Thursday, December 17, 2009

My Views on Health Care Reform

I've had quite a few people asking me how I feel about the direction that health care reform has taken since Lieberman outright screwed any chance for a public option or expansion of medicare. While I am in the middle of several time consuming job related deadlines, let me just say a few words which I am sure fellow progressives might not like to hear.

First, the term dissappointment best characterizes my feelings about the current health care reform proposals in the House and Senate. The House has a public option, but is weak on other cost control mechanisms and imposes undue restrictions on womens' privacy rights. The Senate bill has no public option, but does contain a variety of other measures that reduce health care costs. The big dissapointment for me is that, when all is said and done, there will be no public option and no expanded Medicare. At this point, that's a fact and there's nothing that can be done about it.

Secondly, the term "perplexed" best characterized by reaction to Howard Dean's call to kill the bill and start anew. The following statements by Kevin Drum at Mother Jones is illustrative of my curiosity towards Dean's position.

Here's what I want to know: which one of us is living in dreamland? If you don't like the Senate bill, fine. Don't support it. But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? A presidential election year? 2013? 2014?

Well said. What's more, anyone ever involved in things like NGO work or politics will always say that "sometimes small wins matter". Again, Kevin Drum:

But if it passes, here's what we get:
  • Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.
  • Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
  • Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
  • A significant expansion of Medicaid.
  • Subsidies for low and middle income workers that keeps premium costs under 10% of income.
  • Limits on ER charges to low-income uninsured emergency patients.
  • Caps on out-of-pocket expenses.
  • A broad range of cost-containment measures.
  • A dedicated revenue stream to support all this.
As you read this post, you may know that I spent considerable energies here on Twitter and Facebook, trying to help energize the push for public option. But, I am never one to say that the best way to go down is to go down swinging. At heart, I am a pragmatist and know when tactical retreats are needed. AND RIGHT NOW, A TACTICAL RETREAT IS NEEDED.

What we have is a health care bill that is an utter mess, but better than nothing. In the short run, we no longer have the choice between public option or no public option. Our choice is between failing to pass some needed health care reform measures and hoping to solidify progressive majorities in the next Congress, versus killing health care legislation and...well then what?

I know some of you reading this have worked with me tweeting and retweeting health care stats and calls to action. And we should continue to do this. But, we also need to know what realistic options we have at this moment. Taking Dean's course of action is not one of them. Instead, lets get this needed reform passed, regroup, and focus on getting progressives in Congress in 2010. Then we can give a single-payer a serious push and expect to at least get something akin to a public option.

As an additional note: I think this petition is still worth signing. I still believe we need to make it clear that we object to having the public option sidelined.

Sunday, December 13, 2009

Health Insurance and Mortality Rates: Who Lies?

This article is also posted at

Once again, willful ignorance about health care facts crawled out of the heads of conservative pundits in the weeks following the September release of a peer reviewed study entitled “Health Insurance and Mortality in U.S. Adults.” To be sure, ignorance was perhaps the only advantageous reaction by those more concerned about ensuring the buoyancy of media ratings or the failure of the Obama administration. After all, when discounting for education, income, smoking, drinking, and obesity, this study asserted that some 45 thousand deaths per year are associated with the lack of health insurance. Opposing health care changes would look profoundly immoral if opponents simultaneously admitted that 45 thousand people a year do in fact die due to lack of health insurance.

Unable to give credit to the idea that people do die because they don't have access to health insurance, conservative pundits resorted to those tactics that are typically found together with willful ignorance. Yes, through metaphors and analogies proven so useful for scaring the conservative base into social action, pundits simply assaulted the character of those who conducted the study. When you can't challenge the message, just kill the messenger. The assault included the familiar recitations about the “socialist” nexus between Harvard, science, and Obama, and quickly colored broader conservative discourses about health care reform. The evidence of this conspiratorial triad pointed toward the fact that two of the study's authors, David Himmelstein and Steffie Woolhandler, were also co-founders of a single-payer advocacy group called Physicians for a National Health Program (PNHP). The researchers were quickly cast as the malicious “political doctors” or “left-wing fanatics” preaching a science “infused with left-wing politics”.

With the invention of this epic challenge, the potential for meaningful health care reform debate or respected scientific research was once again sacrificed on the alter for personal and political gain. The study was flawed not because of proof of poor research methods or biased data, but because the authors had well established political opinions supported by the conclusion of the study. That's right, according to conservative pundits, researchers are not supposed to have political views, or if we do, our views have to contradict our research findings in order to be constructively valid and unbiased. Forget the fact that scientists often chose research questions or topics that interest them, which explains why conservative organizations like the Center for Policy Analysis or the Heritage Foundation never thought to ask about the number of people that die a year due to lack of health insurance.

But, for a moment, let's assume that the 45,000 estimate for some reason is higher than actual number of deaths. What might a more orthodox estimate look like? Well, the answer is not hard to find, assuming that one is actually interested in estimating the number of deaths due to lack of health insurance. A study conducted by the Institute of Medicine (IOM) in 2002 for example, reported 18,000 deaths in 2000 due to lack of health insurance. Stan Dorn, a senior researcher at the Urban Institute, updated the data linking health insurance to mortality risks. Dorn's results were shocking. Using the IOM's methodology, the report demonstrated that, in 2006, some 22,000 Americans died because they lacked health insurance. Moreover, when Dorn refined the methodology by rejecting the IOM's assumption that all people between the ages of 25-64 faced the same mortality benefits from health insurance, the numbers take a change for the worse. Now, instead of 18,000 deaths in 2000, Dorn's approach pointed to 20,000. Instead of 22,000 deaths in 2006, that number stood at 27,000 deaths. These numbers are hardly a cause for suggesting that health care in the U.S. is just fine as is. Remember, we waged two costly wars in a response to the tragic death of 4,000 people on American soil on September 11, 2001. Imagine if we would deploy a proportionate response to the tragic death of the tens of thousand of Americans who die each year because they lack access to health care.

There are a wide number of other studies pointing to a clear relationship between higher mortality and the lack of health insurance. A 2008 study conducted by researchers at the Sunnybrook Health Center at the University of Toronto found that, when compared to those with health insurance, uninsured breast cancer patients had significantly higher levels of disease severity and larger tumors, along with lower rates of operations and breast reconstructions. Another 2008 research report, conducted by researchers at the School of Public Health at the University of North Carolina, found that, in Virginia, the insured are 2 times more likely to report being screened for colorectal cancer versus the uninsured. Controlling for a host of possible factors, such as sex, race, age, injury and trauma, a 2009 study, entitled “Downwardly Mobile: The Accidental Costs of Being Uninsured,” found higher rates of mortality among the uninsured. Another 2009 study, entitled “America's Uninsured Crisis: Consequences for Health and Health Care,” found that uninsured children were 20% to 30% more likely to lack needed dental care, immunizations and medicine. The study also found uninsured children to be 6 to 8 times more likely to have unmet asthma and diabetes needs. At the same time, uninsured adults with at least one chronic condition were 40% to 50% more likely to die prematurely.

In fact, the 45 thousand deaths per year due to lack of health insurance should not seem shocking nor unrealistic. When considering that there are currently 47 million uninsured Americans, paired with a demonstrated relationship between having health insurance and lower mortality, 45 thousand deaths a year is only as absurd as the system that allows it to continue. In their rejection of this figure, do conservative skeptics deny a relationship between health insurance and mortality? If so, maybe we all need to drop our health insurance because we're simply wasting our money on a service that apparently does nothing to prolong life.

Whether the number Americans that pay with their lives due to an inefficient health care system is 20 thousand, 30 thousand, or 45 thousand per year should be irrelevant. Any of these figures is alarmingly high. But, the reaction from health care reform opponents is no more about numbers and mortality than it is about offering up viable solutions to a real health care crisis. The reaction is instead based on the fact that the research question itself violates a diverse array of conservative political interests. Rather than seeing an opportunity for escaping from the dark ages of conservative health care reform rhetoric, the study was willfully used as chance for television and radio hosts, along with Republican politicians, to raise their ratings. Science, knowledge, and everyone else has to pay the price.