Tag Archives: healthcare reform

I Don’t Understand This



I said all along this was hinky.


Can one of my readers in the healthcare field please explain to me what “consumer-based lab testing” is? AHIP (America’s Health Insurance Plans) is holding its annual convention in Nashville right now and one of our local biz rags gave a brief rundown of what they’re discussing. “Consumer-based lab testing” came up and it sounds all shiny-sparkly-free-markety-“let’s all shop for our healthcare”-y. And I’m just trying to understand who this is for:

“Without consumer engagement, there is no pressure for prices to go down,” said Elizabeth Holmes, founder and CEO of Theranos.

Theranos, which Holmes founded in 2003 and has former Sen. Bill Frist as a board member, offers accessible and affordable lab testing, with transparent prices available on the company’s website. Holmes likened consumer-based lab testing to at-home pregnancy tests, and said by making lab testing more accessible, early detection becomes possible for patients who are not a part of the existing health care system.

“When prices are transparent and consumers are informed, competition flourishes,” Holmes said.

What the fuck does this mean? If you’re not part of the existing health care system, it’s because you’re either too poor (but not so poor as to qualify for Medicaid), or else you’re one of those young fools who thinks they’re invincible. So you’re gonna, what, get a blood test or a PAP smear or funny lump biopsied by “shopping around” for your labwork? Without a doctor’s referral? I don’t get it. Who’s taking the sample? If it’s a PAP or a biopsy, you need to see a doctor. So I’m just confused who would be “shopping around” for their labwork.

And is cost really the only issue when it comes to who is analyzing your lab work? Or even the most important issue? Isn’t accuracy kind of important, too? Even more important than cost? I mean, I can divine your labwork by gazing into a crystal ball and I’ll do it for $5. Don’t think I’d get many takers.

Or is she saying this is for people who are in the healthcare system? So that when I get my annual PAP smear or have a funny lump biopsied, I’m going to have to shop around and tell my doctor which lab I want processing my test sample? Like I have time for this? Like “consumer choice” is something I have time to deal with in my life? (And yes, I’ve already been down this road with Bill Frist and his infatuation with “shopping” for healthcare). Because again, cost is the only thing I’m supposed to care about?

Please tell me what I’m missing here. I swear to Goddess, Republican infatuation with “shopping” is so far removed from the way most of us navigate our daily lives. I do not want to shop for this shit. Who would? What consumers want, and deserve, is the absolute best healthcare, when they need it, without having to go bankrupt. Always and forever. That’s not shopping, that’s fixing our fucked up system.


Filed under health insurance, healthcare

Best Healthcare In The World, V. Eleventybillion

Have you seen this video making the rounds?

When it comes to wait times for healthcare, I would just like to point out that not only is it correct that until Obamacare, millions of Americans died or sickened because they couldn’t get insurance and access the best healthcare system in the world, but also even ordinary, well-insured people such as myself have to deal with wait times. For example, today I called my doctor and was told her next appointment was at the end of May, over two months away. However, if I want to see her daughter, who is not a doctor but a nurse practitioner, I can get an appointment in April. That’s still a few weeks but it’s not a few months.

Let me remind everyone what happened last time I had to go to the doctor (and yes, I’m starting to think she’s avoiding me, foisting me off on her non-doctor daughter.)

Our system is not wonderful. Anyone who uses it knows that. My insurance company is now sending me quarterly marketing materials that look like warmed-over Cosmopolitan and Marie Claire magazine articles, reminding me to eat my vegetables and to exercise and get enough sleep. They even include recipes, as if the internet hasn’t been invented and I can’t find a damn recipe on my own.

This is what BlueCross BlueShield is spending its money on. But I don’t need that. I already know that stuff. I’d really prefer they stop with the patronizing PR/marketing bullshit. Let me be clear: the absolute last thing I want is a “relationship” with my insurance company. What I really want is for them to just basically do their jobs and otherwise leave me the fuck alone. That shouldn’t be too hard.


Filed under healthcare

Obamacare War Is Over (If You Want It)

Republicans, you can end the Obamacare War if you want. You’ve already lost. It’s a free-market program, you know it is. You can get on board and implement it and let the free market do its thing, or you can continue to drag your feet and have whiny-baby fits, driving up costs with your inaction and obstruction. That’s not exactly how you tell us conservativism is supposed to work, but you know, the choice is yours. Be the principled free market conservatives you claim to be or continue to be this recalcitrant caricature of a political party. Your choice. If you choose the later your party will die, because reality is a potent neutralizer of fear.

Obamacare is working where it’s allowed to work.I give you this headline:

California Man Get Health Insurance For $1 A Month Through Obamacare

And here’s the story:

This is California, where the state didn’t attempt to sabotage the law. There weren’t efforts to obstruct, defund, misinform the public or prevent them from signing up. They didn’t dig their heels in and say, “fuckitall, we’ll just let the Feds set up our exchange, we don’t want to do it.” There wasn’t a rejection of Medicaid expansion, or this ridiculous notion that people could just go to emergency rooms and somehow the rest of the state wasn’t paying for it.

No, in California the state created its own website and was able to roll out its exchange, tailored to its specific needs. It worked on this for months and everything is going well. California is the nation’s largest market, and the rollout here, while not perfect, is also not plagued with the glitches seen elsewhere. It works here because people wanted it to work. Amazing what can happen if you have your want-to.

The war is over, Republicans. Do not be like the lone Japanese sniper living in a tree who still doesn’t know, decades later, that the Empire lost the war.

I find it really interesting that Republicans are working off a 50-year-old playbook when it comes to Obamacare. Today, Medicare is so widely popular, you even have Tea Partiers saying “Hand off my Medicare.”

Cognitive Dissonance Alert

Cognitive Dissonance Alert

Obamacare can work if you want it to. California proves it. If you’re unfortunate enough to live in a state governed by Republican’ts, whose guiding theology is government can’t work and government is the enemy, then it won’t. Simple.


Oregon cuts number of uninsured in its state by 10% in less than two weeks. This thing nobody wanted .. people want! And Blue States are able to implement it nicely.

Imagine what we can do when we work together.


Filed under California, health insurance, healthcare

Why Is This A Bad Idea Again?

No wonder Ted Cruz and the Republicans are having hissy fits over Obamacare. They aren’t scared it will be a disaster. They’re scared it will be a huge success:

TN health premiums on federal exchange to be among lowest

In Tennessee, sticker-price premiums are well below the national monthly average, officials said. That’s before taking into account tax credits that work like an up-front discount for most consumers.

For instance, premiums under the cheapest, or bronze, plan would average $181 a month, the third-lowest rate in the country after Oklahoma and Minnesota.

Premiums under the next-highest level, or Silver, plan would average $235 a month, the second-lowest rate in the country after Minnesota.

Death of another right-wing talking point. Ah, well.

We’ve seen a lot of teeth-gnashing and rendering of garments over employers cutting their health benefits for part-timers, pushing them onto the exchanges. The case of Trader Joe’s has gone viral, with the company explaining itself thusly:

Rather than provide affordable options for purchasing health insurance to part timers (those working less than 30 hours weekly), as Trader Joe’s does now, as of January the company will simply cut them a $500 check to help cover the costs of obtaining coverage under the new exchanges forming under the rubric of the Affordable Care Act.

This, in a nutshell, is Trader Joe’s reasoning, quoted from the email:

Stated quite simply, the law is centered on providing low cost options to people who do not make a lot of money. Somewhat by definition, the law provides those people a pretty good deal for insurance … a deal that can’t be matched by us — or any company. However, an individual employee (we call them Crew Member) is only able to receive the tax credit from the exchanges under the act if we do not offer them insurance under our company plan.

The email offers the example of a single mom making $18 an hour working 25 hours a week who currently pays $166.50 per month for her Trader Joe’s coverage. With the tax credits under the ACA, the message says, she can get nearly identical insurance for roughly half that under an Obamacare health insurance exchange. Add to that the $500 she’ll get in January and the bleak picture of lost benefits starts to change rather dramatically.

Over at Forbes, David Whelan whines that it’s “unfair” that he has to subsidize these part-timers, writing:

Here is the fairness issue. Like most working Americans, I pay an arm and a leg to provide my family with a health plan. I pay my own share of the premium and I forego the tax-adjusted employer-provided portion in higher income. I also have seen my taxes go up, on investments, Medicare, and after we went over the fiscal cliff. I also saw my future Medicare benefits decrease while new taxes on health products (devices, insurance) have been passed on to me indirectly.

So in a variety of ways, through new taxes and a loss of services, taxpayers are now paying not only for their own coverage but also for others to get almost-free health care.

There’s a lot wrong with this, but let’s start with “taxpayers are now paying not only for their own coverage but also for others to get almost-free health care.” Dude. Taxpayers already pay for this — a lot. A LOT. We pay more for healthcare than any other developed country in the world and we already subsidize, through higher healthcare costs, those who are uninsured and underinsured. It’s the cost of the broken healthcare system we currently have.

A helpful video:

A lot of what I see Obamacare doing is unhooking our health insurance access from employment. This is a major social transformation, but it’s one that is utterly predictable given the major workplace transformation which has taken place over the past 20 years: namely, the shift toward “independent contractors” and “part-time workers.”

This is something that hit my life about 20 years ago: even when I was “hired” by an employer, I was still considered an “independent contractor,” meaning I was responsible for my own health insurance (not to mention my own “pension”). And then there are the “part-timers” — that increasingly large share of the workforce given limited hours at places like Walmart, precisely so these companies don’t have to pay benefits.

This transformation in the workplace is very real, and it’s utterly predictable that there would have to be some kind of shift in our health insurance and pension delivery systems to accommodate those who no longer get benefits from their employers. You just can’t pretend these changes haven’t happened and carry on with an outdated system.

While most of us on the left would have preferred universal health care — “Medicare for all” — this is at least a start. No one should be forced to stay at their sucky job because they’re afraid to lose their health insurance. No one should be forced to declare personal bankruptcy because they can’t afford their medical bills because their crappy policy won’t cover them (or they couldn’t afford the policy in the first place). These are realities for millions of people.

And I have to wonder if some employers aren’t fighting Obamacare because they don’t want to lose that element of control over their workers? The “you can’t quit because you’ll lose your healthcare” cudgel?


Filed under health insurance, healthcare

The Pitfalls Of Identity Politics


What was I just saying about wingnuts and the health food movement?



Eden Foods, you are dead to me.

I’ve come to learn that an inordinate number of people involved in the organic foods/natural medicine/holistic health movement are wingnuts. It seems counterintuitive, one would expect these folks to be hippie-dippy peace freaks. But actually a lot of these folks were nurtured in the anti-government, anti-establishment “homesteader” movement of the ’70s, which was a breeding ground for Libertarians. And a lot of them also come out of the survivalist freak show on the far right, as well.

Such are the pitfalls of identity politics. Just because some company markets itself as embracing such progressive ideals as,

Organic agriculture is society’s brightest hope for positive change

doesn’t mean they don’t also believe such crackpottery as,

[birth control] almost always involve immoral and unnatural practices


Plan B and ‘ella’ can cause the death of the embryo, which is a person

… which we all know is utter bullshit. Such is the progressive dilemma: I appreciate CEO and founder Michael Potter’s activism against GMOs, but I find his crackpot views regarding birth control abhorrent. And there are plenty of other organic food companies which don’t hold these bizarre views about birth control, so thanks but no thanks. I’ll take my business elsewhere.



Filed under birth control, health insurance, healthcare

Guess Who Went To The Doctor Today

Last week I went to the dentist. Today I went to my ob/gyn for my annual.

These days, any trip to the doctor is an infuriating, exasperating traipse through our screwed up healthcare system. And I’m a really healthy person, with really good insurance. Still, red tape and insurance bullshit manages to piss me off every damn time.

I had already decided I was going to ask my doctor about the mandatory pre-abortion ultrasound bills currently making their way through the legislature, in particular, the deafening silence from the medical community and ob/gyn’s in general on this and other issues affecting women’s healthcare. But dang, before I could even get to that we got in a debate about socialized medicine.

It started when she told me she wouldn’t perform the ol’ “blood in the stool” test, aka the FOBT, which I’ve had done routinely for 30 something years. This was because, she said, “BlueCross Blue Shield of Tennessee no longer covers it.” Lovely. I repeat: not because I didn’t need it, but because insurance wouldn’t cover it. And that, she said, was because over the past few years insurance has routinely been paying for fewer and fewer things.

This test is an easy, cheap way to detect colorectal cancer. But hey, I’m over 50 now, it’s not like colon cancer is a concern for us olds, right?

Don’t answer that.

It doesn’t matter because she said I need to think about getting a colonoscopy at some point, since I’m an olds, and of course it’s a better diagnostic test. Now, BlueCross BlueShield of Tennessee only pays for one every 10 years if the first one comes back clean. So let’s hope I don’t develop anything in the decade in between tests because apparently I’d have no fucking way of knowing about it.

Okie dokie, let’s hope what I don’t know won’t kill me! Thank you, BlueCross BlueShield of Tennessee! May you all get colorectal cancer and die an excruciating, miserable death.

Yes, Republicans. Do tell me more about bureaucrats coming between me and my doctor. I’m dying to hear.

So then we both commiserated about how awful insurance was. I asked her which insurance company was the best in terms of coverage, since she dealt with so many. She said none of them, they’re all bad. Okay, I said, fine, then why don’t we ditch them all and go to socialized medicine?

“Oh, no! That’s worse,” she said. In England, she said, whether you have a hangnail or cancer, you’re put into the system at the same place. In other words, serious health issues aren’t given any more priority than minor ones. She heard this from a patient who lived in London for two years. Her patient, however, was considered a “guest of the country” and was put to the top of the list, she explained. (I’m a little unclear how the patient would know, plus if that were true, wouldn’t there be astronomical cancer fatality rates there? Which doesn’t seem to be happening.)

“That’s certainly not what my Canadian friends have told me,” I said. “I don’t know about England, but they told me in Canada if something’s seriously wrong, you’re priority. It’s true you might have to wait longer for routine stuff, but heck, I made this appointment a year ago!” It’s true, I had.

“Oh no,” my doctor responded, wagging her finger at me. “I know someone who lives in Vancouver and when she needed something done she went to Seattle.”

Clearly we weren’t getting anywhere, trading our stories about “people we knew.” What I did say was, what do we do? This can’t be the best there is. What we’re doing now isn’t working, too many people are uninsured, and the poor are suffering the most.

“Oh, the poor have TennCare,” she said.

And so it went. Clearly my doctor didn’t know the first thing about people who weren’t her patients. She worked at a nice office in the heart of Nashville’s central healthcare campus, not the Vine Hill or Downtown clinics. Her clients weren’t the uninsured or marginalized. Nor did she know anything about what was happening in the state legislature. I asked her if she was aware that there were bills in the legislature requiring women to get an ultrasound before receiving an abortion.

“Really?!” She seemed genuinely surprised. Jesus, lady! I wanted to scream. You’re a gynecologist! This is your field! Don’t you pay attention to what legislators are doing affecting your own business?

I asked if there was any medical reason why this procedure would be necessary. “They need to do it,” she said, “to determine the age of the fetus.”

“But what if a woman is positive that it’s within the first trimester?”

“They still need to do it, to make sure.”

“To make sure?”

“To make sure she’s telling the truth.”

Wow. So we have this law to mandate a diagnostic procedure because women are liars. Got that, ladies? The government thinks you’re all liars, just like with all of that “legitimate rape” stuff, and so they need to check up on you with a diagnostic tool whose sole function is to make sure you’re telling the truth.

Yes, Republicans. Do tell me more about your belief in “small government.” I’m dying to hear.

Keep in mind, I was just told I wouldn’t get a routine colon cancer diagnostic because my insurance won’t pay for it.

Like an idiot, I asked my doctor if she performed abortions. She told me no.

“Does anyone here perform them?”


“So where does someone go if they need one? Someone with insurance, who can afford it, where do you refer them?”

“Planned Parenthood, I guess,” my doctor answered. “Or Atlanta.”

Keep in mind, Nashville is a healthcare city. Healthcare is one of the largest industries here. We have several major hospitals here. The Nashville Chamber of Commerce proudly touts how healthcare contributes $30 billion to the local economy and creates over 210,000 jobs. But that’s all bullshit. None of that matters if you’re a woman who needs an abortion. For that, you go to Atlanta.

I asked why, although I already knew the answer. But I wanted to hear her say it. And she did. It’s just too controversial, she said. “It’s the religious people, they don’t want it,” she said. Insurance won’t pay for it. Hospitals don’t want to have anything to do with it. And finally she said, “doctors have been killed.”

I’m sure “the religious people” will be thrilled to learn they have successfully intimidated doctors in Nashville into not performing abortions. What’s sad is that Nashville is touted as being a progressive city, a patch of blue surrounded by a sea of red. But we’re still a city where women are second-class citizens because our healthcare needs aren’t treated equally.

It’s not just abortion. My doctor told me that as of January 2009, she can’t perform tubal ligations at Baptist Hospital. Baptist is one of the major hospitals here in Nashville and in 2002 Baptist merged with St. Thomas, another major player, so both are now under the Ascension Health umbrella, which is a Catholic non-profit. I had read that because religious hospitals all receive federal funds, they had to offer some kind of “secular floor,” where stuff the Catholics find religiously offensive can be done.

“It was a room, not a floor,” my doctor told me. “A separate room.” And the nurse technician that would assist her had to clock out, clock in again for the hour of surgery, and clock back out again, so she could be paid out of separate, non-religious funds. But as of January 2009, that room is no longer there. Someone who is not a Catholic will nonetheless have their medical choices made by the Catholic church.

Yes, Republicans. Do tell me more about your belief in “religious freedom.” I’m dying to hear.

This is all just so crazy to me. I didn’t intend to write a novel, but we just covered so much ground. What I wanted to know is why the medical profession hasn’t spoken up as the state house and senate legislate their profession. I mean, good lord, every time something happens in Washington we have a flurry of industry associations and phony astroturf groups telling us why it’s a bad idea. Where’s the TN Medical Assn.? Besides offering “doctor of the day” volunteers and lobbying for tort reform, I mean. It seems they haven’t spoken up because the just don’t know or don’t care.

I asked my doctor why people in her profession didn’t speak out. And she said it’s because nothing was ever going to change. That was just it, it’s too big, too hard, too controversial. It’s not going to change. I was so outraged. I just refuse to believe nothing will ever change. I said, what if people said that back in the days of Jim Crow? We’d still have black hospitals and white hospitals. Yes, she said. You’re right. And that was that.

It was the most disheartening conversation I’ve ever had. Apparently the doctors just can’t be bothered. I mean, I don’t know what else to say and I’m way beyond needing to wrap this up. But I guess I had somehow thought that doctors cared about their patients’ healthcare. Silly me.


Filed under abortion, birth control, Blue Cross, health insurance, healthcare, Nashville, women's rights

Because It’s Not About Birth Control

Okay, who didn’t see this one coming a mile off?

Bishops Reject Birth Control Compromise
Published: February 7, 2013

WASHINGTON — The nation’s Roman Catholic bishops on Thursday rejected the latest White House proposal on health insurance coverage of contraceptives, saying it did not offer enough safeguards for religious hospitals, colleges and charities that objected to providing such coverage for their employees.

The administration said the proposal, issued last Friday, would guarantee free employee coverage of birth control “while respecting religious concerns” of organizations that objected to paying or providing for it.


Under the latest proposal, churches and nonprofit religious groups that object to providing birth control coverage on religious grounds would not have to pay for it. Women who work for such organizations could get free contraceptive coverage through separate individual health insurance policies. The institution objecting to the coverage would not pay for the contraceptives. Costs would be paid by an insurance company, with the possibility that it could recoup the costs through lower health care expenses resulting in part from fewer births.

How does this “not offer enough safeguards” to address religious groups’ objections? Simple: women can still get their hands on some birth control, that’s how! They want a law that gives employers control over women’s health choices. Hell, they’ve already done it.

Look, can we stop trying to appease people who will never, ever be appeased? This is not about birth control! Half the institutions fighting this were already offering their employees contraception coverage and only stopped when it became news.

This is about the failure of the church. This is about the church’s great shame at being completely impotent in the face of cultural change. This is, specifically, about the Catholic church preaching against contraception for years and years and years and nobody paying attention — hell, even Catholic priests and nuns have ignored that piece of church doctrine. The church hierarchy wants the U.S. government to do what they’ve been unable to do, which is to get people to stop using birth control by making it too expensive and too hard to obtain.

That ain’t happening.

Stop paying attention to these idiots. Catholics don’t even pay attention to them. And if the Catholic church wants to spend its money fighting a legal battle it lost long, long ago instead of using that money to care for the poor and marginalized, then that tells you everything you need to know about the Catholic church. They’re a bunch of phonies.


Filed under birth control, health insurance, healthcare, religion, reproductive rights

Today’s Post

Over at First Draft I write about the completely predictable scenario of Red State governors refusing to implement their portion of the Affordable Care Act. Give it a read.

I know blogging has been sporadic lately, and I apologize. It’s just that I’ve started a new project which is infinitely more enjoyable than the crazy which has overtaken our national discourse. You know what? If a Democratic presidential candidate refused to release his tax returns, we’d see a flurry of state legislation mandating such documents before a candidate could get on the ballot. President Obama was required to show his birth certificate, President Clinton was required to show his penis, but Republican candidates like Mitt Romney can sock their money away in offshore accounts and it’s nobody’s business where it is so SHUT UP.

Hey, just for shits and giggles, imagine the right’s reaction if the overwhelming butt-hurt expressed by VIPs at Romney’s Hamptons fundraisers had actually been recorded at a Democratic event. Forget it, we already know: we saw this during the 2004 Kerry campaign, when “limousine liberal” entered the lexicon. The IOKIYAR that guides Republican messaging these days is off the charts; Republicans have become a parody of a political party.

God I am so over this shit, you have no idea. It’s not even interesting anymore.


Filed under Housekeeping

Take The Health Reform Quiz

Test your knowledge of the Affordable Care Act with this simple, 10-question quiz. Tell me how you did in comments – no cheating!

I should say your humble scribe got all 10 correct. A+ for me!


Filed under healthcare

Memory Hole: ACA Edition

And the early reports are in: the entire healthcare law, including the individual mandate, has been upheld. The only exception is the federal government’s right to terminate state Medicaid funds.

Suck on that, Ginni Thomas.


Nothing to see here, move along:

Justice Thomas’ wife says healthcare law is unconstitutional

Virginia Thomas is working to repeal the law through Liberty Central, a conservative group she founded. Her husband, Justice Clarence Thomas, could provide a key vote to strike down the law.

October 21, 2010|By Kathleen Hennessey and David G. Savage, Tribune Washington Bureau

Reporting from Washington — Virginia Thomas, the wife of Supreme Court Justice Clarence Thomas, is working to repeal what she believes is President Obama’s “unconstitutional law” regulating health insurance, an issue likely to be decided by the high court.

“With the U.S. Constitution on our side and the hearts and minds of the American people with us, freedom will prevail,” says a position paper posted on the website of Liberty Central, the group formed by Virginia Thomas this year to advance conservative principles and candidates.

The story goes on to talk about the most important issue of the day: Ginni Thomas’ phone call to Anita Hill. Well done, media.


Filed under healthcare, Media, memory hole, Supreme Court