves so deeply into the daily consciousness of our congressional representatives, that it appears almost as if they have lost the capacity to speak in any other manner or with any independence of thought.

Prof. Obama conducted a very well run seminar in what can easily be described as a highly-charged setting.  The representatives of the two parties, both Senators and Congressional Representatives have been sniping at each other, saying  some of the most outrageous things ever entered into the Congressional Register, attacking with a ferocity just shy of out and out fisticuffs.  It’s a good thing the debates in the wells of both Houses are not near windows.  The amount of acrimonious bile spewed at each other could have led to the defenestration of any number of the members in the tradition of the Bohemians in Prague, first in the 1400s and again in the 1600s.

It’s a good thing the debates in the wells of both Houses are not near windows.  The amount of acrimonious bile spewed at each other could have led to the defenestration of any number of the members in the tradition of the Bohemians in Prague, first in the 1400s and again in the 1600s.

But neither side got it.  At least neither side wanted to be the first to admit that they got it.  As soon as they walked out of Blair House and across the street back to the Capitol, the auditory hallucinations of hyperpartisanship appear to have kicked in like throwing the main breaker on a mental trash compactor.

Regarding health care reform, the lack of substance was arguably all that could be expected.  Regarding reestablishing a beneficial and productive dialogue between the two parties, it was right there for all America to see.  The professor, behaving at his presidential best, conducted an exercise in statesmanship.  The comments, although, at times impassioned, were respectful and under the watchful eye of the Professor-in-Chief. The two sides were able to carry on a debate that did not devolve into shouting or irrational charge and counter-charges.  The summit was a demonstration of political civility on the TV screens or computer monitors for all America to see.

So, now we will see how the introduction of statesmanship into this debate will be able to work its way through the consciousness of both our elected leaders and the American people.  Will it grow over time; were seeds planted that will germinate and change the landscape of the national political scene?

Health care reform, just a few weeks ago declared dead on arrival after the Massachusetts election, has survived.  Is it healthy?  That remains to be seen.  But the recovery of  reform is proceeding in ways that could be best compared to an intensive rehabilitation program.

He left no doubt that his skills as President of the United States have grown and matured in ways that give great encouragement to his supporters and equal concern to his opponents.

The summit today, however, was historical for what it may have saved for American politics, more than the result of the final disposition of health care reform.

Professor-in-Chief Obama is undoubtedly exhausted after today’s intensive experience and exercise in democracy.  But one thing is certain.  He left no doubt that his skills as President of the United States have grown and matured in ways that give great encouragement to his supporters and equal concern to his opponents.  I have said on several occasions that America would have to get used to a very smart president.  Today, we just saw one reason why.

Landing the Health Care Reform Bill: It Feels Like Apollo 11 Redux

The voyage of the legislation to create a Health Care Reform Bill has all the

Sen. Harry Reid Launches Health Care Reform in U.S. Senate. Photo credit: C-Span

emotional elements of landing Apollo 11 on the Moon in July 1969.  Health Care reform has been a long, complex mission with an uncertain outcome.  Is it an overstatement to say that landing on the Moon and returning to Earth was an easier and safer endeavor than getting the Health Care Reform Bills passed, conferenced and onto the President’s desk for signature?

At this moment, it seems almost to be the case.

When Neil Armstrong took manual control of the lunar lander to find a safe spot to set down, a thousand different things could have gone wrong.  In fact, alarms were going off in the cockpit.

As the Eagle’s landing radar acquired the surface, several computer error alarms appeared. The first was a code 1202 alarm and even with their extensive training Armstrong or Aldrin were not aware of what this code meant. However, they promptly received word from CAPCOM in Houston that the alarms were not a concern. The 1202 and 1201 alarms were caused by a processing overflow in the lunar module computer. As described by Buzz Aldrin in the documentary In the Shadow of the Moon, the overflow condition was caused by his own counter-checklist choice of leaving the docking radar on during the landing process. Aldrin stated that he did so with the objective of facilitating re-docking with the CM should an abort become necessary, not realizing that it would cause the overflow condition.  Source: Wikipedia

Eagle Lunar Lander just seconds after separation, Apollo 11, July 1969, Photo: NASA

It’s one thing to read about it.  As we close this 40th Anniversary of the Apollo 11 Landing, it really is much more satisfying to watch it.  This video is one continuous shot of approximately the final 10 minutes of the descent and landing, viewed from the right window of the LEM.  The audio is quite good, as well.  Watching it still stirs in me that sense of excitement I felt as a 16 year old kid glued to the TV set with my family.

[For a similar, but NASA produced video, click HERE.  This is the final approach, and included is an inset window that tracks the Lander’s progress crater by crater.  It provides a sense of perspective for the approach.]

Regarding the impending passage of the Senate bill and then the conference process, if you tend more toward the pessimistic side, you probably agree with Jonathan Cohn of The New Republic:

If your standard for comparison is your ideal health care reform, then of course this will be disappointing. Like every bill that’s moved through Congress, this one would leave millions uninsured even after full implementation–and leave millions with coverage facing substantial, although generally not crippling, financial burdens. It would introduce some reforms to the delivery system and, according to the official cost estimates, generate budget surpluses over time. But it’s not going to radically turn American health care into a paragon of cost efficiency.

If you tend more to the optimistic side, you probably agree with Paul Krugman of The New York Times:

Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable.

So how anyone can call a plan to spend $200 billion a year on Americans in need a defeat for progressives is a mystery.

I wish there were a public option in there; I wish there were broader access to the exchanges; I wish the subsidies were even bigger. There’s lots of work to be done, work that may eventually culminate in a true, not simulated, single payer system. But even in this form, we’re looking at something that will make America a more just, more secure nation.

If you are a Republican or Tea Party Advocate, you are most likely hoping and praying the Health Care Reform bill will suffer the fate of the Soviet Luna 15 Lunar Lander Probe that was launched three days before Apollo 11:

Luna 15, launched only three days before the historic Apollo 11 mission to the Moon, was the third Soviet attempt to recover and bring lunar soil back to Earth. The spacecraft was capable of studying circumlunar space, the lunar gravitational field, and the chemical composition of lunar rocks… After completing 86 communications sessions and 52 orbits of the Moon at various inclinations and altitudes it began its descent. Astronauts Armstrong and Aldrin had already set foot on the Moon when Luna 15 fired its main retrorocket engine to initiate descent to the surface at 15:47 UT on 21 July 1969. Unfortunately, transmissions ceased only 4 minutes after deorbit at a calculated altitude of 3 kilometers. The spacecraft impacted the lunar surface on July 21, 1969. The spacecraft had probably crashed onto the side of a mountain.   Source: Wikipedia.

Launched 3 days before Apollo 11, the USSR's unmanned Luna 15 crashed onto the Moon's surface just hours after the Eagle had safely landed with Armstrong & Aldrin on board.

I’ll give House Minority Leader, Rep. John Boehner (R-OH) the final word…

Photo courtesy Politico.com & BlueStateDigital.com

No, I think I’ll give this Tea Party protester the final word.  Just like the rest of us loyal and patriotic Amurricans, life without spell-check is worse than…oh, wait, he spelled the word right.  In high school he clearly decided to protest which sections of Mrs. Dewey’s English classes were not patriotic enough, because he was getting this way-too-liberal education paid for through public taxation.  And those unacceptable sections happened to include homonyms and writing complete sentences.  I think his pointy hat needs to be cone not a tri-corner.

A Tea Party Protester: The Epitome of the Well-Educated American. Photo: ImageShack

Quinnipiac Poll: What the Republicans Failed to Mention About Health Care Reform

A Sniffer Report: The Quinnipiac House Health Care Bill PollThe Sniffer: Always on the Job to Sniff Out Anti-Healthcare Reform Radiation

During the Senate debate on the Health Care Reform Legislation,  the Patient Protection and Affordable Care Act, a number of Republican senators referred to a op-ed piece by David Broder, Washington Post columnist, titled, “A Budget-buster in the making.”  In his column, Mr Broder quotes from a survey poll conducted by Quinnipiac University released on November 19, 2009.  Mr Broder, focusing on just one question, states:

It read: “President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?”

The answer: Less than one-fifth of the voters — 19 percent of the sample — think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely.

That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.

Hmm, is that so, Mr Broder?  Well, I just happened to read the complete news release from the researchers at Qunnipiac, including all those boring tables and numbers, and I came away with a completely different conclusion.

In Mr. Broder’s defense, he cites the opening statement of the report correctly:

Three-quarters of American voters – 74 percent – like President Barack Obama as a person, but only 47 percent like most of his policies, and voters disapprove 51 – 35 percent of the health care overhaul passed by the House of Representatives which he has endorsed, according to a Quinnipiac University national poll released today.

Voters disapprove 53 – 41percent of President Obama’s handling of health care.

Perhaps, though, Mr. Broder only read those two paragraphs, because just two paragraphs later is this statement:

Voters favor 57 – 35 percent giving people the option of being covered by a government- run health insurance plan, the “public option.” Independent voters approve 55 – 39 percent. The overall approval is down from 61 – 34 percent in an October 8 survey by the independent Quinnipiac (KWIN-uh-pe-ack) University. And they oppose two proposals to modify it:

* Allowing states to opt out of the public option is a bad idea, voters say 49 – 43 percent;

* Voters also oppose 47 – 38 percent the “trigger,” where the public option kicks in only if private insurance does not cover enough people.

Mr. Broder, as well as the distinguished Senators from the Republican Caucus, conveniently forgot to mention these results.  And some others, very important others, but we’ll get to those in a moment.

How should we parse these responses?  First of all, as an experienced researcher myself, the question is not very well written.  Not because of the content; it is a perfectly legitimate question to ask.  But the setup is too complex, and it borders on being a leading question.  It also should have been split into two questions:

  1. Do you think that President Obama will be able to keep his promise,
  2. Do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?

Because of the way the question is phrased, we do not know to which of the two issues the respondent is answering.  Technically, the question should have been thrown out and the results not reported.

This assessment is strengthened in light of the next set of results.  In contrast to the results of the first question, the voters show considerable support for components of the health care reform.  By a margin of 55-37 percent, voters support the public option.  They oppose letting states opt out by 49-43 percent, and they oppose the “trigger” option by 47-38 percent.

Now, I don’t know about you, but these three items are among the most important in the entire health care reform legislation.  Couldn’t one, with some degree of confidence, say that from these results the American public generally supports key elements of the bills going through Congress?

That depends.  When asked if the respondents supported the House version of the bill, the split was 51-35 percent oppose, but 14 percent gave no answer.  The strongest opposition was expressed by whites, over 55 years of age, making more than $100,000, and describing themselves as conservative, and born again Christian evangelicals.   The strongest support came from African-Americans, in the 18-34 year old age range, with incomes less than $50,000 per year, describing themselves as liberal. (No data for Black religious preference was listed.)

As for President Obama’s support of the House bill, the attitude of most Americans toward him appears not to be much affected.  The category “no difference” runs consistently in the 40-50 percent range, with the obvious exception of those who identify themselves as Republican.  Since the percent of people who look favorably upon the president for his support of the House bill averages roughly 30 percent, adding it  to those whose attitude has not changed, we can’t draw too many conclusions, because the ones claiming no difference may be overall positive or negative.

The respondents, however, contradict themselves.  The next four questions all have to do with core concepts of health care legislation: the public option, states having the authority to opt out of the federal plan, the passage of a “trigger” provision that would  activate under a set of conditions where not enough people were covered by an established date, and whether or not Congress should pass the legislation this year.  On all four items, the responses are solidly positive.

But one issue they do not contradict themselves is their opinion of the Republicans and their behavior regarding the health care reform legislation.

While this survey has bad news for the President, the news for Republicans is worse:

Voters say 45 – 36 percent, including 40 – 37 percent among independents, that Obama is better able to handle health care than congressional Republicans. In October, it was 47 – 31 percent in the President’s favor.

Voters also say 59 – 29 percent that Republicans are not making a good faith effort to work with Obama and the Democrats on health care.

As one might expect, neither Mr. Broder nor the Republicans, reading the same industry-supplied script they’ve been parroting for months, mentioned anything about this part of the survey.  In the spirit of fairness, the voters aren’t all that favorably disposed to the Democrats either, but  out of Pres. Obama (45-36% over the GOP), Democrats (36-55%) and Republicans (31-58%) , the GOP  comes out dead last.

The quest for universal health care continues, strongly braving the winds of opposition blowing at hurricane strength.  The storm may increase, but the gale will not deter us.  All storms blow themselves out.  America will have universal health care.  A new blessing of Liberty will be enshrined in the Great American Experiment.

We All Deserve Health Care

The Numbers of a Miracle: 220-215

One step closer.  Not done, but one step closer.  Plenty of  opposition still left.  The Sniffer will remain vigilant.  AHIP, PhRMA, Big Medicine, U.S. Chamber of Commerce, the Anti-Reform PACs and Astroturfers.  Probably not their best day.

The House of Representatives voted, 220-215, and the Affordable Health Care for America Act, H.R. 3962, passed.

Universal Health Care took its closest step to being a reality in the history of  the nation.  We stand at the threshold of being a  healthier people.  Those determined individuals who through choice or calling have dedicated their lives to being healers today were honored.  Yes, honored.  A doctor, a nurse, an aide, a therapist of any stripe, even the chaplain, administrator, clerk, or support staff.  Even those in Big Medicine who dedicate their lives to creating the best medical care possible, despite the the greed that has held them hostage.  Today they were given a new legitimacy, not in what they do, they’ve always had that.  Yes, I know there are those who take advantage of the trust they’ve been given, or reach a point of compassion fatigue where they lose their edge. And make mistakes.  But that is not the point.

Tonight we celebrate the majority, who work and work and work that the sick and injured are given the chance to have their lives back, or to be given a life for the very first time.  Tonight, in America, the healers have a new identity.  Or nearly so.  Like the subtle change from night to twilight, that just perceivable shift from sky black to the dimming of the stars, the new dawn of medical vitality is just over the horizon.

The Caregivers’ dawn is rising.  America the healthy will soon rise right along with them.

Dawn with Star Pike Pictures UK

Dawn with Star. Image Courtesy: http://www.pikepictures.co.uk/prints