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eridani's Journal
eridani's Journal
August 29, 2013

High deductible heath plans maim and kill people

The Impact of High-deductible Health Plans on Men and Women: An Analysis of Emergency Department Care

Background: Prior studies show that men are more likely than women to defer essential care. Enrollment in high-deductible health plans (HDHPs) could exacerbate this tendency, but sex-specific responses to HDHPs have not been assessed. We measured the impact of an HDHP separately for men and women.

Methods: Controlled longitudinal difference-in-differences analysis of low, intermediate, and high severity emergency department (ED) visits and hospitalizations among 6007 men and 6530 women for 1 year before and up to
2 years after their employers mandated a switch from a traditional health maintenance organization plan to an HDHP, compared with contemporaneous controls (18,433 men and 19,178 women) who remained in an health maintenance organization plan.

Results: In the year following transition to an HDHP, men substantially reduced ED visits at all severity levels relative to controls (changes in low, intermediate, and high severity visits of -21.5% [-37.9 to -5.2],-21.6% [-37.4 to -5.7], and -34.4% [-62.1 to -6.7], respectively). Female HDHP members selectively reduced low severity emergency visits (-26.9% [-40.8 to -13.0]) while preserving intermediate and high severity visits. Male HDHP members also experienced a 24.2% [-45.3 to -3.1] relative decline in hospitalizations in year 1, followed by a 30.1% [2.1 to 58.1] relative increase in hospitalizations between years 1 and 2.

Conclusions: Initial across-the-board reductions in ED and hospital care followed by increased hospitalizations imply that men may have foregone needed care following an HDHP transition. Clinicians caring for patients with HDHPs should be aware of sex differences in response to benefit design.

Comment by Don McCanne of PNHP: One of the most important changes in health care financing taking place today is the tremendous surge in the use of high-deductible health plans. This is yet one more study that shows that we should question the wisdom of this policy intervention.

Males whose employers switched them from a traditional HMO to high-deductible health plan reduced their use of emergency department high-severity visits by 34 percent. That is, they did not go to the emergency department when the severity of their condition clearly warranted it. That was followed a year later by a 30 percent increase in hospitalizations. Lead author Katy Kozhimannil stated, "The trends suggest that men might have put off needed care after their deductible went up, leading to more severe illness requiring hospital care later on" (American Medical News, Aug. 26).

High-deductible health plans not only cause financial hardship, they also maim and kill people. And they aren't even necessary as a means to control spending. We can control costs more effectively and far more humanely through a publicly-administered single payer program that provides first-dollar coverage.
August 21, 2013

Insurers seek limited insurance exchange plan networks


Health plans are focused on being ready "and doing what we need to do" as states set up their respective marketplaces, said Karen Ignagni, president and CEO of America's Health Insurance Plans.

But some policy concerns remain. Many states, for example, "still have restrictions on our ability to actually provide high-performing networks for individuals to be able to access high-performing doctors and hospitals to make sure again we're stretching those dollars. That will have to be looked at," she said.

Ignagni was referring to the ?any willing provider? clause, a mandate in some states that requires health plans to allow health care professionals to participate in a health plan's network if the professional agrees to a plan's contract terms, limits and conditions.

She also encouraged giving nurses a broader role, joining them with other professionals as part of health care teams, "so that we can try to customize health care and make it very patient-centered, and again stretch those dollars."

Comment by Don McCanne of PNHP: Insurer opposition to "any willing provider" clauses is yet one more example of why we should question leaving coverage decisions in the hands of the private insurance industry.

Any willing provider clauses allow care provided by any qualified physician to be covered even if that physician is not contracted by the insurer but is still willing to accept payment based on contracted rates. The advantage of such clauses is that patients may choose to continue to see their own physician as long as the physician agrees to the insurer's rates.

Why would insurers want to prohibit patients from having that right? It has to do with their current strategy of switching to narrow network plans - plans that have fewer choices of health care professionals. They say that they can extract even greater discounts from physicians who believe that they will have more patients referred to them by the insurer. Although it is questionable as to just how much further the insurers can ratchet down rates, these limited network plans have the advantage for the insurer of further impairing accessibility, thereby resulting in savings from forgone care, no matter how important that care might be.

Besides reducing the number of physicians in their networks, they also want to increase the number of nurse practitioners, presumably because they can negotiate even lower rates with them than they can with primary care physicians. That assumes that the current movement by nurse practitioners to gain equal pay for equal work will fizzle when the insurers offer the bait.

When they say this isn't about the money, but it's about quality? No, wait, they do say that this is about "stretching those dollars." But how should those dollars be stretched? Should we take away choices of physicians and substitute nurses unwillingly, or should we consider eliminating this egregiously wasteful industry with its unwelcome intrusions? The latter would not only produce immensely more savings, it would also be much more beneficial for patients.
August 21, 2013

Donít Get Complacent About Social Security. They Still Want to Cut It


If losing the House wasn’t enough for Democrats, a benefit-cutting “grand bargain” should finish the job. As Derek Thompson noted in April, the president’s budget cuts both Social Security and Medicare far more than the Republicans’ did. In fact, the GOP’s Ryan budget didn’t cut Social Security at all, and its radical dismantling of Medicare wasn’t scheduled to begin until 2023.

“Crazy Republicans,” said some Democratic cheerleaders, “We’ve given them way more than they even asked for!”

Yeah, crazy all right – like a fox. (Or a Fox Network.) This kind of deal would give them something they’ve always wanted, and let them blame it on the Democrats.

But the news isn’t all bad. There are some promising signs on the horizon, too, and they give us even more reason to seize this moment on behalf of Social Security.

Good news
A recent poll by the National Academy for Social Insurance (NASI) reinforced and expanded upon earlier poll findings when it showed that, by large majorities, Americans would rather raise taxes – including on themselves – in order to expand Social Security’s benefits.

That position was supported by Americans all across the political spectrum, including 74 percent of Republicans.

More politicians are signing on to the pro-Social Security team.

Probably as a result, politicians are getting the message. The “Grayson/Takano letter,” by Reps. Alan Grayson, D-Fla., and Mark Takano, D-Calif., calls on members of Congress to pledge that they’ll vote against any budget that contains cuts to Social Security. Senate Majority Leader Harry Reid, unlike House Democratic leader Nancy Pelosi, has been unequivocal so far in his opposition to cuts.
August 16, 2013

Social media and elections: It's Not Just Anthony Weiner's Problem

This is from Englin Research, whose emails I get.

In light of Cory Booker’s victory in the NJ Senate Democratic Primary on Tuesday, we felt it appropriate to pay homage to the Twitter king of politics in this week’s 3 Things. Without a doubt, Twitter, Facebook, Instagram, etc have rocked the political world, drastically changing the way candidates interact with voters, organizations attract supporters, and electeds communicate with their constituents. When it comes to social media’s influence in politics, we’ve seen the good, the bad, and the ugly:

1. The Good

Social media produces really neat data. Here at Englin Consulting, we’re just the type of people who love to dive into this treasure trove of numbers and trends. And we’re not alone.

This week, researchers at Indiana University presented a study http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2235423 at the American Sociological Association conference that “found election results could be predicted by the percentage of tweets mentioning those candidates, whether or not they were positive.” Politico http://www.politico.com/story/2013/08/twitter-votes-elections-95541.html?hp=l5 has a good summary of how the survey was conducted, but in short, “by examining the percentage of votes for political candidates in the 2010 House races, researchers said they were correctly able to predict the winner in almost all of the races they studied.”

As we noted on Facebook, we don’t think Twitter will replace traditional polling anytime soon. But our political and social media savvy friend Jon Stahl of ActionSprout pointed out that the interesting thing will be to see if predictive Twitter data becomes more prevalent in races where traditional data isn’t as readily available (think smaller, local races). We’re excited to watch what happens.

2. The Bad

The problem with social media is it does. not. stop. A simple mistake feeds the 24 hour news cycle, can become a viral sensation, and throw a campaign into turmoil in under a few hours (for help when you’re in trouble, see our recent 3 Things on Crisis Communications). Campaigns get off message and the public loses sight of the issues and what matters. So while gaffes provide entertainment for the rest of us, they can cause real headaches for campaign staff. That’s why we’re classifying the way social media amplifies the viral nature of gaffes as the “bad.”

In 2012, Mashable looked at how digital media affected elections in a series called Politics Transformed. While political pundits are split on the lasting effect a gaffe can have on a campaign, what Mashable notes is the way campaigns have had to shift in response to the prevalence of social media: “Now campaigns employ more communications teams than ever; digital directors — people who define the tone of candidates' websites, online presences and social media strategies — are necessities.” So we’ll consider this the silver lining of the bad, as we love all things digital and know a lot of smart people heading up digital strategy for campaigns.

P.S. American politicians aren’t the only ones who have social media problems. Apparently, politicians in Japan are having real trouble saving themselves from the pitfalls of Twitter.

3. The Ugly

We bet you were expecting to see us talk about Anthony Weiner here. So we’ll humor you for a moment: While his political demise (partly via social media) hasn’t failed to provide daily reading distractions, we kind of feel like we’re watching a car crash over and over in slow motion. Frankly, we’re tired of the spectacle he’s created in the NYC Mayor’s race and are excited for him to hopefully fade away after Primary Day.

But what Anthony Weiner’s fall from grace reminds us is that social media gives people a platform to to act stupidly, rashly, and ignorantly. Take for example Newt Gingrich, who tweeted that Justice Sonia Sotomayor was a racist the day after President Obama nominated her to the Supreme Court. People on our side do it too. A DNC staffer had some, um, choice words when SCOTUS ruled on health care earlier this summer. So our advice: keep your unfiltered anger and knee-jerk responses off of social media. Sure it’s fast and easy, and for many have very little repercussions, but a social media slip up in the political world can get ugly quickly. And if you thought no one was watching, head over to the Sunlight Foundation’s Politwoops site for a quick reality check. http://politwoops.sunlightfoundation.com/


b]Study: Tweets turn out to be votes

Researchers at Indiana University say they have found that more tweets gets you more votes on Election Day.

A study presented Monday at the American Sociological Association conference found election results could be predicted by the percentage of tweets mentioning those candidates, whether or not they were positive.

By examining the percentage of votes for political candidates in the 2010 House races, researchers said they were able to correctly predict the winner in almost all of the races they studied.

The study looked at a random sample of 537,231,508 tweets from Aug. 1 to Nov. 1, 2010, and data from 406 competitive congressional elections. The more competitive the race, the more accurate their predictions lead researcher Fabio Rojas told NPR.

“It tends to do very well when the race is very competitive. For example, there was one in Utah where, you know, somebody was getting about 47 percent of the vote and the Twitter share was about 45 percent of the vote. So a lot of the cases are within the margin of error of a traditional poll,” Rojas said.

But don’t expect Twitter to replace a traditional poll any time soon, Rojas said.

“I think political polls are going to remain useful. They’ve very valuable in specific cases. So, for example, if I’m interviewing a voter and I’d like to know more about them, a poll is a very good place to do that because we can ask the question directly, while we don’t have as much information about people from social media unless they reveal it themselves through what they write.”

Read more: http://www.politico.com/story/2013/08/twitter-votes-elections-95541.html#ixzz2cAXHO8S9

So Your Boss is a Canadian Mayor

If you’ve been paying attention to the news lately, you may have noticed a rather odd pattern of mayors in Canada getting themselves in some odd situations. Like getting caught doing crack. Ok, that one wasn’t a mayor, but an Alberta councillor.

Scandals do not exclusively belong to The Great White North. Politicians across the world have been accused of soliciting sex from minors, tax fraud, corruption, bribery, and abuse of office. And that’s just former Italian Prime Minister Silvio Berlusconi.

These stories got us thinking about the need for a good crisis communications plan. While you obviously hope that your CEO, Executive Director or candidate doesn’t get accused of doing anything terrible, it certainly doesn’t hurt to plan.

The three pillars of a successful crisis communications plan:
1. Admit It
Alright, you’ve done wrong. Now what?

If you said, “Deny it until I look ridiculous,” you might be Anthony Weiner. When Weiner got himself embroiled in a social media sex scandal back in 2011, he made matters worse for himself by not immediately apologizing for his lack of judgement. Instead, by denying that he sent pictures of himself from his own phone, he dragged the story out and managed to become a laughingstock.

When we screw up, the first thing we want to do isn’t run to a reporter and fess up. It’s to lie, hide or blame someone else. Don’t do this. By admitting wrongdoing and apologizing, you can possibly help yourself by getting out of the public eye a lot quicker.

This is true whether you’re a politician who’s too handy with your phone camera or an organization that takes a campaign communication too far. If you did wrong, the truth will likely come out and it’s much better if it comes from you.

2. Be Outraged
If someone in your organization, business, or political party has just managed to erase years of hard work within a community, you have every right to be angry. So, be angry right along with your public.

When BP’s CEO Tony Hayward said that, “he’d like his life back,” because he was really tired after his company spilled almost five million barrels of oil in the Gulf, BP promptly fired him. After everything that was happening to BP’s public image, the last thing they needed was the face of the company to appear whiny and apathetic.

Sometimes, you have to let the public know that you’re just as upset, if not more, than they are that something bad happened.

Your mea culpa presumably comes with genuine regret; don’t hide it.

3. Fix it
If you’re not going to try to win back the public’s trust, you might as well close up shop, right?

Describe what you’re doing to fix it, and do that. Ask credible people to stand up with you and note how you’re fixing it.

And, at the same time, it couldn’t hurt to do something awesome to demonstrate that you and your organization are still the rock stars you always were; you’re just human and made a mistake.

Politics Transformed: The High Tech Battle for Your Vote

Politics Transformed: The High Tech Battle for Your Vote is an in-depth look at how digital media is affecting elections. Mashable explores the trends changing politics in 2012 and beyond in these special reports.

Without digital, former U.S. Rep. Anthony Weiner's lewd photo may never have seen the light of day. Without social media, people needn't worry about controversial Twitpics or alleged "Facebook hacks." Without the pull of mobile, Romney would never have approved an app that misspelled "America," the country he was working to lead.

Social media is a politician's best dream and worst nightmare — it boasts unlimited access to his constituency, but necessitates 24/7 supervision.

Facebook, Twitter, YouTube, Reddit and a lengthening list of social networks afford the electorate a (somewhat) unfiltered lens with which to view its candidates. With the social web, political hopefuls enjoy a powerful tool for engagement — and just enough rope to do serious damage.

"The old adage used to be 'don't say anything you wouldn't want to see on the front page of a newspaper.' Now it might as well be 'don't say anything that can be boiled down into 140 characters,'" says James Davis, the former communications director of the 2012 Republican National Convention.

Chicken or Egg?
Does the media report on societal and political gaffes because the public is discussing them on social networks? Or do social networks react to information the media surfaces? Which comes first?

"The media is the 24/7 gaffe-o-meter," says U.S. Naval Academy professor of political science Steve Frantzich. "The media is looking for something out of the ordinary."

The author of the book OOPS: Observing Our Politicians Stumble, Frantzich explains that politicians have been spooked by the critical eye of the media, so they tend to be more "careful" and not as "newsworthy." Thus, when Republican presidential contender Rick Perry faltered and couldn't list the government agencies he wished to close, news organizations couldn't resist discussing it.

"One of the appeals of the gaffe is we presume it's a better measure of the real human being than [the candidate's] stock answer or speech," Frantzich says. "The unrehearsed is better. We feel like we've caught them off-guard."

George Washington University political science professor John Sides, author of the blog The Monkey Cage, says he believes it's the media organizations that are constantly influencing the extraordinary attention given to gaffes. Social media, he says, doesn't "supplant" the news organizations that drive daily conversation, but the social networks will "cannibalize" that information to generally increase the shelf life of the story.

"Social and digital has really held the fire to these candidates. There's no room today for misinformation."

It's not a novel concept that campaigns and the news surrounding them often fade to gaffes and mudslinging. Sides says that even John Adams and Thomas Jefferson fought over "superficial" topics.

The thing that has changed, though, is the ability to resurface old issues and comments. Saint Louis University political science professor Robert Cropf says social media has, in one way, shortened the shelf life of a gaffe story, rendering even one week of reporting an eternity. At the same time, digital has created a paradox where everything is archived -– old tweets, old speeches on YouTube, old voting records — can all be easily searched, validated and used against someone.

The things that surface may prove "good for the public but bad for the politician," Cropf says.

But the appeal to discuss gaffes in the media or the social media may simply be part of our human nature, Frantzich says. Society's obsession with blunders may be the voter's way of justifying her election decision, or simply a version of "celebrity envy."

"We come with a whole litany of shortcomings of the opposing candidate to justify our own candidate," he says. "It's psychologically comforting. Gaffes aren't real criteria, but it gives us ammunition when someone challenges our choice; we have an answer.

"We like tearing people down," Frantzich adds. "We love to see the great and powerful fall."

Blooper reels made news long before the advent of social media.

More than 30 years ago, incumbent Gerald Ford spoke what he believed to be true while debating Jimmy Carter. "There is no Soviet domination of Eastern Europe," he said. The comment sparked harsh reproach, and Ford's moment went down in history as a game-changer.

Even earlier, George Romney (Mitt Romney's father) effectively stilted his campaign for the 1968 Republican presidential candidacy. Romney Sr. commented that his earlier support for the Vietnam War was due to "brainwashing" by U.S. officials. Romney withdrew from the race after intense polling fluctuations following the statement.

Granted, we have no solid proof that such moments effectively ended these men's political careers, but they nonetheless garnered enough public and media attention to factor greatly into the final results.

In recent years, though, it seems that these "significant," "crucial," "game-changing" gaffes have become a dime a dozen. In a celebrity-obsessed, tabloid culture, it is as common to hear of a political faux pas as a pop culture rumor.

Dallas Lawrence, a former member of President George W. Bush's communications team and managing director of Burson-Marsteller's Proof Integrated Communications, believes the increasing attention to gaffes is a result of the social media vehicle. "Was social media the cause of the gaffes? No, but it is an accelerant of issues that puts something offline on mainstream," he says. "Social and digital has really held the fire to these candidates. Now even fact checkers are being fact-checked by social media. There's no room today for misinformation. Candidates are going to be held to a higher standard."

Those higher standards have pushed candidates to become more prepared. Now campaigns employ more communications teams than ever; digital directors — people who define the tone of candidates' websites, online presences and social media strategies — are necessities. While we can't administer a vaccine for human error, campaigns have come close to perfecting a treatment.

Lenny Alcivar is one of those Band-Aid men, someone who goes in after the fact to survey the damage, to clean and repair any self-inflicted wounds. He is the rapid response director for Romney's presidential campaign, a position fairly new to the field, but one that is quickly becoming one of the most powerful — and social-media savvy is a requirement.

He says the 2012 election will be made or broken by social media, an expected comment by a man whose job may not exist without the Twitterverse. Yet even amidst the powerful, constant and often uncontrollable churn of hashtags and retweets, Alcivar remains calm.

"We spend no time worrying about hashtag hijacks or gaffes," Alcivar says. "If campaigns spent all their time on the defense, you'd be afraid to go out and talk. We are not going to let our opponent set the tone and define the terms of this race."

"The public needs to learn to edit out things that are unimportant."
And Alcivar says sometimes the supporters come to the candidate's defense online, before the campaign even has to mobilize.

Nonetheless, when a gaffe spreads like wildfire, campaigns have no choice but to step in and attempt to squelch the flames. Just like with actual fires, the key in crisis communication is speed, Alcivar says. Though social media has put more matches in the hands of the public, the campaigns have a shot at extinguishing the story with the right strategy — and fast action.

"Waiting 24 hours can be lethal," says Lawrence. "If you let a story metastasize online, then you'll be fighting to reshape a narrative instead of just correcting it."

Alcivar thinks it's all about the follow-up. "If Twitter is today, then Facebook is tomorrow," he says. Campaigns must keep the conversation going in the direction they wish, and to do that they have to espouse different messages on the right platforms at the right times.

If a candidate's core message is continuously being "amplified," Alcivar says, then all is not lost because of a gaffe.

Do Gaffes Matter?
What Cropf calls the "big kahuna gaffe" is the one to fear. He defines it as "the single cataclysmic moment in a politician's career when what he/she says jeopardizes a whole political career in one fell swoop." He says it's definitely possible that one blunder, one wrong turn, one unexpected remark can "implode a campaign."

Political pundits are split on that concept, though.

Recently, Sides published a graph on his blog, exploring data that seemed to prove the fleeting nature of gaffes. He pointed to major gaffe moments of the 2012 campaign and compared those to polling data. The gaffe moments didn't seem to push or pull on the candidate's popularity in any significant way. To Sides, the data proves these moments don't have long-term implications.

Frantzich says because "gaffes are in the eye of the beholder," supporters will almost always disregard or defend the gaffe, and in turn, the same gaffe will solidify concerns for the opposing party.

For lesser-known candidates or those in local races, gaffes have the potential to cause more damage, says Sides. "In a presidential election, people have more defined attitudes about the candidates. In other kinds of races, in primaries, in the Senate or House, when candidates are lesser known, gaffes may have more potential to harm."

Cropf seems to agree somewhat, saying that if a gaffe isn't relevant to the job being done, then the public may attribute the mistake to the candidate being "tired or under pressure;" thus, the gaffe may not have a cataclysmic impact. But if a gaffe reinforces a persona or impression already surrounding the candidate, it can be dooming.

Social Media Is Still in Its Youth
Social media is powerful in its youth, but it hasn't completely settled — and neither has public sentiment toward it. Politics and social media have only begun to overlap in meaningful ways.

According to Cropf, in the years to come, the public and politicians will grow more accustomed to the access and publicity social media have created and adjust as necessary, even reaching a point of desensitization.

"The public needs to learn to edit out things that are unimportant," he says. "It's not a responsibility of the media, or Facebook or Twitter. It has to be the public that does it ... As younger generations of politicians emerge, since social media is part of their environment, they'll know how to adapt and deal with what they say and how things get out there."

For all the focus social media can place on the slip-ups, mistakes and distractions, most people seem to agree that it ultimately provides a net good for the voting public.

"It gives you an inside look at who your candidates are and what they stand for," says Davis. "And social media gives politicians an opportunity to engage with the public directly."

And that engagement, even if it's teeming with gaffes, is a good thing.

Social Is the Secret Weapon in Local Politics

Social media first took the national spotlight in the 2008 elections, and it continues to expand its influence at every level of American politics. And just as a youthful John F. Kennedy benefited from his grasp of television in the 1960 elections, a new generation of local politicians is using its tactical advantage as digital natives to woo the electorate and launch open government initiatives.

Consider Alex Torpey, the 25-year-old mayor of South Orange, N.J. (official title, "Village President&quot . Torpey's Twitter profile describes him as "Mayor of @southorangenj; philosopher; grad student; founder/partner @veracitymedia; OpenGov advocate; volunteer EMT; writer; musician; person."

Unlike older public officials, Torpey's social media involvement preceded his political career, as an undergraduate at Hampshire College. "I started using Facebook in college in 2005," he says. "There's an interesting thing happening with people under 25 or 30 who started using social media personally and now start using it professionally."

Torpey has found a surprising amount of support in South Orange, a prosperous New York suburb of population 20,000. When he ran for office in 2011, he saw his social media platforms as an alternative to paid ads and has continued to experiment on multiple networks. "I have both a Facebook personal page and a fan page. I started the fan page during the election, but found it didn't meet my needs. People were basically split between the two, and I had to choose between them -– I wanted to be able to send messages."

However, Torpey feels that Facebook has been slow to adapt to the needs of the political process. "You're not supposed to friend people you don't know. But if I'm mayor of a town and sending a message out to the people in the town, it's counted as spam."

Torpey has gotten better responses on Facebook than on Twitter because, he believes, "it's easier to see other people commenting on something. Last year when we had all these crazy storms, there were some residents who had power out for a week, and my Facebook page became a hub of information for people who had power out."

Torpey is on a fast (and well-informed) learning curve. For example, he is unusual among local politicians in having his own YouTube channel. "People really like videos," he reports. "People will turn the video on and start making dinner."

Torpey also deploys Instagram to promote local events and Foursquare to announce his whereabouts to constituents. He's exploring crisis mapping platforms to initiate SeeClickFix for municipal services, and he's interested in trying Localocracy.com, a means to promote voter registration and engagement among the young.

He's most excited about his township's open data initiatives. Whereas the town was accustomed to five or seven people showing up for budget meetings, Torpey says, "We've had a couple hundred people take a look at our budget online." This allows him to answer direct questions about how tax money is being spent. "When I sent the explanation of how things fit together, they said 'I want to get involved and make the town better.'"

Torpey's findings are born out by a recent study from Brock University analyzing the use of social media in the 2010 Niagara (Ontario) municipal election. Although the local candidates used an array of social media in their campaigns, most of it had a billboard function (as in "Support Me" from the candidate and "I Support You" from the voters). Most candidates failed to stimulate genuine interaction. The study concluded that "social media did not have a significant impact on the electoral success of the candidates," adding that candidates will need to realize how social media differs from the "news-release, one-directional type of communication used in mass media, flyers and most websites."

In the past, people would have resisted the idea of an elected official founding a news organization that covers himself. But the brave new world of political social media has blurred many of these lines. (Think Michael Bloomberg, Bloomberg news and Bloomberg Government.)

One analyst who is watching this space closely is Micah Sifry, co-founder and editor of the Personal Democracy Forum. But he admits that the social media usage of local officials is difficult to track. "We've got 100,000 elected local offices, without the resources to look at them." One issue he signals is the problem of "the campaign feed morphing into the official." Many candidates create Facebook and Twitter feeds for their campaigns. Once these are established and the candidates are elected, they often segue straight into platforms to address constituents. This would not have been a possibility in the days of old media, when there was no way for paid political advertisements to morph into platforms for office holders. "There are rules against this," Sifry points out. "You're not supposed to use campaign resources for office resources. But no one is monitoring it."

Sifry believes that most local office holders have rapidly learned how to use social media with more sophistication, out of necessity. "You don't have as many interns managing the feeds any more. Lots of local officials like being in charge of their accounts –- there's a freedom and directness they enjoy." He sees most local officials focusing on the trifecta of Twitter, Facebook and YouTube, although "some are toying with Pinterest, since you have greater reach to women with it."

At the same time, local politicians have also become aware of social media's risks. This became apparent with New York Congressman Anthony Weiner's 2011 "sexting" scandal, when Weiner tweeted suggestive comments and pictures of himself to a female constituent, costing him his office.

The Anthony Weiner case made people a tiny bit smarter about being careful, but not as much as you would think," Sifry notes. "You still see staffers accidentally tweeting from their boss's account. That's not as bad as what Anthony Weiner did, but you definitely have slippage. No media seems to stop the ability of politicians to be complete idiots."

Tweeting politicians were dismayed to learn that the Sunlight Foundation hosts a tool called Politwoops to display deleted tweets, ranging from minor misspellings to many forms of "awkward."

University of Washington professor Philip Howard (currently a fellow at Princeton) notes some new research on how different politicians approach digital media. "Republicans tend to use digital media for coordinating their message, broadcasting out content that has been drafted from senior campaign officials, and policing each other's political values," he observes. "Democrats tend to use digital media for engagement, conversations, and sometimes slip up because they debate and don't stay on message as well. Professional campaign managers at all levels dislike social media because using it results in some loss of message control."

No one should assume that the U.S. has the last word in social media and local politics. A number of new ideas are emerging abroad. In Berlin, the Pirate Party has developed an open source platform called Liquid Democracy, which allows party members to directly collaborate with local officeholders on shaping the party platform. (Alex Torpey is interested in adapting the model for New Jersey.) In Mexico, visitors to the country's biggest news portal, Animal Politico, can use a feature called Diputuits, pronounced "dipu-tweets," an interactive map of the House of Representatives with links to individuals' Twitter feeds. (U.S. Congress tweet aggregator Tweet Congress pales by comparison.)

Even Wikipedia looked beyond the U.S. to engage local government with its first hyper-local project. In Monmouth, Wales, the local city council provided early and essential support for the development of their city as the "world's first Wikipedia town."

As the 2012 elections approach, it's useful to recall that it's still the early days of this movement. None of the most influential social networks in question –- Facebook, Twitter or YouTube — have reached their tenth birthdays, while Pinterest and Foursquare are still in their infancies. As digital natives make their way in the world, social media will continue to overhaul American democracy in new and unexpected ways.

August 10, 2013

More Doctors Are Quitting Medicare. True, but more doctors are also accepting Medicare


The Wall Street Journal last month portrayed physician unhappiness with Medicare as a burning issue, with a cover story that detailed why many more doctors are opting out of the program.

And yes, the number of doctors saying no to Medicare has proportionately risen quite a bit -- from 3,700 doctors in 2009 to 9,539 in 2012. (And in some cases, Obamacare has been a convenient scapegoat.)

But that's only part of the story.

What the Journal didn't report is that, per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.

Comment by Don McCanne of PNHP: Since the beginning of Medicare, we have heard stories that doctors weren't going to take it anymore; they were going to drop out of Medicare. Some have, but it's a negligible number. Those who say that Obamacare is forcing more doctors to drop out of Medicare will have to explain to us how that computes with the fact that the numbers of physicians agreeing to accept Medicare has increased by almost 30,000 this year alone, for an all-time high of over 735,000.

What is more reassuring is the result of California Healthline's very small informal survey of physicians. They found out what most of us who have been in the profession for a few decades already knew - physicians feel ethically obligated to stick with Medicare. What do you think their ethicalsense would be under an improved Medicare program that covered everyone?

My comment: Well duh! Given the ageing of the population, not accepting Medicare would mean cutting yourself off from millions of patients over 65 who are only going to get more numerous.
August 7, 2013

Why Seniors Are Turning Against The GOP

Is my demographic starting to catch a clue? Looks like it.


We first noticed a shift among seniors early in the summer of 2011, as Paul Ryan’s plan to privatize Medicare became widely known (and despised) among those at or nearing retirement. Since then, the Republican Party has come to be defined by much more than its desire to dismantle Medicare. To voters from the center right to the far left, the GOP is now defined by resistance, intolerance, intransigence, and economics that would make even the Robber Barons blush. We have seen other voters pull back from the GOP, but among no group has this shift been as sharp as it is among senior citizens:

—Seniors are now much less likely to identify with the Republican Party. On Election Day in 2010, the Republican Party enjoyed a net 10 point party identification advantage among seniors (29 percent identified as Democrats, 39 percent as Republicans). As of last month, Democrats now had a net 6 point advantage in party identification among seniors (39 percent to 33 percent).

What do seniors care about now? Our Democracy Corps July National Survey found that:

—89 percent of seniors want to protect Medicare benefits and premiums.
—87 percent of seniors want to raise pay for working women.
—79 percent of seniors think we need to expand scholarships for working adults.
—77 percent of seniors want to expand access to high-quality and affordable childcare for working parents.
—74 percent of seniors want to cut subsidies to big oil companies, agribusinesses, and multinational corporations in order to invest in education, infrastructure, and technology.
—66 percent of seniors want to expand state health insurance exchanges under Obamacare

August 5, 2013

Why medical tourism? Just do the math for a joint replacement


Shopenn, 67, an architectural photographer and avid snowboarder, had been in such pain from arthritis that he could not stand long enough to make coffee, let alone work. He had health insurance, but it would not cover a joint replacement because his degenerative disease was related to an old sports injury, thus considered a pre-existing condition.

Desperate to find an affordable solution, he reached out to a sailing buddy with friends at a medical device manufacturer, which arranged to provide his local hospital with an implant at what was described as the “list price” of $13,000, with no markup. But when the hospital’s finance office estimated that the hospital charges would run another $65,000, not including the surgeon’s fee, he knew he had to think outside the box, and outside the country.

“That was a third of my savings at the time,” Mr. Shopenn said recently from the living room of his condo in Boulder, Colo. “It wasn’t happening.”

“Very leery” of going to a developing country like India or Thailand, which both draw so-called medical tourists, he ultimately chose to have his hip replaced in 2007 at a private hospital outside Brussels for $13,660. That price included not only a hip joint, made by Warsaw-based Zimmer Holdings, but also all doctors’ fees, operating room charges, crutches, medicine, a hospital room for five days, a week in rehab and a round-trip ticket from America.

“We have the most expensive health care in the world, but it doesn’t necessarily mean it’s the best,” Mr. Shopenn said. “I’m kind of the poster child for that."
August 5, 2013

Swiss voters back single-payer health insurance


The proposal of creating a single fund for health insurance would be accepted by voters if the ballot for the initiative were held today, according to a poll commissioned by the pharmaceutical lobby group Interpharma.

About 65 per cent of the population would approve the proposal and 28 per cent would reject it, according to the first poll conducted on the issue. The result is still not very conclusive, as only about 31 per cent of people surveyed said they would actually participate in the vote.

In 2014 or 2015, the initiative for public health insurance will be put to a nationwide vote, which if accepted will see current providers of basic cover replaced by a single public fund. Under Swiss law, health insurance is compulsory, and residents currently may choose between offerings of about 60 companies which provide coverage.

The initiative – supported by the centre-left Social Democrats and by the Greens as well as by patient and consumer organisations – would leave only supplemental insurance in the hands of private companies.

The survey was conducted as part of the 2013 Health Monitor by GfS Bern research and polling institute. The Health Monitor also showed that three out of four people in Switzerland view the health system in Switzerland positively, the highest share ever.

August 3, 2013

Find out about ACA health care plans in WA State


Starting this fall, Washington residents will have a new way to find, compare and enroll in health insurance. It's called Washington Healthplanfinder, and it gives individuals, families, and small business owners the confidence to choose the plan that best fits their needs and their budget. Washington Healthplanfinder offers:

•Apples-to-apples comparisons of health insurance plans
•Financial help to pay for copays and premiums
•Expert customer support online, by phone, or in-person through a local organization, insurance broker or agent

August 2, 2013

Medicare for Allí would cover everyone, save billions in first year: new study


Upgrading the nation’s Medicare program and expanding it to cover people of all ages would yield more than a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses.

That’s the chief finding of a new fiscal study by Gerald Friedman, a professor of economics at the University of Massachusetts, Amherst. There would even be money left over to help pay down the national debt, he said.

Friedman says his analysis shows that a nonprofit single-payer system based on the principles of the Expanded and Improved Medicare for All Act, H.R. 676, introduced by Rep. John Conyers Jr., D-Mich., and co-sponsored by 45 other lawmakers, would save an estimated $592 billion in 2014. That would be more than enough to cover all 44 million people the government estimates will be uninsured in that year and to upgrade benefits for everyone else.

“No other plan can achieve this magnitude of savings on health care,” Friedman said.

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About eridani

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity
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