5-4

As always, we got rousing coverage from the cable news networks:

The Supreme Court upheld the individual insurance mandate of President Obama’s “Affordable Health Care Act” in a 5-4 decision on Thursday, sending cable news and Twitter into a frenzy.

Moments after the 193-page ruling was released by the court, several media outlets–including CNN and Fox News–erroneously reported on-air that the mandate had been struck down.

“BREAKING NEWS: INDIVIDUAL MANDATE STRUCK DOWN,” CNN’s on-screen scroll blared. “Supreme Court finds measure unconstitutional.”..

CNN, though, was not alone in its rush to report the news.

“Fox News was so eager to see the healthcare mandate fail they forgot to read past the 1st page of the ruling,” Jason Keath wrote, pointing to a screengrab of the network’s breaking news stumble.

Health care vs health care systems

When I say the U.S. has an awful health care system, one of the most common rebuttals is to point out all our great technology. Why, anybody in the world would prefer to have a major medical procedure done in an American setting versus just about any other location. That’s true enough. Our technology is fantastic, and even though our educational system leaves much to be desired, we do have many great doctors, both those bred at home as well as those who come from abroad. But that isn’t what I mean when I talk about our health care system. I’m talking about the way we deliver care, the type of care available to the average citizen, and the cost of that care. Our technology may be wonderful, but that doesn’t mean anything if it costs us exorbitant sums to get it to the average person. Take a look at these two charts:

Of the Western nations surveyed, we spend more than anyone else. Yet in terms of efficiency, we’re ranked 17 out of 19. That’s pitiful.

via PZ.

One reason U.S. health care sucks

I hate hearing this moronic meme that the United States has the best health care in the world. It doesn’t. Anyone who thinks otherwise is ideologically deluded. I’m looking at you FOX Noise.

One major reason for our tendency to suck is that we have relatively little emphasis on preventative care. Countries with real health care, such as Canada, tend to pay a whole lot less overall in their costs while detecting diseases and illnesses early. (As it happens, this tends to help out poor people quite a bit, but hey, that might shrink the unsustainable, ideologically-driven, money-powered, larger-than-pre-1929 income gap we have going on right now.)

Exemplifying the issue is the recent approval of an insanely expensive prostate drug:

Medicare officials said Wednesday that the program will pay the $93,000 cost of prostate cancer drug Provenge, an innovative therapy that typically gives men suffering from an incurable stage of the disease an extra four months to live.

The good news is that the drug extends survival rates by about 4 months versus no treatment and two months versus chemotherapy. The bad news is that Dendreon, the company that makes Provenge, is about to make a billion or so dollars off the taxpayer. It claims this reflects the billion they put into research, but how much of that was subsidized by the government? And are they going to reduce the cost once they recoup their money? (Hint: No.)

But bioethicists who study health care decisions say Medicare’s ruling on Provenge mirrors the bias of the overall U.S. health system, which emphasizes expensive treatments over basic medical care. Health care costs account for nearly one fifth of the U.S. economy, more than any other country.

“We tend to put our health care dollars into very high-tech interventions that produce very marginal improvements,” said Dr. Steven Miles, a professor at the University of Minnesota’s Center for Bioethics. “The problem is that we have created a health care system that is uniquely inadequate in terms of access to primary health care, which is where you get the most bang for your buck.”

One of the big problems with our new health care law is that the stubbornness and fear Americans have towards change has prevented a single-payer system. “But my lib3rty!!!11!!!”, they say. Well, I hope you like a side of late-stage cancer with all that freedom. (Wait…do dead people have liberty?)

2010: FTSOS in review, October to December

This is the fourth and final installment in the 2010 review of FTSOS. See the other three here and here and here.

October:
The most important post I think I have ever made was the one about Tyler Clementi. He was the Rutgers student who was outed as gay by his roommate. As a result – and as a result of a bigoted society – he killed himself. His death was an unnecessary tragedy that ought to bring shame to anyone who has ever voted against civil rights for gays or anyone who has ever made one moment of a gay person’s life more difficult directly because that person was gay.

October is Breast Cancer Awareness Month, so it was disconcerting to read that a few high school refs were being threatened with punishment for trying to support breast cancer research. They wore some pink whistles during football playoff games in order to raise awareness; they were later told they were in violation of some petty dress code and therefore may be facing suspension – including suspension of the pay they had planned to donate to the Susan G. Komen Foundation. After the blogosphere erupted, the organization that oversees refs in that area (Washington state) backed down.

I also went to some length to explain a few basic things about religion that conflict with science. Miracles, directed evolution, intercessory prayer, and the belief that faith is a virtue are all things which science rejects. It simply isn’t possible for someone to hold belief in any of those things and also logically claim he has no conflict with science.

November:
This was the month the board which oversees local quack Christopher Maloney agreed with me that by not referring to himself as a naturopathic doctor, he was creating confusion; people might think of him as a real doctor. Except for when he insists on putting himself in the spotlight or when there is a special occasion (such as this), I consider the issue he created to be done. He lost.

In this month I used the Socratic Method to explain our likely basis for morality. I largely pointed to our common ancestry and the obvious survival benefits that cooperation offers. I also talked about why we ought to act certain ways. We all use ultimately subjective reasoning, and that’s okay: Most of us share a number of values inherent in our nature. We use these values as our common basis for saying what is right or wrong. It’s sort of like a stand-in for objectivity. And we all have it.

I also used Edwin Hubble’s calculations for the age of the Universe to demonstrate a key point about science. One of the most enduring and annoying criticisms of science by people poorly versed in the sciences is that the practice has a history of being wrong. If it has been wrong about so many things in the past, why should anyone believe it now? Except science really doesn’t have the history everyone seems to think it does. The issue is with poor or limited data (such as what Hubble had). The scientific method actually has no limitations in and of itself. The limits come from our own minds.

I also discussed a paper from Nature which a number of creationists butchered. My focus was a particular creationist familiar to FTSOS readers, but a quick search at the time showed that a whole slew of creationists had fundamentally misunderstood the paper. This is understandable since it is unlikely any of them even read the paper (not that they would be able to understand most of it anyway), merely taking their cues from other creationists. In short, the paper was a study of how alleles become fixed in asexual populations versus sexually reproducing populations . In the former, alleles, if they are particularly advantageous, tend to spread through populations rapidly, quickly becoming fixed. But in drosophila, researchers found that for alleles to spread and become important, fixation was not necessarily required. Alleles act in much more complicated systems in sexually reproducing populations than in asexual organisms, so the way their frequency rises or falls is also more complicated.

December:
Since I mentioned FTSOS hitting the arbitrary number of 100,000 hits in an earlier installment of this review, I suppose I will also mention that it hit 200,000 hits in December. There isn’t much more to add to this, though, is there?

In a more significant post, I pointed out that the Catholic Church thinks (probably without realizing it) that Double Effect is wrong. The Church stripped a hospital in Arizona of its affiliation because the hospital made the correct choice to save a woman’s life at the expense of the not-a-human-being fetus she was carrying. This is pretty much the example textbooks give in order to illustrate the very concept of Double Effect.

I also wrote about a local (real) doctor who supports some quackery. Dustin Sulak is from Hallowell, Maine and he has been making a living making out marijuana prescriptions. That’s all fine and dandy (and I’m sure he is being responsible with his power), but he also supports Reiki. That whole ‘field’ is just a bunch of malarkey that has no place in medicine. I find it unfortunate that a perfectly qualified medical professional would lend credence to something so obviously made-up like that.

Finally, I lamented the fact that Republicans were holding up three extremely important bills this month. All three – the repeal of DADT, the New START treaty, and the 9/11 First Responders health care bill – were eventually passed or ratified. The whole hub-bub was a political creation: the Republicans want to embarrass the President, not get anything done. I don’t think the Democrats are by any means wonderful, but at least they tend to be at least half-way pragmatic. And they want 9/11 First Responders to have fucking health care.

So this concludes my review of FTSOS for 2010. Hopefully the next dozen months will be even better.

Common sense and the individual mandate

Over at The Pump Handle, Liz Borkowski lays out the obvious reasons why we need the individual mandate.

To understand the role of the individual mandate, we need to remember that insurance is fundamentally about pooling risk. Out of a large pool of people, the odds are that only a few of them will incur major medical expenses in a given year. Everyone in the pool pays an annual premium, and those premiums will cover the expenses of the unlucky ones who end up needing chemo or heart surgery.

What the government has done with the Affordable Care Act is to promise the insurance industry a large risk pool that includes a lot of healthy youngsters who’d previously gone uninsured, and in exchange require insurance companies to stop denying, rescinding, and charging exorbitant rates for coverage based on applicants’ health conditions. To create the larger risk pool, the law requires that everyone have health insurance, and it provides Medicaid coverage and subsidies for those who’d have trouble affording private plans on their own.

If we lose the individual mandate, insurance companies will be left with a smaller, sicker risk pool, and the result will be higher premiums. Jonathan Gruber does the math and finds that without the mandate, average premiums would be 27% higher in 2019.

I think the initial conservative response is going to be an appeal to libertarian ideals. In fact, that has been the only Republican response since the country started discussing the issue. But trying to argue ideology isn’t going to fix anything. Obama – a pragmatist more than a so-called socialist or anything else people call him without being able to define – and the Democrats pushed through a bill which helps to resolve the issue: high health care costs and insurance companies (legally) operating in bad faith. The only way we’re going to make this thing work is if we all pay into it. That might suck, and we might whine that the single mother or father should – from an ideological/asshole standpoint – be shit-out-luck when she or he breaks a leg, but it’s just about the only thing that’s going to work in the U.S.

Pesky facts

Don’t go about blaming the health care bill for Democratic losses. Those who voted against the bill lost their seats at a higher rate than those who voted for it.

At least they aren’t all crazy

Despite Dubya being the worst president after James Buchanan, Andrew Johnson, Millard Fillmore, and Franklin Pierce, his messed up ideology is not wholly pervasive within his family.

She may have been born into a Republican family, but Barbara Bush, the 28-year-old daughter of former President George W. Bush, sounded more like a Democrat this weekend during an interview with Fox News. When “Fox News Sunday” host Chris Wallace asked her whether she supports President Obama’s health care reform plan, she responded: “I guess I’m glad the bill was passed.”

“Why do, basically, people with money have good health care and why do people who live on lower salaries not have good health care?” she said. “Health should be a right for everyone.” She is president of the Global Health Corps, an organization that champions global health equity.

The article goes on to cite Laura Bush’s support for Supreme Court nominee Elena Kagan, as well as her support for abortion rights and same-sex marriage. It’s nice to at least know that whole family isn’t a bunch of loons.

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