This video on affordable health care is pretty hilarious. Via Ezra.

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

The great discussion around universal health care has to do with mandates. If a health care plan doesn't include individual mandates, is it really universal? The Urban Institute says no. It seems that massive health care reform that doesn't include mandates could be disastrous, "[V]oluntary measures alone would leave large numbers of people uninsured."

This is something I've been thinking about for a long time. Whenever we are ready to implement massive universal health care reform, I just don't see it following through without individual mandates. Of course, we should make sure it is affordable, but I've just met too many young people that don't see the point in buying health insurance because they're young and healthy. These "young and healthy" people would serve as the foundation for making health care affordable for the rest of us. Meanwhile as a message to the proudly uninsured: You never know when you will suffer a terrible accident or sudden illness that will leave you devastated and massively in debt. 

Photo by Flickr user Chandra Marsono used under a Creative Commons license.

I really don't want to sound insensitive about something I literally have no experience with, but is it really worth writing an entire news story about how the HPV vaccine shots hurt?  I mean, I haven't gotten the shot, but I've gotten hepatitis shots somewhat recently, and sure, the injection site was sore for about a day and for a few hours I didn't have full movement in my arm, but it wasn't anything for the AP to get all excited about. Here's how the AP describes the standard reaction to the vaccine:

The pain is short-lived, girls say; many react with little more than a grimace. But some teens say it’s uncomfortable driving with or sleeping on the injected arm for up to a day after getting the shot.

It doesn't seem like girls are having a special reaction to this shot or that it is significantly different from other vaccines. Is it really any surprise that the media would focus on the painfulness of a shot that is given nearly exclusively to teenage and pre-adolescent girls?  I think it's pretty irresponsible for the AP to breathlessly report a 180 person increase in vaccine shot related fainting among girls in the past year, especially when 100 percent of the new cases came from this new vaccine that was only mandated and prescribed this year. 

PS: Amanda Marcotte has a good cultural/feminist analysis of the entire "shots hurt" story. 

    In the United States, approximately two-thirds of all high school seniors have engaged in sexual intercourse.1 According to the Department of Health and Human Services, approximately one in four persons will become infected with a sexually transmitted disease (STD) by the age of twenty-one.2 Additionally, the United States has one the highest rate of teenage pregnancy of any industrialized nation with about forty percent of woman becoming pregnant before the age of twenty.3 While there has been no conclusive evidence that abstinence-only based sexuality education programs either prevent the onset of intercourse or reduce the frequency of intercourse, the United States government currently finances three federal abstinence-until-marriage programs.4 By prohibiting State governments from promoting the use of contraceptives in their school sex education programs in order to receive Federal funding, the United States government is endangering the welfare of its citizens.  
    According to a report entitled “School-Based Programs to Reduce Sexual Risk Behaviors” commissioned by the Division of Adolescent and School Health within the Centers for Disease Control and Prevention (CDC), “Because incidence of pregnancy and STDs among teenagers is so great, these consequences involve not only the individuals involved and their families, but overall welfare dependency, unemployment, and medical costs in the United States.”5 In 2002, there were an estimated 750,000 pregnancies (450,000 live births) among 15-19 year old girls.6 With the proper use of a condom, chance of pregnancy can be reduced by 98%.7 Furthermore, sexually active teenagers have the greatest chance of becoming infected with an STD than any other age group.8 With about 9.1 million persons between the ages of fifteen and twenty-four being infected every year in the U.S., almost half of all new STD cases occur among young people.9 According to the CDC, at the end of 2003 somewhere between 1,039,000 and 1,850,000 people in the United States were living with HIV/AIDS.10 Of the approximately 40,000 new cases each year, about half occur with persons under twenty-five years old (usually infected through intercourse).11 With the use of a condom, the chance of infection from intercourse with a person with HIV-AIDS is reduced by 80 to 87%.12
    In 1981, Congress passed the Adolescent Family Life Act (AFLA) “to promote chastity and self discipline” among adolescents by funding “family-centered” programs. The Act, sponsored largely by political conservatives, was used to almost exclusively fund religious and right wing groups that often maintain (without any significant scientific proof) that dissemination of safe sex practice information hastens the initiation of sexual activity and the frequency of intercourse among youths. Allegedly, many of these groups, including Sex Respect and Teen-Aid, relied on “scare-tactics” and misinformation about disease and pregnancy prevention in order to promote their abstinence-based initiatives. In 1983, the American Civil Liberties Union filed suit against the program on the grounds that it violated the seperation of church and state as required by the U.S. Constitution. In 1993, the case between the challengers and the Department of Justice Counsel for the Department of Health and Human Services (DHHS) reached an agreement in which certain requirements must be met before the granting of funds through the AFLA to any sex education program. These stipulations include having AFLA grantees submit their curricula to the DHHS for  “consideration of whether the curricula teach or promote religion and whether such materials are medically accurate.”13
     A 2004 report from the office of Rep. Henry Waxman (D-CA) found that two-thirds of government-funded abstinence-only programs contain misleading or inaccurate information pertaining to abortion, contraception, genetics, and sexually transmitted infections. The report prompted the Government Accountability Office to investigate the claims, releasing a report in 2006 supporting Waxman’s findings.14
    In 1996, Congress attached an additional abstinence-only Federal program to a welfare reform law. According to Title V of Section 510 of the Social Security Act, “Neither the State nor any of its sub-awardees may use Federal or matching funds under this award to promote the use of contraception.” All federally funded sex education programs must adhere to this requirement.15 Over $1.5 billion have been allocated to these federal and state programs since 1996. President Bush has requested $242 million for the funding of abstinence-only programs in his FY2008 budget. Since states are required to match federal funds for abstinence-only programs, some states are forced to divert money away from more comprehensive, medically accurate sex education programs. Eleven states have refused to accept such federal programs because of these terms.16
    In 2007, Congress authorized an extensive year-long study by the Mathematica Policy Research, Inc found that students who participated in federal abstinence-only programs were just as likely to engage in pre-marital sex as those students who did not. They were also found to engage in sexual-risk behaviors at the same mean age and have the same approximate number of sex partners as students who did not participate in the federally funded programs. Another study focusing on individuals engaged in virginity pledge programs (promoting chastity until marriage) found that, although many did delay the onset of sexual activity, many of these youths (88%) still engaged in premarital sex but were less likely than non-pledgers to use contraceptives at first intercourse or to get tested for STDs.17
    Relying on evaluations of twenty-three separate national surveys, the “School-Based Programs to Reduce Sexual Risk Behaviors” report by the CDC found that comprehensive school sex education programs covering topics such as abstinence, conception, pregnancy, STD, and HIV-AIDS did not lead to an increase in sexual activity. Programs designed to promote the use of contraceptives, such as condoms, also did not increase the onset or frequency of sexual activity. “Indeed, all of them either delayed the onset of intercourse or had no effect upon the initiation of intercourse. Furthermore, of the four studies that focused on program impact on the frequency of intercourse, none found significant increases in sexual activity, and one found a significant decrease among the relatively small proportion of youths who initiated intercourse after program implementation.”18
    It is estimated that only 10% of school districts in the U.S. have comprehensive sexuality programs that promote not just abstinence but the use of contraceptives and safe sex practices.19 The CDC “School-Based” report stated that two studies it analyzed indicated that some comprehensive programs reduce the onset of sexual activity, limit the number of sexual partners, and increase the use of contraceptives. “Logically they should also reduce pregnancy, births, STD, and HIV rates.”20 It is the responsibility of the American government to ensure the general welfare of its citizens. When the federal government blatantly disregards rigorous scientific data in order to promote ineffective morality-based sexuality programs in state school systems, that government can be held accountable for actually harming the lives of its citizens.

Or they won't be allowed back to public school. 

Via the New York Times:

"Judge Nichols had sent letters this week to the homes of more than 800 households with children in public schools, strongly recommending that the children be immunized Saturday at the courthouse, where health department workers had set up tables to process paperwork and give shots, or that parents prove that the children had already been immunized in accordance with state law."

You know how conservatives like to blame uninsured illegal immigrants for the rising costs of health care? Well, the Economic Policy Institute released this graph that shows change in the share of the uninsured with and without post-2000 immigration increases.* Don't you love it when you can point to a graph to prove your point?

* This post originally said this was a change in overall health care spending.

Every couple of months, a presidential candidate comes up with a new proposal for how they plan to solve the health care crisis -- 46.5 million Americans are uninsured. The 18-34 age group makes up the largest percentage --39 percent -- of the total uninsured. So even if you're currently covered under some kind of student health care plan, that coverage will evaporate the day you graduate. That's why you should care about what the candidates say about health insurance.

The only problem is, health care plans are confusing. One way to get around this is to look at health08.org and look at their side-by-side comparison tool for what each candidate is proposing.

Congressional Quarterly reported a Familes USA analysis of the Census Bureau information on the uninsured for 2006-2007. Are they who you thought?

Four out of five of the uninsured were from working families, with 70.6 percent employed full time and 8.7 percent employed part-time. Of the total 89.6 million uninsured, 64.2 million were between 18 and 64 and more than a third were ages 25 to 44, the age group that makes up the largest percentage of the uninsured.

The numbers fly in the face of the rhetoric of personal responsibility and opportunity that's so often whipped out to argue against social spending. Most uninsured Americans are working -- and they're working fulltime. Health insurance isn't affordable. A few isolated plans, like Tonik, make it more affordable for young adults -- but they're not commonly offered. (Only 8 states.)

In the Families USA analysis, young adults are clearly disproportionately affected -- but the disaggregation for younger folks is 25-44. Other studies, such as that by the Commonwealth Fund in August 2007, break the numbers down to focus on adults 18-29. The conclusions? It's a huge and growing problem. They find 13.3 million young adults were uninsured in 2005, up from 12.9 million in 2004.

Going back further, a Kaiser Foundation report in 2004 showed that one in three young adults (18-29) were uninsured as opposed to one in six older Americans at that time. Young adults 19-24 were less likely to be insured -- 34.9 percent were not -- than young adults 24-29 -- 30.6 percent. 

Commonwealth found that 60 percent of uninsured young adults (19-29)
have forgone health care as a result of their insurance situation. In one amazing NYT Magazine article, read the stories of the young and uninsured, trying to avoid the exorbitant costs of urgent health care despite excruciating and dangerous conditions and accidents. There's the young woman with tuberculosis, a man with a spinal fusion, and a young man whose appendix nearly ruptured. (Exposition on the quality of care received by the uninsured can wait for a second blog post, no doubt soon to come.)

  Yesterday, in a display of cynicism and extreme ideological rigidity, President Bush held a press conference to say that he will Veto a bill that expands the popular S-CHIP (State Children's Health Care Program) because it will lead us to the dreaded socialized medicine that all these crazy liberals are talking about. He added that the plan raises taxes (it doesn't, unless you smoke cigarrettes) and that it covers children whose parents make as much as $83,000 a year (good!). The program is set to expire on September 30th, so the need to reauthorize is urgent. The President says he supports a reauthorization, but does not want to expand the program. Under Bush's plan, there will still not be enough money to cover all of the children eligible of SCHIP coverage.

  Americans shouldn't be fooled by Bush's despicable press conference yesterday. This is a bipartisan bill that passed with a veto proof majority in the Senate. Conservative stalwarts such as Orrin Hatch and Charles Grassley adamantly support SCHIP expansion. Yet, President Bush is so tied to his market based ideology that he will be denying millions of innocent American children access to Health Insurance. This bill is not socialized medicine, though some of us wish it was. It will simply add funding to a succesful, popular program, that allows states to invest in the health of its children. Expanding coverage to lower/middle income Americans is exactly the right thing to do. Millions of middle class Americans cannot afford health insurance because they are squeezed by declining wages and high energy prices. All of this while hedge fund managers are swimming in dollar bills. It is only sensible to take this moderate action, to make sure that 13 million children are no longer punished by their parents' income level.

 Even worse, Bush tried to blame this on the Democrats in Congress, saying that he wants to extend the program, while his opponents are "playing politics." Give me a break. Expanding health insurance to children in a bipartisan, cost effective way is the furthest from playing politics that you can get. Playing politics would be if you threatened to veto a bill simply because you are so fundamentally against the idea of government health care that you can't think clearly. He should be ashamed of himself. As should any member of Congress who votes to uphold the President's veto.

At last! Employer-provided health insurance costs about $12,000 for the average family, of which about $3,000 is paid by the worker. 

The Washington Post  reported that although the rise in costs this year is the smallest since 1999, it still continues to outrun average wages and consumer prices. 

The study cited in the article also showed that people are more nervous about the rising cost of health insurance than they are about not being able to pay their mortgage or losing their jobs. With costs rising like they are, main concerns might turn in to an "all of the above" sort of situation. 

The American federation of State, County and Municipal Employees union went on strike this morning at the University of Minnesota. The local newspaper reports that the workers feel the standard annual pay raises given by the university do not compensate for a rising cost of living. Included in the union are health care and technical workers, and while the University insists that emergency health services will still be available, this is concerning. 

The university is located over a broad stretch of the city, on the east side of downtown, bordering neighborhoods that are generally lower income than the rest of the city. The U of M medical clinics, in their varying locations and purposes, serve not only the students, faculty and the surrounding neighborhoods that need them, but also the Twin Cities area and suburbs. 

From the above linked article: 

"Because health care and technical workers are also involved, this strike may limit the number of non-emergency services provided by Boynton Health Service, the Community-University Health Care Center in the Phillips neighborhood, the university's dental clinic and its veterinary medical clinic."

The clinic available to students will be limited as well as the care center in Phillips, a neighborhood with 31.9% families below the poverty line, including 40.6% of children (according to the 2000 census) and a median family income that is 46% lower than that of the city of Minneapolis as a whole. This area deserves to continue to have access to regular medical care, and I have no problem with a marginal rise in my tuition in order to help provide that (as a rise in worker compensation will likely contribute to this).

There will still be ambulances and emergency services, but how long will the university allow the cities to go without every day care available? Dental and veterinary clinics might seem marginal in comparison, but what about your grandmother's scheduled root canal or your dog's injuries that need attending to? 

I can understand the administration trying to save a little money here and there, but I believe that these workers are a vital part of the community and the university as a whole, and are well worth paying a more generous wage for the crucial services they provide.

The New York Times reported over the weekend that sexual reassignment surgery is now publicly funded in Brazil. A court ruled that such surgeries must be part of a constitutionally guaranteed right to medical care.

Often people wait and save money for years until they can afford these painful and expensive surgeries, but as we saw in Transamerica, the relief felt outweighs the cost. America has a hard enough time convincing the public that health care is deserved, could you imagine the battle for publicly funded reassignment surgery?

The basis for E.H. Carr's international relations classic, The Twenty Years' Crisis:  1919-1939 An Introduction to International Relations, is based on the quest for equilibrium that must be maintained in order to achieve the most in the international arena.  There is constant conflict between Utopian fantasy and cynical realism.  It's a matter of the bureaucrat versus the intellectual.  Both need to compromise.

 What does this have to do with Michael Moore?  Michael Moore makes good documentaries.  His latest, Sicko, is the fourth-most successful documentary in history.  However, because of the way he presents his materials it cannot be a useful tool to enact policy.  

I discussed earlier the need for a balance between Utopianism  and realism, but in convincing people of policy there's a need for good information, passion, but also restraint and good journalism.  Michael Moore's goal should have been to convince people that were not already set on the idea of universal health care coverage.  Instead he further polarized the situation.  First, let's look at one of his choice of subjects:  a single mother who volunteered to clean up after 9/11 who now needs an expensive inhaler each month that she can barely afford.  By choosing her Moore set himself up to be charged with almost insulting manipulation.  He took one of the greatest tragedies in American history and made it a central feature of his film.  To further compound his error, he takes her on a boat to Cuba where they receive immediate medical attention and she receives the expensive inhaler for five cents.  Once again, if he wanted to prove his point he could have taken her to any European country with socialized health care.  Once again, he choose to have her treated in a country that is bitterly antagonistic to America.  He can do better.  The rest of his examples are far more indicative of the health care crisis in American than the 9/11 volunteers and less insulting to the viewer's intelligence.      

If history is any indication, compromises need to be reached unless tyranny is to reign.   If Moore had chosen to present Sicko in a less polarizing way, more would be done.  As those who want a more just society, we need to behave respectfully to those who disagree with us and convince through solid argument and representative examples, not blatant manipulation.    

The New York Times front page story "Market Forces Cited in Lymphoma Drugs’ Disuse" on Saturday was a chilling case in point as to how the profit motive perverts American health care, (per Ezra, Michael Moore et al.) The piece explains how Bexxar and Zevalin, federally approved drugs for lymphoma, are often not prescribed by doctors purely for monetary reasons, even when they might save lives. Dr. Oliver W. Press, a professor at the University of Washington and chairman of the scientific advisory board of the Lymphoma Research Foundation called it "astounding and disappointing” that they are used so little.

According to the Times, oncologists have financial incentives to use other treatments that they are paid to administer, rather than merely the treatments that are the most medically and economically effective. Imagine, instead, if we paid doctors to treat patients successfully. Sounds like a recipe for better outcomes and lower costs. But only a socialist would support such a system, right?

cross-posted on TAPPED.

An article in yesterday’s New York Times chronicles the battle over expanding the State Children’s Health Insurance Program. Doctors, consumer groups, many state officials, and a broad bipartisan coalition in Congress want to see more children covered under SCHIP. Meanwhile the Bush administration stands staunchly opposed to the program’s expansion, deriding it as a step towards government-run healthcare, which some believe will be costly and add unnecessary bureaucracy.

It’s well known that the United States has one of the highest infant mortality rates in the developed world (about 6 per 1,000 births). Progressive health care wonks have long suspected that sub par Medicaid coverage for pregnant women and cuts to programs like the State Children’s Health Insurance Program are culprits. Last month, the counter-CW folks over at Slate announced that actually, babies die because wealthy American spend a lot of money on fertility drugs, prenatal care, and other newfangled treatments that save otherwise unviable pregnancies and lead to increased rates of prematurity and infant mortality.

Yesterday a must-read article on infant mortality in the South appeared in The New York Times. On this issue, at least, it seems counter-intuition will only take us so far: American infant mortality is very much a byproduct of poverty, with all the usual disturbing implications for race and gender. In Mississippi, the poorest state in the country, the infant mortality rate rose from 9.7 to 11.4 per 1,000 births in 2005. Nationwide, white Americans have an infant mortality rate of 5.7, while African Americans have a much higher rate of 14.0.

Poor black mothers are especially at risk for a variety of reasons, ranging from high rates of obesity (which can make ultrasound monitoring difficult and lead to diabetes, thus under-nourishing the fetus) to increased deaths from SIDS, accidents, and disease. Doctors are few and far between in rural counties, and local doctors report that many poor women have no prenatal care at all. In addition, the governor of Mississippi, Haley Barbour, has raised barriers for entrance into the Children’s Health Insurance Program.

All in all, not a rosy picture.

Cross-posted at TAPPED.