Cognitive Dissonance and Health Care

Crossposted from Democratic Convention Watch

I have wondered aloud for years why people vote against their own self-interest. People tell me various answers but none that have ever made enough sense to me. So here's this:

Cancer patient Kathy Watson voted Republican in 2008 and believes the government has no right telling Americans to get health insurance. Nonetheless, she says she'd be dead if it weren't for President Barack Obama's health care law. Source.

You might think that Kathy would, in 2012, be thinking of voting Democratic and changing her mind about the individual mandate. But no. She's a small businesswoman, and doesn't want the government involved in telling business what to do (especially where the individual mandate is concerned) but that she should be able to buy health insurance even with her pre-existing condition. She doesn't realize that insurance is a business, too, and her cancer-riddled body does not fit within their money-making model. Without the government telling the insurers they must cover her, they will not, at least not at any affordable premium cost.

There you have it, a woman who would be dead now if not for ACA, and she STILL supports the people who worked to derail it.

The overall article in which Kathy's story appears is about the people across America who will likely die if the Supremes gut the ACA. They are cancer patients, AIDS patients, cardiac patients, the elderly relying on medications for chronic conditions, and this is not to mention the people who become sick or injured afterwards.

And that doesn't even touch the problems that doctors will face. Consider:

Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.

Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits offered at no cost to the patient. But this new preventive service benefit was created by the ACA, so presumably with the ACA overturned, Medicare no longer is allowed to pay for wellness visits. Do you tell Mrs. Jones that Medicare might not cover the visit? Provide the visit anyway, hoping that somehow Medicare will find a way around the Supreme Court ruling and pay for it? Offer it at no charge, or try to collect the 20% you would collect for a normal (non-preventive) office visit?

 Your second patient, Mr. Jones, another senior, comes in for a follow-up visit for an ongoing chronic condition. You decide to renew his expensive brand-name prescription drug, knowing that he is eligible for a 50% discount because he has fallen into the Medicare Part D “doughnut hole.” Oh wait … the Medicare Part D drug discount was part of the now-defunct ACA. So does that mean he now has to pay full price? Do you prescribe the drug anyway, knowing he can’t afford to pay the regular retail price? Prescribe a lower cost no-name brand drug that he doesn’t tolerate as well?

I read articles like these and wonder: the Supremes have access to the same sources I do, so do they read any of these articles? I have read, tagged, and made notes, on my printed copy of the Affordable Care Act. While I cannot recite it from memory, I know a lot about the law, its structure, and its interconnections. I know that none of the Supremes have read it, that was discussed at the hearing. 

If I were a Supreme, and was making a decision that affected the lives and deaths of millions of people, I know I would take the time to read the legislation. To rule without even knowing what the legislation says is to rule blindly. I would do everything I could to not only listen to the people who testified in front of me, but also to research, and have my staff research, everything I could about the impacts related to my decision. While I would certainly cede to the rule of law, I would want to know everything I could about the base data. To do anything less is a complete disservice to all Americans and the rule of law on which this country was founded.

Why do I care more about Americans and their health than the Supremes do? 

Today’s #HCR Moment: The Rebate Checks

Crossposted from Democratic Convention Watch

Remember the ACA facet which says that health insurers must rebate to policyholders the amount of money policyholders paid in premiums that did not go to health care costs if those costs are less than 80%/85%? The percentage was dependent on whether it was a group or individual policy. Those checks are going to go out soon, and the first paragraph of the attached letter will say:

“This letter is to inform you that you will receive a rebate of a portion of your health insurance premiums. This rebate is required by the Affordable Care Act—the health reform law.”

Kaiser has done some work on the actual numbers:

The largest rebates overall are projected to go to consumers and businesses in Texas (total $186 million) and Florida ($149 million); Hawaii is the only state where no insurer is expected to issue a rebate.

Consumers receiving rebates in the individual market are projected to receive $127 on average, with amounts varying significantly by insurer and state. The average rebates for individual purchasers expected to receive them range from just a few dollars in some states to as much as an average of $305 in Alaska, $294 in Maryland, $243 in Pennsylvania, $241 in Idaho, and $236 in Mississippi.

If you have a WSJ subscription, you can see the full breakdown by type of policy, amount of average rebate and state here.  That chart indicates that the total number of Americans who will receive rebate checks is:

Individual policyholders: 3,360,858
Small Group policyholders: 4,932,786
Large Group policyholders: 7,475,657
Total:  15,769,301

That's almost 16 million people. Trying to find the number of people who have private health insurance is a little tricky. We know that about 87 million people have insurance, but many of them are covered by government programs (Medicare, Medicaid, SChip, military benefits, government workers). Depending on whose statistics you believe, the number of people covered by employer plans runs between 42% and 48%. Thus, the overall conclusion is that as health insurance rates keep climbing, and the number of uninsured keep rising the premium dollars are NOT going to health care costs, but rather to the companies. Which, ahem, now have to send that money back.

So let's recap: the Affordable Health Care Act is working! It's decreasing the amount of money that just gets kept by the insurance companies who keep saying they need to raise premiums to cover costs. (Liars.) This is in addition to the other benefits of covering more people including offspring in their 20's, people with pre-existing conditions, people who don't receive employer benefits and cannot afford individual plans on the open market, plus the decreased Medicare donut hole, and free preventive services. And yet, people seem not to like this, according to most polling. Yet another Ich Kreplach moment, but a win for most Americans nonetheless. 

If you miscarry, you can go to jail

I'm not joking. In Tennessee, there's a new law that has passed both chambers which allows prosecution if a pregnant woman miscarries. Even in the first few weeks when she is carrying an embryo. Let's be clear: about half of all fertilized eggs never become babies, as per NIH.

It is estimated that up to half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among those women who know they are pregnant, the miscarriage rate is about 15-20%. Most miscarriages occur during the first 7 weeks of pregnancy.

Some common causes include, but are not limited to, obesity, maternal age, diabetes, physical problems with the egg, and physical problems of the mother. Suddenly, this is a crime. Miscarriage can also be caused by accident, exposure to toxins and chemicals and all sorts of other things. For example, if you have cancer and are undergoing chemo and get pregnant, a miscarriage is likely. You're in a car accident. Or you accidentally fall down the stairs. Like this:

Life can't get much worse for Christine Taylor. Last month, after an upsetting phone conversation with her estranged husband, Ms. Taylor became light-headed and fell down a flight of stairs in her home. Paramedics rushed to the scene and ultimately declared her healthy. However, since she was pregnant with her third child at the time, Taylor thought it would be best to be seen at the local ER to make sure her fetus was unharmed.

That's when things got really bad and really crazy. Alone, distraught, and frightened, Taylor confided in the nurse treating her that she hadn't always been sure she'd wanted this baby, now that she was single and unemployed. She'd considered both adoption and abortion before ultimately deciding to keep the child. The nurse then summoned a doctor, who questioned her further about her thoughts on ending the pregnancy. Next thing Taylor knew, she was being arrested for attempted feticide. Apparently the nurse and doctor thought that Taylor threw herself down the stairs on purpose.

Amazing? No – the far right in action in Iowa. 

Let's say you're a drug addict who is raped and gets pregnant. You go for drug treatment so that the baby can be born clean. In Alabama, you can be arrested for child endangerment since you exposed the fetus to drugs, even though the intent is to protect the pregnancy. It's happened to 60 women to date. 

It's hard to know what to say here. You've got a bunch of far right teabaggers who care about cellular clumps, which is what a 2 week old embryo actually is: undifferentiated cells. Care more then they do about actual people. Look at all the couples who try in vitro: most of those embryos are lost. Should they be prevented from trying because of the fear of jail?  Should a woman immediately go to bed and stay there once she knows she's pregnant to avoid any potential threat? The people who write these laws are insane, and devoid of any knowledge of science. And yet they get re-elected. Get up, get angry, and make sure everyone you know knows what they're voting for when they vote for a Republican. 

Today’s #HCR Moment: Three Notes From Your Doctor

Crossposted from Democratic Convention Watch.

Yesterday, Ryan's budget, Year 2, passed the House Budget Committee. No surprise. It will also likely pass the House, and then die in the Senate. As it should. If you hated it last year, this year's version will make you equally miserable, especially since the Rethuglicans reneged on the trigger deals agreed to last summer. You don't have to read it (although I did) to know that it screws everyone except the very rich, and especially the very poor, the elderly and women. This last point by virtue of defeating all proposed Democratic amendments related to women's health.

In sharp contrast, the Obama campaign has launched the following:

Click on your status and learn precisely what this act has done for you and those you love. 

I report these two items together to reinforce the stark differences between what it means to be a Democrat and what it means to be a Republican. 

If you know someone who is unaware of what the Affordable Care Act does, show them this link. If they say “I don't want government in my health care”, ask them which they prefer: a government that leaves medicine between you and doctor, but simply provides free preventative screenings if you want them vs a government that forces you to endure, and then pay for, and unnecessary medical procedure. It is THAT STARK a difference.


The mistake we made in 2009 was to let the wacko right control the conversation and the frame of the conversation on health care. We CANNOT allow that again.  WeMUST take the offensive and frame the conversation going forward.

And finally, my third note: yesterday, the Lancet reported that they have reviewed a number of studies related to aspirin and found preliminary evidence that aspirin is good not just for your heart, but also as a cancer preventative, and for cancer patients, a drug that helps to decrease the rate of metastasis.  Whether you, personally, should take aspirin and at what dosage is something for you to discuss with your health care provider. Ask the next time you see him/her. There are some side effects of aspirin, and there are some people who should never take it, but if you can, this may be a cheap and easy way to do something incredibly positive for your health.

The Road We’ve Traveled

The Obama campaign has released this 17-minute documentary by Academy Award-winning filmmaker Davis Guggenheim’s documentary about President Obama’s first three years in office and the tough calls he made to get our country back on track. If you recognize the narrator’s voice — that’s Tom Hanks.

There are a couple of minutes about the auto bailout, since they are probably assuming that they’ll be running against Mitt Romney who famously wrote Let Detroit Go Bankrupt.

Utah Weirdness

Last night were the Utah caucuses that will lead to a determination (or a runoff) of whether Orrin Hatch will be the Republican Senate candidate this November. Running at age 77 for his 7th term. I was hunting around for results, and all I can find is that he did very well in some places, poorly in others, but no determination at the time of this writing, except that turnout, at 125,000 – 200,000 people, was very high.


So I'm reading the Salt Lake Tribune and come across this:

Sen. Mike Lee is among a group of conservative senators who want to phase out Medicare and shift seniors into the health program that covers Congress and all federal employees. […]

Their proposal would allow seniors to pick from the expansive menu of insurance options now offered to all public employees by private companies, with the government picking up a share of the cost depending on how much money the person makes.

The bill would also gradually increase the Medicare-eligibility age, which is now 65, by three months a year until it reaches 70.

I had to read this several times. When I was done laughing, I went and got another cup of coffee and read it again. 

The insurance choices for Federal employees are mighty fine. Great coverage (including birth control, but let's not go there) and reasonable premiums, co-pays and deductibles to the patient. The thing about it is that it would cost the government MORE to go to this system. That's right kids, despite the GOP meme of lower the deficit, they want to AT LEAST DOUBLE what health care would cost the government viz-a-viz senior citizens, and increase the number of people who lose jobs. 

Suddenly the government would be paying private industry (which processes claims to the tune of 15 – 30% of each premium dollar) to do what Medicare administrators do at a cost of 2 – 4% of premium dollar. Plus, that would cost government jobs, meaning the government would now need to pay unemployment compensation. Not to mention that the Senate plan (and some of the other government plans) cover more things at a higher payout than Medicare.

I used to be appalled at the Republicans, now I can only laugh. Does Medicare cost a lot of money? Sure. Could we find ways to streamline costs? Sure. Should we come up with a “solution” that costs more? Only the Republicans could do something like this.

The War Against Women Continues, and Now Includes Men

When the Pennsylvania House goes back into session in March, they'll be considering House Bill 1077, the “Women's Right to Know Bill”. You guesses it, ultrasounds…

Providing for ultrasound test requirements to determine gestational ages of unborn children; establishing the right to view ultrasound image and ultrasound video of unborn child and the right to observe or hear the fetal heartbeat; providing for powers and duties of the Department of Health and for duties of physicians performing abortions; requiring certain reports to be filed with the Department of Health; imposing administrative sanctions and criminal penalties; and providing for remedies. Full bill.

If you live in Pennsylvania and want to call your rep, you can find his/her contact info here.

I keep ending up with the same two questions: who's going to pay for this? It seems that since the state won't pay, the docs won't do it for free, and insurance won't pay since it's not medically necessary, women have to pay to be raped. 

My bigger question though, is why do the Republicans want MORE government action in medicine? Their argument against the Affordable Health Care Act was that it put government between a patient and doctor. They seemingly want government out of every single aspect of people's lives except when it involves shoving an ultrasound probe up a woman's vagina. 

But there's more, and it's on a national scale. Remember the Violence Against Women Act which came out of Joe Biden's office in 1994? The one that authorized funds related to domestic violence, sexual assault and stalking? It's up for re-authorization and Republicans are opposed. Yes, Republicans like violence against women. Yes, it does slightly expand:

The bill includes smart improvements aimed, for example, at encouraging effective enforcement of protective orders and reducing the national backlog of untested rape kits. The Republican opposition seems driven largely by an antigay, anti-immigrant agenda. The main sticking points seemed to be language in the bill to ensure that victims are not denied services because they are gay or transgender and a provision that would modestly expand the availability of special visas for undocumented immigrants who are victims of domestic violence — a necessary step to encourage those victims to come forward. 

Every single Republican on the Judiciary Committee voted against it. Their idea? Cut funding, and obliterate the Justice Department on Violence Against Women.

Finally, we come to the Blunt Amendment which would not only eviscerate the Affordable Health Care Act, but would allow employers and insurance companies to deny coverage to anything that went against their “moral and ethics.” Men, they obviously hate you, too. Here is a list of things insurers and employers could say no to:

  • HIV/ADIS testing (you should have been more careful)
  • Liver transplants (you shouldn't have been drinking)
  • Hepatitis treatment (we don't know how you got it, so we're assuming the worst)
  • Lung cancer treatment (even though you say you weren't smoking, we think you were)
  • Accident coverage (you shouldn't have been skiing, skydiving, swimming, diving, running, driving so fast, etc., those things can be dangerous)
  • Type 2 diabetes coverage (it's your own fault for not eating better)
  • Cardiac conditions (you should have taken better care of yourself)
  • Mental health coverage (you should treat it with prayer)

Here it is. And yes, really, under the amendment they can refuse everything on the bullet list. And more. Who the @$%&)#@ made insurance companies and employers the arbiters of “ethics”? The pedophile priest church? Enron? Exxon? BP? Any Wall Street bank? Really? Ethics? 

How Stimulus and Health Care Reform Turned Out

Ezra Klein:

The latest Chicago Booth poll of economists focuses on the 2009 stimulus. The first question asked whether the stimulus increased employment by the end of 2010. Eighty percent of the polled economists agreed. Four percent disagreed. Two percent were uncertain.

The second question asked whether, over the long run, the benefits would outweigh the long-term costs (like paying down the extra debt). Forty-six percent agreed. Twelve percent disagreed. Twenty-seven percent were uncertain.

Dana Milbank:

At the last possible moment to save his reelection, the economy is beginning to hum, as evidenced by Friday’s jobs report. And Obama’s Republican opponents are shaping up to be as formidable as, well, marshmallows. While Mitt Romney, Newt Gingrich and Rick Santorum are making each other unelectable, the president is singing Al Green, congratulating Super Bowl winners, playing with science projects, raising obscene amounts of campaign cash and watching his poll numbers soar.

Reform Jewish Leader Criticizes One-Sided Contraception Hearings

Rabbi David Saperstein: “The government has a compelling interest of the first order in ensuring that all individuals are able to access necessary services.”

— Sean Thibault or Katharine Nasielski

Bishop William Lori, representing the United States Conference of Catholic Bishops, testified at the House Committee on Oversight and Government Relations Hearing entitled, “Lines Crossed: Separation of Church and State. Has the Obama Administration Trampled on Freedom of Religion and Freedom of Conscience?”  In it, he analogized the government mandate that most employers must cover birth control, without co-pay, to a hypothetical situation in which a kosher restaurant would be mandated to include pork on the menu because of its health benefits. Rabbi David Saperstein, Director of the Religious Action Center of Reform Judaism, issued the following statement in response:

Today, an all male ‘witness’ panel was allowed to speak at the GOP’s hearing examining the Obama administration’s new regulation requiring employers and insurers to provide contraception coverage to employees. When Georgetown law student Sandra Fluke was presented to testify on behalf of the Minority, she was shown the door. She would have been the only female voice speaking on behalf of the millions of women who support access to birth control. Here is the basis of her testimony, had she been allowed to speak.

Bishop Lori chose to use a vivid and unusual analogy between religious employers providing comprehensive health care coverage to their employees and kosher delis being forced by government to sell pork on the grounds that pork is good for you.  While I appreciate the humor and creativity of this analogy that sought to raise important issues of balancing free exercise of religion against other compelling government interests, picturesque analogies are not always the most effective or accurate.  Unfortunately, this analogy is flawed in ways that obscure rather than illuminate the important moral, religious and legal issues involved.

First, the government’s interests in the functioning of the health care system  are manifestly far greater than mandating stores sell a particular healthy food, pork or otherwise, and the analogy unintentionally trivializes the need to ensure all Americans have access to quality healthcare in a manner that does not discriminate against women. Indeed, every individual partakes of the health care system at some point in his or her life – whether it is in the process of birth, death or points in-between. That care is paid for by the individual or the public; either directly or through some form of private or public insurance. As such, the government has a compelling interest of the first order in ensuring that all individuals are able to access necessary services. In contrast, no one needs to eat in a particular restaurant and no one needs to eat one particular form of (assumed) healthy food, pork or otherwise.

More after the jump.

When pulling together a panel for a Congressional hearing on birth control, wouldn’t you think it would have at least one woman on it? Come on! This is what Rep. Darrell Issa, the House Oversight Committee Chairman, said when turning away the sole female voice that would have been heard:

“As the hearing is not about reproductive rights and contraception but instead about the Administration’s actions as they relate to freedom of religion and conscience, he believes that Ms. Fluke is not an appropriate witness.”

Second, Bishop Lori’s argument also fails to distinguish for-profit consumer relationships from employer-employee relations.  The Supreme Court has long upheld a broad range of government regulation, including religious employers, health and safety requirements, requirements to pay into social security (which was upheld by the Supreme Court over employer’s religious objections in United States v. Lee), bans on a number of forms of discrimination (again with some accommodation of religious free exercise) and requirements that employers accommodate the religious practices of its employees, unless doing so would cause “undue hardship on the conduct of the employer’s business.”  This is quite different than the government trying to regulate what foods a restaurant must provide to its customers, where there is a much lower government interest and no well-settled pattern of government regulation.

Third, Bishop Lori’s analogy compares the limited religious exemption for kosher caterers allied with synagogues with the broad exemption that the Obama Administration has now established that would protect the religious conscience of employers with moral objections to contraceptive coverage. Not only will a church, synagogue or other house of worship, parochial school, or missionizing group not be required to include contraception in its health plan, but now religiously affiliated entities, such as church affiliated hospitals, social service entities and universities, will also be exempt from providing the coverage, under the compromise announced last Friday. This compromise was praised by Sister Carol Keehan, President of Catholic Health Services, who said she was “pleased and grateful that the religious liberty and conscience protection” was accomplished. What Bishop Lori did not elucidate was the moral basis for the Church to oppose the government providing millions of women with basic health care services, services that ironically will cut significantly unwarranted pregnancies and attendant abortions.

Finally, the attention to Bishop Lori’s analogy should not obscure the greatest flaw of these hearings. The House Oversight Committee did not allow witnesses opposed to the church’s position to testify and, among the witnesses who testified, not a single one was a woman. Is diverse representative discourse not the point of Congressional hearings?  Does the committee so lack confidence in the free marketplace of ideas that is at the core of our democratic system of government?  I urge the committee to convene hearings that can truly debate the important issues involved. As someone who believes in ensuring both access to contraception for all women and the robust protection of religious autonomy, it seems clear that the fundamental rights of all women and the fundamental rights of religious conscience deserve no less.

B’nai Brith Commends President’s Stance on Iran in SOTU

— by Sharon Bender

B’nai B’rith is encouraged by President Obama’s State of the Union commitment to “take no options off the table” to “prevent Iran from getting a nuclear weapon.” Iran, the world’s largest state sponsor of terror, has ignored international entreaties to cease its quest for nuclear weapons. B’nai B’rith commends the world powers that have united behind the United States to implement sanctions against the Tehran regime.

We also welcome the concrete support the president gave Israel when he stated unequivocally that the ties between the United States and Israel are strong:

Our iron-clad commitment to Israel’s security has meant the closest military cooperation between our two countries in history.

On the domestic front, the president indicated he will seek comprehensive immigration reform measures this year, will work to lessen America’s dependence on foreign oil and will continue to work to ensure health care reform measures help those Americans who need it most-all issues B’nai B’rith strongly supports..

It was encouraging that the president noted the precarious situation in Syria, stating:

I have no doubt that the Assad regime will soon discover that the forces of change can’t be reversed, and that human dignity can’t be denied.

As an organization committed to human rights, B’nai B’rith paid special attention to the president’s declaration of the need for global tolerance:

We will stand for the rights and dignity of all human beings…We will support policies that lead to strong and stable democracies and open markets, because tyranny is no match for liberty.

B’nai B’rith supports the president’s call for a nationwide investment in and overhaul of our current energy policies, touting alternative energy programs instead. The nation’s current dependence on foreign oil undermines our security and in some cases, forces the United States to deal with countries that may not share our commitment to democracy and freedom.

B’nai B’rith supports legislation that would help pave a smoother path to citizenship upon high school graduation for foreign-born children raised in the United States without documentation. We were pleased to see the president endorse this important measure. B’nai B’rith also supports the president’s call for women to earn “equal pay for equal work.”  

The president’s reiteration of his commitment to health care reform was also welcome:

I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage, or charge women differently from men.

More after the jump.
B’nai B’rith has long supported comprehensive health care reform and is an advocate of the legislation that gives all Americans equal access to medical care.

B’nai B’rith hopes the president maintains his stated commitment to protecting the promise of retirement security for America’s seniors. But we will be vigilant as we ensure Medicare and Social Security continue to serve those who most need these vital safety nets.

Regarding the payroll tax holiday that the president referenced, B’nai B’rith appreciates the president’s focus on keeping more wages in workers’ pockets.  

Recognizing that the annual address is meant as a framework for the president’s priorities, B’nai B’rith will analyze the details as they emerge and work to ensure action on our key priorities.

B’nai B’rith International, the Global Voice of the Jewish Community, is the oldest and most widely known Jewish humanitarian, human rights and advocacy organization.  For 168 years, B’nai B’rith International has worked for Jewish unity, security, continuity and tolerance.  Visit