Archive | Class War

The Medicaid threat that isn’t getting much attention

Speaking on Medicaid

This story was co-published with NPR’s Shots blog. No corner of the health care system would be harder hit than Medicaid, the federal-state health insurance program for the poor, if Republican leaders in Congress round up the votes to repeal major portions of the Affordable Care Act. GOP lawmakers have proposed winding down the Medicaid expansion… Continue Reading →

Paul Ryan says 22 million people will ‘choose’ not to have health insurance under GOP plan

Paul Ryan Meme

House Speaker Paul Ryan (R-WI) this week disputed reports that 22 million people would lose insurance under the Republican health care plan. During an interview that aired on Tuesday, Fox News host Brian Kilmeade asked Ryan to respond to a recent Congressional Budget Office (CBO) report that said there would be 22 million more people without… Continue Reading →

About those people leeching off government subsidies

Some companies have done away with assigned seating, opting for a more communal workplace. Photo of Parallel courtesy of Allsteel

This is something I’ve been telling people for weeks: Namely, that employer-provided health benefits are subsidized, too.

And now, per the CBO scoring of the Senate bill, 4 million people would lose employer-provided coverage next year — because this bill phases out the employer tax credits:

The Senate Republican healthcare bill could see 4 million people with employer-provided health insurance lose their coverage, according to a report from the non-partisan Congressional Budget Office. The new bill was always likely to leave fewer Americans with health insurance, considering the House version left 23 million more uninsured by 2026. It succeeded there, too: 22 million more people will be uninsured under the Senate plan. But stripping coverage from Americans who get it at work is truly stunning. Employer-based coverage is considered the backbone of the current system, and it’s a frequent subject for Republican rhetoric that dictates if people want insurance, they should get a job. Lesson learned: Don’t sleep on Mitch McConnell.

Whee!

Andrea Mitchell: ‘A brutal image for Republicans and supporters of this bill, frankly’

Elise Lefkowitz, Andrea Mitchell. Photo © Tony Powell. 2017 Great Ladies Luncheon. Ritz Carlton. April 26, 2017

You may not know that many, many years ago, Andrea Mitchell was married to a man with multiple sclerosis. I think she’s actually sensitive to this issue.

MSNBC host Andrea Mitchell described the scene of disabled protesters being carried out by Capitol police in front of Mitch McConnell’s office as “brutal” images for the Republican party. The long time NBC host began a segment on the newly released Senate healthcare bill and explained what was happening at Speaker McConnell’s office. Mitchell said, “Police… Continue Reading →

Voting against their own interests…

Jay Bookman at the AJC had a very good opinion piece regarding promises made by Trump during the elections regarding care for opioid addictions in some of the hardest hits states. The proposed Republican Senate Health bill does not do anything to help this problem, in fact, it is taking away resources for this very problem…

“We’re going to take all of these kids—and people, not just kids—that are totally addicted and they can’t break it,” Trump told a town hall meeting in Columbus back in August. “We’re going to work with them, we’re going to spend the money, we’re gonna get that habit broken.”

As political strategy, it was brilliant. In the industrial Midwest, where Trump in essence won his victory, 95 percent of the counties where he outperformed Mitt Romney also had higher than average rates of drug mortality.

Yet this is the thanks they get. Instead of spending more money, Trump and his fellow Republicans are slashing those programs. In addition to drastic Medicaid cuts, both the House and Senate bills would strip the requirement that private health-care plans cover addiction treatment ….

And nursing homes and care for children is traded for a tax cut.

Both bills cut $800 billion in funding for Medicaid  — much of which covers health care for poor children, for the disabled and for the elderly in nursing homes. Through tax cuts, both bills then smuggle that $800 billion to those who are deemed much more in need.

You know, those in the top 1 percent of income, those who have already benefited enormously from this economy, those whom President Trump sneeringly derides as the elite even as he and his party alter the structure of government and the economy to further enrich that very same elite.

I followed the comments in the paper and on social media. The usual folks that bang the drum for the GOP and Trump are eerily silent on this.

Will conservatives blow up the Obamacare repeal?

Senator Mike Lee discusses criminal justice reform.

It seems possible:

Sens. Ron Johnson, Ted Cruz and Mike Lee made clear during a closed-door GOP meeting Tuesday that they’re not ready to support the party’s health care bill. One aide said the three threatened to vote no — Johnson because of process concerns, Lee and Cruz because of policy concerns — though other aides and lawmakers said the senators were vocally frustrated, but didn’t go as far as making serious threats.

“I don’t think a lot of people are at yes right now,” Sen. John Thune said after the meeting. “I wouldn’t characterize it as there were any, like, ultimatums. But there were concerns being voiced both with respect to substance and process, and that’s kind of a natural part of the conversation. I mean, we’re trying to work through both of those issues to get to, hopefully, a vote next week on a bill that we can all be for.”
Why this matters: Details about the health care bill are finally starting to emerge, forcing senators to say where they stand — and many don’t seem happy with what’s being presented.

One aide who attended Wednesday’s working-group meeting described it as “testy”; another said “there was a lot of brio in the room.” The meeting focused on waivers from certain Affordable Care Act regulations, as well as other market reforms. The waivers wouldn’t explicitly touch regulations protecting people with pre-existing conditions, and even those more limited waiver provisions will likely be removed from the bill next week if the Senate parliamentarian says they don’t comply with the rules for the reconciliation process. Losing that part of the bill would be a big loss for conservatives.

Opioid Deaths Skyrocketing …

Yesterday, the Washington Post report that opioid deaths in the U.S. have skyrocketed since 2005 according to a government report issued this month by the Healthcare Cost and Utilization Project.

The 2014 numbers, the latest available for every state and the District of Columbia, reflect a 64 percent increase for inpatient care and a 99 percent jump for emergency room treatment compared to figures from 2005. Their trajectory likely will keep climbing if the epidemic continues unabated.

The report, released by the Agency for Healthcare Research and Quality (AHRQ), puts Maryland at the very top of the national list for inpatient care. The state, already struggling with overdoses from heroin and prescription opioids, has seen the spread of the synthetic opioid fentanyl, which can be mixed with heroin or cocaine and is extraordinarily powerful. Gov. Larry Hogan (R) this year declared a state of emergency in response to the crisis.

The roots of the problem of opioid addiction are as old as history, but, the recent spike in opioid addiction and overdoses are attributed to two main factors, pain becoming a vital sign that a doctor looks at during an examination (remember the introduction of the smiley face posters for pain) and an extended release version of oxycodone released in 1996.

Fifteen years ago, a report by the Joint Commission on Accreditation of Healthcare Organizations, a nationally recognized medical society which accredits hospitals, stressed that pain was vastly undertreated in the United States. The report recommended that physicians routinely assess pain at every patient visit. It also suggested that opioids could be effectively and more broadly used without fear of addiction. This latter assumption was entirely mistaken, as we now understand. The report was part of a trend in medicine through the 1980s and 1990s toward treating pain more proactively.

The report was heavily publicized, and today it is widely acknowledged that it led to massive – and sometimes inappropriate – increases in the use of prescription opioid drugs to treat pain.

With more opioids being prescribed by well-meaning doctors, some were diverted from the legal supply chain – through theft from medicine cabinets or trade on the black market – to the street for illicit use. As more opioids leaked out, more people started to experiment with them for recreational purposes…

The second major factor was the introduction of an extended release formulation of the potent opioid oxycodone in the 1996. You may know this drug by its brand name, OxyContin. In fact, you might have been prescribed it after having surgery.

The drug was designed to provide 12-24 hours of pain relief, as opposed to just four hours or so for an immediate release formulation. It meant that patients in pain could just take one or two pills a day rather than having to remember to take an immediate release drug every four hours or so. This also meant that OxyContin tablets contained a large amount of oxycodone – far more than would be found in several individual immediate release tablets.

And within 48 hours of OxyContin’s release on the market, drug users realized that crushing the tablet could easily breach the extended-release formulation, making the pure drug available in large quantities, free from harmful additives such as acetaminophen, which most recreational and chronic abusers find irritating, particularly if they inject it intravenously. This made it an attractive option for those who wanted to snort or inject their drugs. Surprisingly, neither the manufacturer nor the Food and Drug Administration foresaw this possibility.

When one looks at the states that have the highest death rates for opioids, one can easily correlate this to the high number of prescriptions per 100 people. West Virginia,  Ohio, and Kentucky have a rate of 96 to 143 prescriptions written to people. New Hampshire has a rate 72 to 81 prescriptions per 100 people. These numbers just astonished me. But, the sources of people that abuse these drugs vary widely.

Most people who abuse prescription opioids get them for free from a friend or relative. However, those who are at highest risk of overdose (using prescription opioids nonmedically 200 or more days a year) get them in ways that are different from those who use them less frequently. These people get opioids using their own prescriptions (27 percent), from friends or relatives for free (26 percent), buying from friends or relatives (23 percent), or buying from a drug dealer (15 percent). Those at highest risk of overdose are about four times more likely than the average user to buy the drugs from a dealer or other stranger.

What will the Trump administration do about the opioid crisis? Well, not much that will be productive.

The White House is calling for a 95 percent funding cut for the Office of National Drug Control Policy, the agency leading the charge against the country’s opioid epidemic, according to sources knowledgeable about the White House’s draft budget for the coming fiscal year. ONDCP is responsible for coordinating drug prevention programs across federal agencies and was slated to fund President Donald Trump’s much-lauded opioid commission.

The budget would slash ONDCP’s $380 million budget to $24 million. It would eliminate the High Intensity Drug Trafficking Areas program, which coordinates local, state, and national efforts to reduce drug trafficking and has a $250 million annual budget. It would also cut the Drug-Free Communities Support Program, which funds community-based youth substance abuse prevention programs. The budget calls both programs “duplicative of other Federal programs.” The budget is a “passback” draft: it was cleared by the White House budget office last week, but will still need to be approved by Congress.

On the campaign trail, Trump promised to “spend the money” to address the opioid epidemic, but his proposed budgets and policies thus far would drastically cut federal funding to tackle the issue.

MAGA

 

 

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