Category Archives: Health Care

It’s Horror Film Season in D.C.

In most low grade horror films, particularly of the slasher variety, there’s a point where the hero, using the ‘Last girl’ thinks the killer is dead, only to have the bad guy rise and start attacking again. Like those poorly thought out monstrous plots the GOP is taken their ACA repeal and shown to the world that it is not dead.

Cassidy-Graham, the latest, and truly most likely to be final, attempt to repeal the ACA is shambling its way toward a vote on the Senate floor. This is likely the final push as the Senate Parliamentarian has ruled that the Budget Reconciliation bill must pass by Sep 30th.

There have been, of course, no debates (apparently only 90 seconds of debate remains on the clock.) No committee hearings or mark-ups, no public hearings, and there will be no CBO score letting us know the final cost and the number of people who will lose their insurance, but the GOP is plunging ahead despite all that.

This is an example of perverse incentives. Millions of people, perhaps tens of millions if the earlier bills are any guide, getting tossed off their insurance is something that would normally make an elected official very hesitant, but there’s something more terrifying to the sitting GOP members, a primary challenge.

For a number of years, approaching a decade now, the GOP has through a mixture of lies and hyperbole, painted the ACA (Obamacare) as the greatest evil, failure, and theft of liberty to have ever risen against the nation. (Death Panels anyone? Worse than Slavery?) They have convince their dedicated base that the law must be repealed and election cycle after election cycle they have promised just that, while lying their asses off about ‘replace.’ This cycle of lies and over promising fertilized the ground Trump’s candidacy. (gee, thanks.) If they don’t pass something, then a loud mouth with bigger lies and bigger promises will challenge them from the right in the primary. For senators that’s a serious threat and for House members it very nearly electoral death because safe districts make such challenges stronger than competitive ones.

Because of the calendar deadline if the Senate passes this bill the House will be faced with the choice of passing it as is or killing it. I would not bet on its death.

I have friends for whom this bill will be a terrible thing. There is no doubt that if it passes and is signed, millions and millions of people will be enraged and the Democratic party will be emboldened to go even bigger, having had their faces shoved in the fact the GOP will never compromise for market based solutions.

I keep hearing Jamie Lannister saying “How do you think this ends?”

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This Opera is not Over

Today the U.S. Senate will vote to advance to debate a bill repealing the Affordable Care Act, AKA ObamaCare. There are two bills under consideration by Senate leader McConnell and as of the time of this writing, the freaking morning of the vote, it is not know which bill or bills the Senate will be voting upon.

Consider that for a moment, the forces pushing and pulling at the GOP are so implacable that they are moving forward on legislation that they not only have not read, have not studied, and for which the parameters are unknown but that the exact bill is unknown. Because their margin of votes is tiny, by using reconciliation they avoid the legislative filibuster, they have even brought Senator McCain, still recovering from surgery and fresh off his diagnosis of an aggressive and dangerous cancer, up from Arizona to supply his single vote. (Presumably in favor of stripping healthcare from millions of Americas as he fights for his life with those same resources he is about to strip from thousands that voted for him.)

Whichever bill is advanced, the repeal and replace that will cause about 22 million to lose their healthcare insurance or the repeal and delay that will make that number as high as 32 million, it will be a disaster for individuals, the United States, and the Republican Party. If it’s such a disaster why are they doing it?

Because the GOP politicians, individually, are trapped.

One the House side migration, the rural/urban divide, and gerrymandering, quite a few GOP representatives come from ‘safe’ districts where the Republicans simply cannot lose the general election. However this does not free up the GOP rep to vote as he please, it rather forces him or her further right with each election cycle. Knowing that no one from their ‘left’ can threaten them these representative fear their ‘right.’ To be challenged in their primary is their greatest fear and failing to vote for the end of the hated ‘ObamaCare’ will almost certainly provoke a challenge. That they can lose. It doesn’t matter that this issue is so grave and so damaging that it can flip a safe district. If they do not survive the primary the general is meaningless. So they dig their own graves hoping for a miracle to save them. Moderate Republicans are even more vulnerable to this process as they are already viewed with suspicion by the party members at large.

Senators, facing statewide election and not gerrymandered districts, are less prone to this process but even at the state levels the same forces are at play, some states tilt so far ‘left’ or ‘right’ as to be consider ‘safe.’

I do not know where this will end. Until they are working on and debating the next big bill, likely to be their true love, taxes, the fat lady has not sung.

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Universal Healthcare is not Slavery

So from the left side of the political spectrum that has been an assertion that ‘healthcare is a right.’ For the moment let’s set aside if they are in fact correct with that position. (And no the preamble to the constitution doesn’t establish it, that section has no force of law. It’s what gamers call ‘color text.’) In response to this position some on the right, generally from the libertarian wing, have counter-claimed that asserting that healthcare is a right means making an illegitimate claim on another’s person’s labor and that is de factor slavery.

Slavery? That is an absurd proposition beyond the boundaries of the asinine.

First off, the healthcare professions, doctors, nurse and the like would still be compensated for their labor. t would not be stolen without compensation or consent, so it in now way resembles slavery. It is the height of offensiveness to even suggest such a thing.

Second, all right require the labor of others. You want a right to a trail? That means that there must be judges, District Attorneys, clerks, bailiffs, and a whole host of support personal. You want a right to vote? There has to be registers, clerks, and again a vast support network. A right which is not protected and not enforced is no right at all and that protections and enforcement requires people and their labor.

Where the questions of labor that is compelled is the taxation. Taxes represents the labor of people that has been confiscated to support the public good. There is a great and vigorous debate over what constitutes a public good and therefore what sort of things are so valuable, so essential, that collective we must take some from most in order to support the goal.

There are strong arguments on both side about healthcare and if it is a public good or an individual responsibility, but comparisons to slavery are only for the dim and the deluded.

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Health Care is going to be Expensive

There is no nation among the rich prosperous ones where health care is cheap. There are places where citizen pay less from their own packets and there are ones where they pay more but when all factors and subsidies are considered the inescapable fact is that modern effective healthcare is expensive. Outside of science-fiction it is going to remain that way. After all productivity in healthcare is not measured in patients/hour but in survival rates and more that measure takes herculean effort.

There are only two broad paths forward on paying for this expensive healthcare; the costs are socialized, born by all or people are left to fend for themselves against the wolves of disease, accident, and misfortune. As a society and as a political entity this is the choice before us.

Now, it doesn’t matter how you dress it up in ‘freedom’ and ‘choice’ and whatever other inspiring words you want to use, moving away from socializing the costs is moving towards throwing people to the wolves. It is the end result of such policies, to say otherwise is either foolish or deceptive. If you want that course, owe up to the cost and understand that people are going to suffer and people are going to die for that choice.

I also think that the ‘throw them to the wolves’ option is not sustainable. As the costs rise and more people are wrecked on the shoals of medical misfortune there will be outcry and there will be outrage. Eventually that system will collapse under the human misery and in their desperation who knows what the political body will turn to for relief?

On the socializing costs path there are a great number of people who seem to think that the only choice on that road is ‘single payer’ but that too is folly. If you take the time to study system around the globe you will find that there are numerous solutions to the question of how do you socialize the costs.

This problem is not going to go away and it is not something you can dash off and forget about after passing your big tax cut or it will bite you and everyone else on the ass.

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Is This A Dagger …

Well if they stick to their schedule the U.S. House of Representative will vote tonight to repeal the ACA ‘ObamaCare.’ Note that this is a budgetary bill and as such should it survive in the Senate will be immune to filibuster.

As I write this it is uncertain if Paul Ryan has mustered the votes to pass the bill out of the House. To satisfy the more conservative members of the GOP he has recently added even more draconian amendments to a bill that has already been scored by the CBO as pushing up to 14 million people off their health insurance by next year’s off-cycle election.

Now in addition to allowing insurers to charge older patients up to five times the rate of younger patients while slashing subsidies so that their prices sky rocket, this bill now seeks to strip out the essential coverage requirements of the ACA. This is a list f ten essential aspects that all health insurance now must cover, such as drugs.

This amendment stripping the coverage requirements may not survive the senate because it can easily be ruled as beyond the budget and that would open it up to a filibuster. Even if the parliamentarian rules the amendment allowed there are wavering GOP Senators unhappy with the such extreme measures, and the GOP’s vote margin is one vote. (Normally it would be two, but one member is out ill.)

Why add this is it almost certainly cannot pass the Senate?

Because they are facing a pressure that they cannot resist, the Tea Party Base.

For six years the number one target on the Tea Party’s hit list has been the ACA and the GOP has gone along, promising repeal on day one of they reign. There are people who hate the ACA because it is not single payer, there are people who hate the ACA because of limited networks and high costs, there are people who hate the ACA because it forces you to buy insurance, and there are people who hate the ACA because it makes some people pay more in taxes.

Some of these group can be made happy by reforming and adjusting the ACA, but those last two can only be happy with killing it. Amid the GOP no faction has the number to impose their will and many have the number to kill anything they hate. Ryan has been trying to square that circle and to my eyes he’s given up.

He’s going to win over enough of the Tea Party/Freedom Caucus to get the thing off his desk and onto McConnell’s where it will likely die.

If it dies in the Senate McConnell should look out for knives in the back – a grand Senatorial tradition even if this time they will be metaphorical. The conservative GOP Senators, Cruz and the like, will be blaming him and Ryan will be pushing that train with everything he’s got. His only hope is selling the lie that Repeal would have worked if the Senate have gone all wobbly.

This is a trap of their own construction and if millions of lives didn’t hang in the outcome I’d be getting the popcorn.

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Gravity Always Asserts Itself

As a kid I watched countless hours of Warner Brother cartoons and among my favorite were the Roadrunner and the Coyote. Invariably at some point in his futile attempts to catch the Roadrunner the Coyote would find himself suddenly without ground beneath his feet. For the first few moments, everything was fine, but once became aware of the fact, gravity took command and his fall began.

For more than six year the Republican Party has railed against the ACA and encouraged their political base to view it as an evil that must be destroyed. That destruction has been their premier promise in every election cycle and now, with control of both congress and the White House, it is within their grasp. However, like the Coyote they have discovered that the ground beneath their feet is not what they believed it to be.

Immediate repeal means throwing twenty million or more people off of their insurance. Even if you are not inclined to think of the news media as hostile to conservatives there is no universe where that plays well on the evening news and with number that large nearly every person will know someone who lost their coverage. It will be a painful, personal, and powerful storm of anger.

Not repealing means enraging the base, encouraging the dreaded ‘primary opponent’ that all officials in safe districts fear, and sparking intra-party warfare between the more pragmatic and Freedom Caucus wings.

Repeal and delay, vote for repeal but word it so that the effect occurs two, four, or more years down the road throws a hand grenade into the individual insurance market. What company will want to participate when the market will cease to exist in just a short time? Insurers flee, people loose their coverage, mandate are not enforced and a death spiral for the industry is a real possibility. That means people with deep pockets and political connections will be very angry.

Complicating this terrain is the fact that the President-elect is well known for his lack of consistency. Is he committed to repeal for ‘conservative’ reasons? This is a man who has praised single-payer nationalized healthcare, hardly a conservative policy. And just recently his spokespeople have affirmed that under the President-Elect’s plans no one will their coverage, no one.

They have dashed off the precipice, there is no ground under them save the disastrous and countless distance below, and no one will be inclined to give them any aid.

If they do manage to repeal, without dealing with the very thorny and difficult issues infusing this problem, (Which is likely because in six years they have advanced zero legislative packages to institute a ‘conservative’ solution.) they will have done more to hasten single-payer in this country than any ten liberal politicians.

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My CPAP wisdom

It was a little over four years ago that I received by diagnosis of severe sleep apnea. It came as a surprise; though I snored and had issues with being tired I had not expected that this would happen. I started CPAP therapy and this gave me my life back. So now that it has been four years I thought I would put together a small post sharing what I learned about making this therapy work effectively. Before we continue, these are simply my personal experiences. I am not a medical professional and you should always consult with a medical professional about any therapy you are engaged in.

1)   The Right Mask

First and foremost in getting the most of your CPAP therapy is finding the right mask for you face and your sleeping habits. Personally I started nasal pillows, which isn’t even really a mask. This was a device that affixed right under my nose and plugged directly into the nostrils. I thought it might work best because of the small profile, however I tend to open my mouth during my slumber, and this dropped my pressure below therapeutic levels. Even with a chinstrap I couldn’t keep my mouth closed. (A symptom I am sure many would say it equally true when I am awake.) This also ruled out the nose only masks. I tried several nose & Mouth masks before I found one with a gel form that sealed nicely against my skin without requiring too much pressure.

So if you first few masks don’t work for you, keep looking. There are all sorts of masks with all sorts of materials. Keep at it until you find the right one.

2)   A Clean Mask

Most instructions that come with the masks advise cleaning on a weekly basis, but this may be too infrequent. Each night you use the mask oils from your skin become affixed in a thin layer on the contact surfaces, degrading the seal. I have found that by purchasing CPAP mask wipes, I can clean the contact surfaces each night and improve the seal. This reduces how tight the mask needs to be when worn, and improves the general effectiveness of the therapy.

3)   A Shorn Face

If you’re male, and particularly if you are hirsute and given to ‘five o’clock’ shadow, it would be prudent to shave before bed. Just like gas masks, sleep apnea therapy masks do not function well with beards and unshorn skin.   You see a common theme appearing in my advise, getting a good seal. The point of the therapy is raising the pressure in you airways so that you have unobstructed breathing and you can keep properly oxygenated. A good seal is critical to obtaining that needed pressure.

4)   The Right Accessories

The mask and your skin are the most critical elements in securing good therapy, but making your sleep comfortable can sometimes be a matter of the correct ancillary devices. I myself tumbled and turn in my sleep, when I first started my CPAP therapy I often woke myself either tanged in the hose or by the roar of air escaping the machine after I had pulled the tubing free of the connectors.

I found a hose stand on Amazon that works well for me. The base slips between the mattresses and it hold the hose overhead, much like an IV stand does in a hospital, allowing me to toss and turn with little restriction.

I hope that this sharing experience helps someone out. If you think you may have sleep apnea I cannot stress enough the need to be tested. I didn’t think this applied to me, but during testing they discovered my blood oxygen levels were dropping in the high 80’s, and as I understand it, anything under 95% is considered dangerous. If people tell you that you snore and stop breathing, get thee to a doctor. If you wake up constantly through the night, get thee to a doctor. If when you stop moving you find yourself falling asleep, get thee to a doctor.

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