The election is over, and President Barack Obama will continue as the 44th president of the United States. There will be much attention paid by the pundit class to the mechanics of the campaigns, to the techniques of microtargeting potential voters, the effectiveness of get-out-the-vote efforts. The media analysts will fill the hours on the cable news networks, proffering post-election chestnuts about the accuracy of polls, or about either candidate’s success with one demographic or another. Missed by the mainstream media, but churning at the heart of our democracy, are social movements, movements without which President Obama would not have been re-elected.
WASHINGTON — With many states lagging far behind schedule, the Obama administration said Friday that it would extend the deadline for them to submit plans for health insurance exchanges, the online markets where millions of Americans are expected to obtain private coverage subsidized by the federal government.
The original Nov. 16 deadline will be extended to Dec. 14 — and in some cases to Feb. 15, the administration said.
The Congressional Budget Office predicts that 25 million people will obtain coverage through the new online shopping malls known as insurance exchanges. Most of them will receive federal subsidies averaging more than $5,000 a year per person to help them pay premiums.
Every state is supposed to have an exchange by Jan. 1, 2014, when the federal government will require most Americans to have insurance. Many states delayed work on the exchanges to see the outcome of a Supreme Court case challenging the health care law, then waited to see if President Obama would be re-elected.
If a state wants to run its own exchange, its governor still must submit a declaration of intent — generally a brief letter of one or two pages — by Nov. 16. But states will have more time to submit the detailed applications required by federal officials.
The White House has repeatedly said that states were making excellent progress toward creation of the exchanges, even as Republican governors and state legislators expressed ambivalence or outright opposition. In addition, state officials who want to establish exchanges said they were having difficulty because Mr. Obama had yet to issue crucial regulations and guidance.
In a letter to governors on Friday, Kathleen Sebelius, the secretary of health and human services, said that many states had asked for “additional time” to submit applications indicating whether they wanted to run their own exchanges or help the federal government run exchanges in their states.
Anyone who still has a smidge of humanity left after our $6 billion electoral argument should consider the symbolism at the top of a ballot now headed for history's vault. The incumbent's father is from a race of people first brought to these shores in chains and sold like whiskey barrels at portside auctions. The challenger's father was born in Mexico, to a family of sexual and religious outlaws who fled the United States.
At the first-ever Republican convention, in 1856, the party platform called for ending the two great sins of American life - "these twin relics of barbarism, polygamy and slavery."
Slavery and polygamy are indeed relics, for the American story is one of working past the barbarism, past the irrational hatred - an arc of enlightenment, with dips along the way.
All of which makes Tuesday's election worth looking at from a longer, wider view. The audacity of electing a black man or a Mormon bishop to lead the free world is something, still. But the overarching Great Experiment - the attempt to create a big, educated, multi-racial, multi-faith democracy that is not divided by oligarchical gaps between rich and poor - is still hanging in the balance.
Animus based on skin color has hardly disappeared: a majority of Americans, 56 percent, harbor some anti-black sentiment, up from 49 percent four years ago, according to a recent Associated Press survey.
You need only read the comments section on a typical day on Glenn Beck's Web site, The Blaze, to find that pond scum has found a crowd. There, Michelle Obama is oft-compared to a cow, her husband is routinely labeled a Muslim Kenyan, and the following type of anonymous post about blacks, from July 12, goes by without challenge: "I think they should go to Africa and live among 'their people' and see how far they get. They as a whole do not appear to see past color and 'gimmee somethin' mista.' There is something missing with these people."
Republican governors are scrambling to figure out what to do about health reform, now that President Obama has won reelection and there’s no stopping the Affordable Care Act.
At least a half-dozen Republican governors vowed not to implement the health-care law until after the November election. “I will make that decision number one after the election,” Alabama Gov. Robert Bentley told a local television station in September.
New Jersey Gov. Chris Christie said in late October, “I’ll make decisions when I have to.”
States face a Nov. 16 deadline to inform Health and Human Services whether they will create a health insurance exchange, the new marketplace that each state will have in 2014.
Republican state leaders must decide quickly whether to implement it or have the federal government do so. Obama also faces imminent challenges to carry out the legislation.
By Noam N. Levey, Washington Bureau
5:49 PM PST, November 8, 2012
WASHINGTON — President Obama's victory all but assures that his landmark healthcare law and its guarantee of insurance coverage for nearly all Americans will be implemented, effectively putting an end to the Republican campaign to derail the law.
That outcome — which seemed almost unimaginable this spring when the Supreme Court considered whether the Affordable Care Act was constitutional — puts immediate pressure on many Republican state leaders who fought it. They must decide in days whether to implement it or have the federal government do it for them.
Tuesday's results also present Obama with a new set of challenges as he tries to fulfill the promise of his signature legislative achievement, the biggest expansion of the social safety net since Medicare and Medicaid were created in 1965.
A few weeks ago, I let some people I don’t know very well put me to sleep, cut open my bum right knee, stick in some metal tools, and whack out some torn cartilage. I trusted them so completely to take good care of me that my heart rate just before sack out ‘n’ whack out time was lower than it would have been had Dunkin’ Donuts run out of coffee.
You might think I could be that relaxed because I had researched exactly what procedure offered me the best chance of a good result, which hospitals and surgeons had the lowest rate of infections and other complications doing this procedure, etc. You might think I — a high-muck-a- muck physician healthcare executive — could do some kind of real comparison of how likely surgeon A in hospital No. 1 would be to make my bum knee the best it could be, with the lowest risk of complications, compared to surgeon B in hospital No. 2.
You’d be wrong. I made my decision about who would do my surgery based on my family doctor’s recommendation, and my hospital choice based on what hospital I knew best. My family doc referred me to one particular surgeon because that surgeon took good care of other patients my doc had referred to him, had good training, did a lot of similar procedures and because he had a good reputation. I don’t think my family doc had any better real data to go on than I did when deciding who should do my surgery, data such as a large analysis of how that surgeon’s knee patients did over the long haul, sophisticated studies of his complication rates, etc.
What does it mean when two very influential physicians with access to all kinds of information about physicians and the quality of care they provide don’t have really good comparative information about which surgeons would provide the best care for them and their patients? Simple: it means that kind of information does not exist about most surgeons, surgical procedures, or hospitals where the surgery is performed. For most care we receive, we simply cannot reliably compare one hospital, or one surgeon, or one family doc, to another.
Even when we can get what looks like good information — comparisons of surgical infections for surgeons or hospitals doing the same procedure — we often have little idea how reliable that information really is. If the sample size was small, if Dr. Femur-Whacker with the higher infection rate had more diabetic patients than Dr. Art Rittic with the lower infection rate, the comparative numbers may be meaningless.
That means we are often stuck instead making assumptions based on surrogate measures of quality. We compare hospital size because there is some evidence that the more procedures a hospital and a surgeon do together, the better their outcomes. However, those studies compare classes of hospitals (larger versus smaller), and not one specific hospital to another. That makes it difficult to know if the results apply to a specific larger or smaller hospital to which you have access.
We use reputation as a surrogate, hoping that if a surgeon or hospital has a good reputation with our family doc, they must be pretty good. We use awards and “seals of approval,” from external expert healthcare agencies such as The Joint Commission. These also, however, do not reliably tell us about our individual chances of doing well after undergoing a specific procedure at the hands of a specific surgeon at such hospitals.
How do we make up for this lack of good, reliable information? Gather all the information we can, get second opinions before we have a procedure we might not need, search websites such ashospitalcompare.hhs.gov for what quality data does exist, ask why you are being referred to one particular surgeon or specialist versus another, ask surgeons how often they and their surgical team do this procedure, etc. Be a better part of the surgical team than most patients: be informed, ask good questions, make sure everyone who touches you cleans their hands in front of you, ask for good instructions and follow them carefully, etc.
By Carl Finamore BeyondChron (San Francisco), Nov. 5, 2012
Let’s not kid ourselves, despite all the talk about healthcare reform the last few years, getting sick in America is still very risky.
There are 25 million people with insurance in 2010 still struggling to pay medical bills according to a conservative estimate by the Commonwealth Fund. In fact, nearly two-thirds of all personal bankruptcies are still linked to those debts. Meanwhile, those without any health insurance were estimated at 48 million in 2011 with the Congressional Budget Office estimating that even after the Affordable Care Act is fully implemented seven years from now, at least 29 million people will remain completely uninsured. Overall, not such a good social contract for most Americans. However, it appears to be a very good deal for wealthy investors. What better source to consult than Bain & Company. Yes, that Bain & Company.
According to Bain, private equity global investments in healthcare doubled in one year – from $15 billion in 2010 to $30 billion in 2011.
That remarkably concentrated investment represents a whopping 15 percent of all private equity deals in the world last year and netted an astounding profit of $500 billion. The question is raised - what impact, aside from the aforementioned huge profits for the few, does that investment in private healthcare have on the rest of us?
I wanted to ask this and other questions of someone equally expert at providing care to patients as Bain is at making money off patients. So, I paid a visit to a working doctor attending the October 27 national conference of Physicians for a National Health Program (PNHP) held in San Francisco.
Andy Coates, MD, is president-elect of PNHP, an acute care physician at a community hospital in upstate Troy, New York, a medical director at a county public nursing home and a faculty member at Albany Medical College. A busy guy.
Asked to identify the number one problem with healthcare in the United States, Dr. Coates replied: “I am very tempted to say ‘profit is the problem,' end of story.”
But there’s more. “The American system has an enormous amount of unnecessary bureaucratic waste," he elaborated. "A great burden of time-consuming administrative efforts, aimed at extracting profit from caregiving, weighs upon us. So much of the cost of healthcare has nothing to do with what is happening at the bedside. The quest for corporate profits undermines the effort to provide medical care to human beings."
Now that President Obama has been reelected, it appears the Patient Protection and Affordable Care Act, better known as Obamacare, is here to stay. And as annual open enrollment periods get underway at many companies, both employees and employers face changes in health insurance coverage and requirements over the next two years.
In Massachusetts, implementation of the federal health care law could be more complex and confusing because of the state’s own universal health care law. While the laws are similar — Obamacare is based on the Massachusetts system adopted under former governor Mitt Romney — they have conflicting provisions. How those conflicts might be resolved remains unclear.
“The Massachusetts law and the federal law don’t sync up,” said Ellen Kaplan, who owns Group Health Specialists in Framingham, which helps small companies with their health insurance plans. “And who’s going to trump whom? Nobody knows.”
Many of the requirements that will be put in place through 2014 will primarily affect employers. But workers will also see changes affecting how they choose and pay for health insurance.
When the Patient Protection and Affordable Care Act (commonly known as "Obamacare") was signed into law in the spring of 2010, congressional opponents vowed that the fight was not over. The most disastrous features of the new law would not take effect until 2014, leaving time for a concerted campaign to avert catastrophe. The way to spend that time, these opponents argued, was working to "repeal and replace" the law that Congress had just enacted.
The "repeal and replace" formulation quickly caught on, but it was not without its critics. That Obamacare should be "repealed" was obvious, given how strenuously conservatives and many independents objected to the new law. But "replace"? Hammering out the details of a new health-care law might easily stir controversy and sow discord, thereby undermining the push for "repeal."
This concern is not unfounded. But repeal will not be enough, for a simple reason: Although Obamacare would worsen many of the problems with our system of health-care financing, that system clearly does call out for serious reform. Despite the widespread public antipathy toward the new health-care law, simply reverting to the pre-Obamacare status quo would be viewed by many Americans, perhaps even most, as unacceptable. After all, a repeal-only approach would leave many of the most grievous flaws in our system of financing health care unaddressed. Chief among them would be steadily rising health-care costs, driven by the same misguided government policies that so evidently demand reform.