Mira
Mira's JournalStates of Health / Atul Gawande / The New Yorker
States of Healthby Atul Gawande October 7, 2013
Ours can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. “I should have known better,” he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.
This week, the centerpiece of the Affordable Care Act, which provides health-insurance coverage to millions of people like Sullivan, is slated to go into effect. Republican leaders have described the event in apocalyptic terms, as Republican leaders have described proposals to expand health coverage for three-quarters of a century. In 1946, Senator Robert Taft denounced President Harry Truman’s plan for national health insurance as “the most socialistic measure this Congress has ever had before it.” Fifteen years later, Ronald Reagan argued that, if Medicare were to be enacted, “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” And now comes Senate Minority Leader Mitch McConnell describing the Affordable Care Act as a “monstrosity,” “a disaster,” and the “single worst piece of legislation passed in the last fifty years.” Lacking the votes to repeal the law, Republican hard-liners want to shut down the federal government unless Democrats agree to halt its implementation.
The law’s actual manifestation, however, is rather anodyne: as of October 1st, healthcare.gov is scheduled to open for business. A Web site where people who don’t have health coverage through an employer or the government can find a range of health plans available to them, it resembles nothing more sinister than an eBay for insurance. Because it’s a marketplace, prices keep falling lower than the Congressional Budget Office predicted, by more than sixteen per cent on average. Federal subsidies trim costs even further, and more people living near the poverty level will qualify for free Medicaid coverage.
How this will unfold, though, depends on where you live. Governors and legislatures in about half the states—from California to New York, Minnesota to Maryland—are working faithfully to implement the law with as few glitches as possible. In the other half—Indiana to Texas, Utah to South Carolina—they are working equally faithfully to obstruct its implementation. Still fundamentally in dispute is whether we as a society have a duty to protect people like Paul Sullivan. Not only do conservatives not think so; they seem to see providing that protection as a threat to America itself.
Obstructionism has taken three forms. The first is a refusal by some states to accept federal funds to expand their Medicaid programs. Under the law, the funds cover a hundred per cent of state costs for three years and no less than ninety per cent thereafter. Every calculation shows substantial savings for state budgets and millions more people covered. Nonetheless, twenty-five states are turning down the assistance. The second is a refusal to operate a state health exchange that would provide individuals with insurance options. In effect, conservatives are choosing to make Washington set up the insurance market, and then complaining about a government takeover. The third form of obstructionism is outright sabotage. Conservative groups are campaigning to persuade young people, in particular, that going without insurance is “better for you”—advice that no responsible parent would ever give to a child. Congress has also tied up funding for the Web site, making delays and snags that much more inevitable.
Some states are going further, passing measures to make it difficult for people to enroll.
Read the rest
: http://www.newyorker.com/talk/comment/2013/10/07/131007taco_talk_gawande?printable=true¤tPage=all#ixzz2gQHL28TN
Real Time with Bill Maher. On in an hour. We may be in for a treat and be entertained.
Guests:Billy Crystal
Joy Behar
Jeremy Seifert
David Frum
and Chris Hayes
HBO 10 pm EST
and a repeat at 11 pm
Chelsea Clinton- my first exposure to the grown woman
She's on with Jon Stewart, and overwhelmingly I am thinking I'm looking at Hillary. She has the features of her Mom's face, and there's a bit of Bill as well. But the way she uses her eyes is an exact replica of her Mom.
That eye sparkling thing they do is not something I'm fond of watching, so I was not happy she has adopted that for herself.
Oh, well. It's such a treat to see a grown Democratically raised child of substance and breeding, one who was also fortunate to have had the best possible education.
She is of course smart, articulate, brilliant. That first smart does not include her appearance.
The dress is one where I wish the money spent on it had gone elsewhere to feed some poor children, it was way too much of a not so good thing. Had she fed those children there would have been plenty money left to put her into a less ridiculous looking simple dress.
I had fun seeing her and listening to her. After all, I've "known" her since she was about 12.
Did I read self portrait? Here's one though a little late for "purple". Spoiler: Bruise on my arm.
I took this photo with the camera built into my laptop. A week ago I braced myself with the arm where I broke the humerus 2 years ago, and have a new but EVER SO MUCH LESS BAD break.
Tonight I feel sorry for myself enough to show it to you.
I"m told I'll be quite OK in two months.
So, don't cry for me, Argentina. Just send healing light!
Print out a stack and fill out as needed - Fitzsimmons 'toon about mass shootings
McCain publishes opinion piece in Pravda – but not in the Pravda he wanted / Geezer embarassment
Posted by
CNN's Leslie Bentz
Senator John McCain has a message for the Russian people; “I am pro-Russian, more pro-Russian than the regime that misrules you today”.
In an opinion piece titled “Russians Deserve Better That Putin,” published by the Russian news website Pravda, Senator McCain took aim at the current Russian leadership, including Vladimir Putin. “They punish dissent and imprison opponents. They rig your elections. They control your media,” the senator said in his piece.
The Arizona Republican, who does not support same sex marriage in the U.S., also criticized Russia’s recently passed anti-gay legislations, saying Russian lawmakers “codify bigotry against people whose sexual orientation they condemn.”
The legislation banning the promotion of "gay propaganda" among minors became law in June, as Putin began his third term as president.
The article was published Thursday, after some initial confusion over which “Pravda” McCain would actually be writing for.
Pravda, which means “the truth” in Russian, became the biggest newspaper during the Soviet period of Russian history. It was the official mouthpiece of the Central Committee of the Russian Communist Party. The newspaper was closed down after the collapse of the Soviet Union in 1991, then reopened in 1997 as the official paper of the Russian Communist Party. The current Pravda has a considerably smaller circulation compared to its Soviet glory days.
Pravda.ru, the news outlet that actually published McCain’s piece, is an electronic news website founded in 1999.
For the rest go to:
http://politicalticker.blogs.cnn.com/2013/09/19/mccain-publishes-opinion-piece-in-pravda-but-not-the-one-he-wanted/
Dr. Janis Olowski is allowed to speak and finish on Rachel's show. Was cut off earlier by CNN
She is the chief medical officer at the hospital where the victims are today.
She was making an emotional plea about her constant exposure to victims of gun violence and says something needs to be done to put a stop to it, all but teary eyed making an appeal to help her have to deal with less victims.
As soon as she started the personal comments, and the direction they were going in became apparent, CNN cut her off and went to inane sideline chatter about today's tragedy.
I yelled at my TV to let her finish.
Just as I had yelled at the TV earlier, when they cut away from President Obama's speech about the economy and they went to pundit talk about his comments on the shootings.
CNN needs to hear from any of us who have a few minutes to spare.
They so suck in the inanity and repetition of their reporting, and in their making editorial choices in what they "let us hear".
It's deplorable.
edited to add that Rachel just said the Docor had put in her resignation this morning before the shootings, and will be on Lawrence O'Donnell's show in a half an hour.
Thank you Rachel for picking up their slack.
A realistic concept in divided America - We have honestly seen this before. It's about Colorado
Spectacular idea. Can you support a new system to name storms? Well worth considering.
Go to http://www.climatenamechange.org
Since 1954, the World Meteorological Organization has been naming extreme storms after people. But we propose a new naming system. One that names extreme storms caused by climate change, after the policy makers who deny climate change and obstruct climate policy. If you agree, sign the petition at http://www.climatenamechange.org/#/pe...
Safety Belt - Crash Helmet - and Diapers were needed for Breaking Bad tonight
I saw it with 4 college students in a downtown theater, where they filled it (for free admission) with fans of all ages and walks of life.
The noise of the folks in their anticipation and the commentary was like the buzzing of excited and nervous bees. When the show started it was as if their throats were all cut in the same second, til the cacophony would resurge during commercials to stop in an instant same breath stop when the show resumed.
It was an unprecedented experience when it comes to the behavior of a crowd.
Two comments from the college students afterwards:
"I need a beer now to sober up"
and
"I was going to have a nice quiet evening and meditate, now I'll be sitting on my bed, crying myself to sleep."
It was a night to remember.
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