How Medicare and other federal subsidies rope the elderly into painful, futile, and costly end-of-life care. By Shannon Brownlee.
Today’s most ">startling story, from TPM’s Daniel Strauss, is about the growing signs Kansas—yes, Kansas—may be moving crabwise towards a deal to expand Medicaid in order to solve the fiscal crisis created by Gov. Sam Brownback’s enthusiasm for tax cuts.
Brownback, who had previously expressed strong opposition to Obamacare, signaled Wednesday he wasn’t totally opposed to a Medicaid expansion.
“I haven’t said we’ll take it. I haven’t said we wouldn’t,” Brownback said according the Lawrence Journal-World. “Last year, I signed the bill that the Legislature passed [saying] that the Legislature had to approve any Medicaid expansion. I think that’s the way to go because it’s going to involve long-term costs. And the Legislature, that’s their primary authority.”
Now, the conservative Kansas state legislature will hold a hearing on a proposal being crafted by the Kansas Hospital Association in talks with Brownback’s staff that would expand Medicaid in the state through Obamacare. It’s an odd situation given that Brownback, a conservative governor who’s gotten plenty of national attention for standing by his unusually deep tax cuts, has previously opposed expanding Medicaid through Obamacare.
The specific plan that’s been in the works between the Kansas Hospital Association and Brownback’s staff is meant to be acceptable to a Republican governor like Brownback, according to Ward, the Democratic state representative. It’s similar to other plans used in Republican-controlled states to expand Medicaid through the Affordable Care Act.
The plan, according to Kansas’s KCUR, would use federal Medicaid funds to let adults with low incomes buy private insurance coverage. Most important, though, is that the proposal strikes a law passed by conservative Republicans that bars the governor of Kansas from expanding Medicaid without first getting legislative approval.
“What the Hospital bill does is strike that law, repeal that,” Ward told TPM on Tuesday. “And then it directs the governor to engage CMS [Centers for Medicare & Medicaid Service] and get a waiver to expand Medicaid on the red-state model, which is vouchers to buy insurance through the exchanges, it has a work training requirement, and it also has some copay, similar to Arkansas and Indiana.”
In other words, the plan gives Brownback the opportunity to say he’s tricked the socialist Obama administration into paying for non-socialist Medicaid reforms that demand some personal responsibility from those people. And if the legislature’s removed from the picture, then Brownback pretty much has a monopoly on both negotiations and approval.
Meanwhile, HHS officials have to bite their tongues, roll their eyes, and for all I know, maybe have to tell reporters off the record that yeah, that Sam Brownback’s a tough negotiator, all right. It’s understandable: Anything to get people health insurance. I’m just kinda glad Kathleen Sebelius is no longer in a position of having to offer cover to Kansas Republicans engaged in this kind of charade.
Sorry it’s snowing yet again in the South and East. Hang on. Spring officially arrives in just 15 days.
Here are some warm and dry midday news/views snacks:
* Iranian Supreme Leader Ali Khamanei hospitalized with what many believe is stage four prostate cancer.
* RCP’s Scott Conroy makes the shaky case for a Lindsey Graham presidential campaign. A lot seems to depend on Sheldon Adelson.
* National Q-Poll of Republicans confirms CW by showing Walker and Bush first and second with nobody else in double-digits.
* James Fallows talks to some historians about Netanyahu’s abuse of history.
* At the Prospect, Paul Waldman examines a Fox News poll ostensibly showing Americans panting for war with Iran, and finds some funny language.
And in non-political news:
* Second mistrial in sentencing phase of Jodi Arias case.
As we break for lunch, here’s Eddy Grant performing “I Don’t Wanna Dance,” at the Glastonbury Festival, in 2008, I believe. It looks like everybody was in a groove.
So the Wall Street Journal’s Janet Hook has published the first big MSM overview of the fight for the U.S. Senate in 2016, and duly reports the landscape is going to be nearly as good for Democrats then as it was for Republicans in 2014. 24 of the 34 seats up are currently held by the GOP, with seven of them (Ayotte, Grassley, Johnson, Kirk, Porter, Rubio, and Toomey) in states carried twice by Obama. No Democratic seats this time are in red states, though Michael Bennet and especially Harry Reid are both considered vulnerable. All Democratic Senate candidatates, of course, will benefit from better turnout dynamics than in 2014, and those in battleground states (CO, FL, IA, NV, NH, NC, OH, WI) will be affected by presidential campaign investments.
Democrats would need to gain 4 net seats to retake control of the Senate if they hang onto the White House and the Veep’s gavel, and 5 otherwise.
The Donkey Party better get it cooking this Senate cycle, because 2018 presents another gigantic opportunity for the GOP, with Democrats defending 25 of 33 seats. Then in 2020 Republicans get to defend 22 of 33.
You see why my book talks about the prospect of metronomically alternating elections with Democrats likely to win in presidential years and Republicans in midterms? It tends to set up that way especially in the Senate with those six-year terms that alternatively expose incumbents to presidential and midterm cycles.
I don’t know how I missed Gershom Gorenberg’s take on the Netanyahu speech to Congress at the Prospect the other day, but as you might expect he provides the essential Israeli political context in this succinct graph:
In the end, Benjamin Netanyahu’s speech before Congress was precisely what was expected from the beginning, from the day that House Speaker John Boehner publicly invited the Israeli prime minister: an Israeli campaign event before a more impressive and much more sycophantic audience than the Israeli prime minister could have found at home; a Republican show designed to use Israel against President Barack Obama; and a blow to the connection between Israel and the United States that Netanyahu and Boehner supposedly hold so dear.
What’s really galling is that Bibi would so endanger his country’s security for a glorified campaign stop. But like many pols over the centuries, he seems to have concluded maintenance of his power is identical to the national interest. And no backdrop back home would remotely compare to Congress:
Netanyahu insistently, desperately, wants to get the campaign conversation back to Iran. Much more than he’d like, that conversation has been devoted to economic issues, particularly to out-of-control housing prices. Last week, Israel’s state comptroller issued a detailed report that assigned central blame for the housing crisis to Netanyahu. The prime minister’s immediate response to the comptroller’s report on housing prices was, “The biggest challenge facing us is the threat of Iran having nuclear arms.”
A poll published mere hours before Netanyahu’s speech showed that 56 percent of the public consider home prices the main issue of the campaign, and only 31 percent assign that status to Iran. The pollsters framed the choice too narrowly, but the mood it reflects is real.
The chance to speak about Iranian nukes to reflexively applauding members of Congress came just when needed. When he picked the date, Netanyahu didn’t know the housing report was coming. But he did know that he’d get an hour of free television time, two weeks before elections. Israeli election law strictly limits the amount of broadcast time that parties get for campaign ads. And the ads began, as scheduled, on the very day that Netanyahu addressed Congress—but the speech didn’t use any minutes of his Likud Party’s quota, because it didn’t count as an ad.
I suspect many members of Congress didn’t quite realize how they were being used, but unfortunately, many others would have been delighted at the idea they were giving Bibi a tangible boost at a critical moment in the Israeli election campaign. After all, the Israeli cause as defined by Netanyahu is their own idea of a U.S. foreign policy.
You probably first became aware of former congressional staffer Mike Lofgren when he became disgusted by the debt-ceiling fiasco, quit his job, and went public with a scathing tell-all article at Truthout.org in September 2011.
To those millions of Americans who have finally begun paying attention to politics and watched with exasperation the tragicomedy of the debt ceiling extension, it may have come as a shock that the Republican Party is so full of lunatics. To be sure, the party, like any political party on earth, has always had its share of crackpots, like Robert K. Dornan or William E. Dannemeyer. But the crackpot outliers of two decades ago have become the vital center today: Steve King, Michele Bachman (now a leading presidential candidate as well), Paul Broun, Patrick McHenry, Virginia Foxx, Louie Gohmert, Allen West. The Congressional directory now reads like a casebook of lunacy.
Lofgren made news with this rhetoric chiefly because of his Republican pedigree. He began as a staffer for Rep. John Kasich in the early 1980’s. Kasich is now a two-term governor of Ohio. From there, Lofgren built his career focusing on military matters for the House Armed Services Committee and the budget committees of both the House and the Senate.
He followed his Truthout article with a 2012 book: The Party Is Over: How Republicans Went Crazy, Democrats Became Useless, and the Middle Class Got Shafted. I think the title is self-explanatory.
Lofgen doesn’t pulls any punches in this review, as you can tell with his opening:
When I was a congressional staffer, I became acutely aware that elected officials choose issues to put at the top of their agendas mainly for their ability to shake money out of the purses of contributors. The subsequent histrionics in the House or Senate chamber are pure theater for the benefit of C-SPAN and the poor recluses who watch it. Behind every political cause is a racket designed to privatize the profits and socialize the losses.
Lofgren concludes that the War on Terror is ultimately this kind of racket, too.
It is difficult to read Pay Any Price and not come away with the sick feeling that the Bush presidency—which, after all, only assumed office by the grace of judicial wiring and force majeure—was at bottom a corrupt and criminal operation in collusion with private interests to hijack the public treasury. But what does that say about Congress, which acted more often as a cheerleader than a constitutional check? And what does it tell us about the Obama administration, whose Justice Department not only failed to hold the miscreants accountable, but has preserved and expanded some of its predecessors’ most objectionable policies?
Partisans may squabble over the relative culpability of the Bush and Obama administrations, as well as that of Congress, but that debate is now almost beside the point. If Risen is correct, America’s campaign against terrorism may have evolved to the point that endless war is the tacit but unalterable goal, regardless of who is formally in charge.
You definitely want to read the whole thing. Over a 28-year career in Congress working on defense issues, Lofgren gained the kind of perspective you can’t get any place else.
You may have read that the next “cattle call” for Republican presidential wannabes is this weekend, at something called the Iowa Ag Summit, on the hallowed turf of the Iowa State Fairgrounds. You may have also read this morning that Sen. Marco Rubio has abruptly canceled his appearance there, citing a scheduling conflict with a family wedding, which might make you wonder how interested he really is in running for president.
Turns out Rubio may just be sparing himself a very unpleasant experience, since the Iowa Ag Summit has basically been created to put public pressure on the presidential field to support the continuation of federal ethanol subsidies, which are really getting some bipartisan heat in Washington. Bloomberg Politics’ Julie Bykowicz has an excellent report on the elaborate effort by Big Corn to leverage the Iowa Caucuses to save its bacon:
Support for ethanol, a political darling of the past decade, has withered as domestic production of oil and gas has boomed. Critics cite not only government subsidies for the industry but also studies showing that converting corn into ethanol is environmentally harmful. “The worm has turned,” says C. Ford Runge, an agricultural economist at the University of Minnesota at St. Paul. “There’s a certain amount of embarrassment among politicians that they went down this road so far.”
To Bruce Rastetter, an Iowa pork and ethanol mogul, the solution is obvious: Focus on the White House. Rastetter founded Heartland Pork, one of the country’s biggest pork processors, in 1994, before moving into ethanol in 2003. He was a donor to Mitt Romney’s 2012 super PAC, Restore Our Future; now the newest crop of presidential hopefuls is courting him. That’s helped Rastetter sign up about a dozen prospective 2016 candidates to an agriculture summit planned for March 7 at the Iowa State Fairgrounds in Des Moines. Expected attendees include former Florida Governor Jeb Bush, Wisconsin Governor Scott Walker, New Jersey Governor Chris Christie, and former Texas Governor Rick Perry. Texas Senator Ted Cruz, who has sponsored legislation rolling back ethanol mandates in the past, also RSVP’d.
This isn’t just an isolated industry effort; it has engaged the entire state political establishment, especially Governor-for-life Terry Branstad:
The summit dovetails with efforts by Iowa Governor Terry Branstad, a Republican who is close to Rastetter, to start a grass-roots effort to make ethanol a central issue in the Iowa caucuses next January, traditionally the first vote of the presidential primary season. Earlier this year, Branstad announced the formation of a new group, America’s Renewable Future, which intends to mobilize a pro-ethanol army of 25,000 people from each party to participate in the caucuses. The group is backed by Growth Energy, the most active ethanol lobby, and headed by Branstad’s son Eric, who was Iowa field director for the 2004 Bush-Cheney campaign. He says he plans to open an office in each of Iowa’s 99 counties. “We can get our message into the coffee shops where the candidates are,” Eric says. “Then we can use Iowa’s unique status to teach the rest of the country how important ethanol is.”
It’s hardly the first time ethanol has become a litmus test in the Caucuses. When George W. Bush announced for president in 1999, the first policy position he took was a ringing reaffirmation of support for ethanol, and a long record of hostility to the subsidy was a factor in John McCain’s refusal to contest Iowa in 2000 and his half-hearted effort there in 2008. But you get the sense that the Iowa economy’s dependence on ethanol (and more specifically, on corn production) is a lot bigger today, and the industry’s getting a bit panicked.
In 2011, Congress let expire a tax credit worth $6 billion annually to ethanol producers, along with a tariff on foreign ethanol imports. The Obama administration has since moved to lower ethanol quotas for oil refiners, who must use plant-derived fuels under the 2007 Renewable Fuel Standard. In November the Environmental Protection Agency, which never set quotas for 2014, said it would delay issuing new guidance on how much ethanol oil refiners must use until sometime this spring.
The effect has been devastating in Iowa farm country, which is “in semi-crisis,” says Steffen Schmidt, a political science professor at Iowa State University in Ames. Without rising ethanol demand, bumper harvests are creating a corn glut that’s sent prices from more than $8 a bushel in 2012 to less than $4 now. Less money for farmers means less spending: Tractor manufacturer Deere laid off more than 800 Iowa workers in January, in its second round of cutbacks since August; and seed maker Monsanto and chemical giant Syngenta say they expect sales to slow this year. “Ethanol is a serious issue in farm states,” Schmidt says.
At the Ag Summit each prospective presidential candidate will be subjected to 20 minutes of direct questioning by event organizer and ethanol champion Rastetter. Maybe Marco Rubio, who has called for the phase-out of ethanol subsidies, just didn’t want to go through that.
In a long, fascinating Dave Weigel article about the Clinton email “scandal” beginning to assume the familiar outlines of so many conservatives-versus-the-Clintons brouhahas of the past, it’s made clear that Democrats are less worried every minute about the issue, while Republicans are dragging it into the fantasy-world of their other Clinton obsessions. It’s telling that even Bernie Sanders, who is seriously thinking about challenging HRC for the 2016 presidential nomination, dismisses the email “scandal” impatiently.
In some reports, the Democrats have been portrayed as dodging questions about the Clinton story because they are not “rushing to defend her.” There certainly are Democrats, some with rooting interests in Clinton rivals, who are speculating that the e-mail story could wound her 2016 presidential campaign. Yet in Congress, the consensus of many Democrats was that this was just the latest story in a running campaign to discredit a politician who had survived worse.
And the more Democrats disdain the “story,” the more the most disreputable Republicans embrace it. Weigel notes that two of the groups leaping into it avidly are Citizens United and Judicial Watch:
Citizens United is run by David Bossie, who founded the group after years as a congressional investigator into the Whitewater and Clinton finance scandals. Judicial Watch was more or less founded to file lawsuits against the Clinton administration.
But whatever their original motivations, there’s not much question Republicans are driven like candle-moths to the possibility the emails will give them fresh justification to pursue their precious: the shimmering fool’s gold of Benghazi! Even Lindsey Graham, who as a former Clinton impeachment manager should recognize the symptoms of derangement, cannot stop going there:
Graham’s long experience let him watch the Clintons face similar quandaries, fight back, and—with the strong support of Democrats—move past the scandal.
“The difference this time is that there are four dead Americans,” said Graham. “It’s not about money, it’s not about, you know, personal misbehavior. It’s about responsibility. It’s about four dead Americans.”
Might as well drag in another dead American, Vince Foster.
So Jeffrey Toobin wrote his column on yesterday’s oral arguments in King v. Burwell, and here’s the most interesting speculation yet about the Chief Justice’s unusual silence—and the one time he interrupted it:
Roberts’s one question may turn out to be extremely important…..
Anthony Kennedy had asked about “Chevron deference,” a doctrine of law that describes how much leeway the executive branch should have in interpreting laws. Verrilli, not surprisingly, said that the Chevron doctrine gave the Obama Administration more than adequate permission to read the law to allow subsidies on the federal exchange. “If you’re right about Chevron,” Roberts said, at long last, “that would indicate that a subsequent Administration could change that interpretation?” Perhaps it could, Verrilli conceded.
The question suggests a route out of the case for Roberts—and the potential for a victory for the Obama Administration. Roberts came of age as a young lawyer in the Reagan Administration, and there he developed a keen appreciation for the breadth of executive power under the Constitution. To limit the Obama Administration in this case would be to threaten the power of all Presidents, which Roberts may be loath to do. But he could vote to uphold Obama’s action in this case with a reminder that a new election is fast approaching, and Obamacare is sure to be a major point of contention between the parties. A decision in favor of Obama here could be a statement that a new President could undo the current President’s interpretation of Obamacare as soon as he (or she) took office in 2017. In other words, the future of Obamacare should be up to the voters, not the justices.
If Toobin’s right, it will be interesting to see if any conservatives buy the argument and restrain their fury at Roberts for saving Obamacare twice. It’s an issue that transcends this case, of course: all the supposedly tyrannical powers Obama has assumed in the face of congressional obstruction are fully available to future Republican presidents. Leaving aside the handful of conservatives whose objections to “executive overreach” are not limited to its application by the wrong “team,” you’d think they’d have to privately admit Roberts has a point.
Eddy Grant was born in Guyana on this day in 1948 (making him one day younger than Chris Squire) but moved to the UK as a child. As the proponent of a syncretic style of Caribbean music he called Ringbang, Grant spent a good deal of time in recent years reformatting his earlier pop hits, like this one: “Electric Avenue,” performed live in Capetown. It’s good morning music.
I’m discovering that Brunswick Stew tastes better every day it sits in the refrigerator. And also that making too much of the stuff for company pays off down the road. Our California friends call it “BBQ Soup.”
Here are some remains of the day:
* While Justice Department is charging Ferguson, MO, police with pattern of racially biased behavior, it will not charge Darren Wilson of civil rights violation, citing lack of evidence to prove he was not defending himself.
* Rep. Chris van Hollen first Member of Congress to leap aggressively into race to succeed Barbara Mikulski.
* Attempt to override Keystone XL Pipeline veto falls five votes short in the Senate, to no one’s surprise.
* At Ten Miles Square, Martin Longman notes you don’t have to operate on the same financial playing-field as others when your last name is “Bush.”
* The Other College Guide gets a strong review from the Seattle Times.
And in non-political news:
* NTSB may reopen investigation of 1959 plane crash that killed Buddy Holly, Ritchie Valens, and the Big Bopper.
That’s it for Wednesday. Let’s close with Chris Squires jammin’ on “Astral Traveler” from the early Yes album Time and a Word. I’d almost forgotten how good these guys were before anybody talked about Prog Rock.
Since I’ve made a few ominous noises about the possible fallout from Hillary Clinton’s email practices at the State Department, I should note two very persuasive arguments available today suggesting the real scandal could be sloppy or incomplete reporting by the New York Times, which broke the story on Monday.
Mike Tomasky asked the right question late yesterday:
The article says that there were “new” regulations that Clinton was supposed to abide by. It notes that one past secretary of state, Colin Powell, who served from 2001 to 2005, sometimes used his personal email account “before the new regulations went into effect.”
So, a key question would seem to be this: When did the new regulations go into effect? If 2007 or 2008, then Clinton would appear to be in direct violation of them, depending on what precisely they said. If later, it gets a little murkier.
Oddly, the Times article doesn’t say. It doesn’t pin the new regs down to a specific date or even year….
The new regs apparently weren’t fully implemented by State until a year and half after Clinton left State. Here’s the timeline: Clinton left the State Department on February 1, 2013. Back in 2011, President Obama had signed a memorandum directing the update of federal records management. But the National Archives and Records Administration (NARA) didn’t issue the relevant guidance, declaring that email records of senior government officials are permanent federal records, until August 2013. Then, in September 2013, NARA issued guidance on personal email use.
A senior State Department official emailed me to say that “in October 2014, a Department-wide notice was sent out which explained each employee’s responsibilities for records management. Consistent with 2013 NARA guidance, it included instructions that generally employees should not use personal email for the transaction of government business, but that in the very limited circumstances when it is necessary, all records must be forwarded to a government account or otherwise preserved in the Department’s electronic records systems.”
A separate analysis by Bob Cesca at The Daily Banter goes into the various laws and regs in more detail, and argues the only reg (no law) Clinton might have violated was one involving the archiving of her private email—which she later complied with. He’s as unimpressed as Tomasky at both the relatively unremarkable nature of her “crime” and the quality of reporting by the Times.
Now none of this is to say the content of her emails might theoretically contain some dynamite, as congressional Republican “investigating” Benghazi! clearly hope. But that’s true of anyone in public office. So unless more develops, it’s probably time to call off the hunt for alternative Democratic presidential candidates.
I literally groaned aloud when I read this headline from The Hill a couple days ago: “Centrist Dems ready strike against Warren wing.”
The accompanying article by Kevin Cirilli was exactly what I expected: the congressional New Democratic Coalition, with advice from the Progressive Policy Institute, Third Way, and the New Democrat Network, is going to release some sort of agenda/messaging document, like every other identifiable Democratic group in Washington. One of the NDC members and PPI president Will Marshall allowed as how they think Democrats need to talk about economic growth as well as redistribution. Nobody said a damn thing about Elizabeth Warren, other than the NDC member who called her a “great leader.” Yet in Cirilli’s mind—and perhaps this was planted there by one of the “centrists” speaking off the record—this is a “strike” being readied against Warren, if not a full-fledged Struggle for the Soul of the Party.
Ironically, the only Democrat quoted in the piece as directly suggesting Warren’s approach might be politically off was Howard Dean, not exactly your classic “centrist.”
And indeed, Dean’s quote may have been what motivated the esteemed Democratic activist and strategist Mike Lux to rise to Cirilli’s bait and pen an angry response to the “DC centrists” at HuffPost.
Lux accuses the “centrists” of building up “straw men” of populists like Warren bashing the wealthy. But he seems to be attacking his own “straw men” in interpreting a plea for attention from the NDC as some sort of intraparty Big Bertha.
I cannot speak for any of these people, though I know most of them (other than Dean) pretty well. But it sure sounds like a “fight,” to the extent one actually exists, born of ancient grievances rather than anything said by Elizabeth Warren or anybody else in the present tense.
As a veteran of the intraparty wars of the 1990s and early 2000s, I really don’t know that this is what the Donkey Party needs right now, when Democrats are more in accord on big issues than at any time in my own memory, and with a pretty important election ahead. Yes, of course, there are significant differences among Democrats on policy issues; we’re about to see one of them, on trade policy, blow up for a bit. But it’s just ridiculous to see everybody reaching for their guns over vague nuances of emphasizing this over that theme in messaging documents that nobody’s read and that frankly few will ever read.
There are plenty of calm ways to talk about legitimate differences, and when it comes down to it, primaries are available to let the rank-and-file decide. Perhaps the very first step would be for Democrats to avoid the temptation to seek attention through media types who are trolling for a “Democrats in disarray” article. If I were them, I sure wouldn’t have Kevin Cirilli on speed-dial status.
The transcript of today’s Supreme Court oral arguments in King v. Burwell are out, and since the legal pundits all seem to still be working on their takes, I’ll just cite two tweets from Jeffrey Toobin that to me seem to sum up what we don’t know, which is probably more important than what we do know:
Weird near silence from cj roberts at today's argument #scotus— Jeffrey Toobin (@JeffreyToobin) March 4, 2015
I strongly suspect some analysts will probably put stock in Kennedy’s discussion of the “doctrine of constitutional avoidance,” which in this case would probably mean construing the statute in a way that does not create a constitutional problem—the kind of “undue burden” on or coercion of states the plaintiff’s construction of ACA suggests. And indeed, it would be a pretty rich irony if the same “federalism” concerns that led to the Court making ACA’s Medicaid expansion optional could save Obamacare subsidies. But as Kennedy himself suggests, his “concerns” could lead himself and the rest of the Court in any number of directions.
I’m inclined to consider Roberts’ silence as ominous, but who knows? Let’s just say the arguments did not create the impression of a Court majority frothing to find anyway to kill Obamacare.
Well, my Georgia Bulldogs gave it the old college try, and actually led Kentucky by 9 points in the second half before the insanely talented Cats took over. Now Georgia needs a win at Auburn Saturday to lock an NCAA bid.
Here are some Wednesday midday news/views treats:
* Hospital stocks surge on perceptions Justice Kennedy leaning against plaintiffs in oral arguments for King v. Burrell. More about that later.
* SCOTUSblog analysis of arguments also concentrates on Kennedy questions, but less certain it’s good news for the government.
* Bill Scher the first to ask “what if” HRC forced out of presidential race by email disclosure and what it might lead to.
* Interesting argument at Politico that Boehner actually presiding over “coalition government,” not a majority, in the House.
* 7-1 decision of Alabama Supreme Court instructs probate judges to defy federal court rulings and stop issuing licenses for same-sex marriages.
And in non-political news:
* A guide to bargains available at Radio Shack while company’s banktruptcy is in progress.
As we break for lunch, here’s another excellent Squire bass performance, though the cameras don’t show him a lot. It’s a 2001 performance of “Roundabout” from Fragile. The amateur dancers on stage are members of an orchestra with whom Yes was performing that night.
What a lot of people probably “know” about Medicare and end-of-life situations is the Big Lie told by Sarah Palin and others that the Affordable Care Act had modified Medicare to set up “death panels” aimed at forcing old people and special needs kids into the grave as a cost-saving measure.
The fact that Medicare, before and after the enactment of Obamacare, actually subsidizes invasive, humiliating, fruitless and (yes) wildly expensive care for people already at death’s doors may be hard to credit for some people. Perhaps anyone who read Palin’s infamous Facebook post on “death panels” should have to read Shannon Brownlee’s review of The Conversation: A Revolutionary Plan for End-of-Life Care, by Dr. Angelo Volandes, and Curing Medicare: One Doctor’s View of How Our Health Care System Is Failing the Elderly and How to Fix It, by Dr. Andy Lazris, in the latest issue of the Washington Monthly.
Brownlee, who is senior vice president at the Lown Institute and a lecturer at Dartmouth, skillfully weaves together accounts from Volandes and Lazris of cruel and irrational treatment regimes they’ve felt forced to administer under the current system with her own experience of her father’s death. “Go to the hospital” and “keep treating” are almost always the imperatives, regardless of what the patient or his or her family—who often have no way of understanding what’s happening to them—actually want or need.
Lying just below the surface of these… books is a set of political decisions with which the United States will be forced to grapple in coming decades. When a frail, elderly person gets sick, takes a fall, or has trouble breathing, it’s as if they have stepped onto a slippery chute leading straight into the hospital, no matter how fervently they and their families might wish to avoid invasive treatment as they age and approach death. That’s because hospital services are what our medical industrial complex has been built to offer, and delivering invasive end-of-life care is the job for which we have trained our doctors and nurses. Medicare policy, federal subsidies for hospitals, and taxpayer dollars for medical training all have helped create a technology-rich, hospital-centric system.
What we don’t do is train clinicians to talk to patients, and what we don’t have is the community-based infrastructure for delivering “high touch” care to people where they live. We don’t provide the simple services, like regular meal delivery and aides to help with housecleaning and bathing, that can help an elderly person preserve some autonomy and dignity. We don’t have enough primary care doctors practicing in the community—in part because our teaching hospitals make more money when they train more specialists—and the primary care doctors we do have are too busy to make house calls. Of course, there’s always an assisted-living facility— for those who can afford the $3,000 to $6,000 a month. For the rest of us, once we can no longer perform the simple tasks of daily living, like cooking for ourselves, or toileting, we can either move in with the kids or go to the nursing home.
My own perspective is undoubtedly colored by watching first my stepfather and then my father die slowly in ICU units during the last few years, which embroiled my family in an endless struggle to pry the truth from the armies of medical personnel treating them. When most recently my mother died suddenly, at home, we all said “it was a blessing.” Perhaps it’s time to incorporate that sentiment into our health care policies.
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