The $1,000 test that will destroy health insurance

Ezra Klein in the Washington Post discusses how relatively cheap human genome mapping will destroy the health insurance industry and lead to single-payer Medicare-for-all coverage.  


In 2008, Congress overwhelmingly passed, and President George W. Bush signed, the Genetic Information Nondiscrimination Act. Ron Paul was the lone dissenter. The legislation bars insurers from denying coverage or raising premiums on individuals who show a genetic predisposition toward particular diseases. And in doing, it armed a time bomb beneath the health-care industry.


[snip]

As we sequence more genomes, mine more data, and conduct more studies, we’ll find a lot more connections [between genes and diseases]. Eventually, genomic testing will be a powerful predictor of future illness. And it raises the potential that young people will get themselves tested and then purchase insurance based off the result. So those with a clean genomic result might go for a cheap catastrophic plan, while those with a high risk of developing pricey illnesses will opt for more comprehensive insurance.

The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control.

________________

I would argue further that adverse selection already occurs to some degree with healthy adults often going without insurance or avoiding health maintenance until they qualify for Medicare, which is one reason why Medicare usage is disproportionately high in an individual's first year of use.  Why pay for coverage or a service when that service will be covered by Medicare in a short period of time? 

In one of the quirks of the US system, workers slave away and submit payroll taxes to cover [often wealthy] seniors while they themselves are without insurance. Odd that.  I think Americans just don't understand how screwed up this concept is... and we limp towards single-payer. While I appreciate Klein's argument, private health insurance is already destroyed.

Catholics and the health insurance (ie, birth control) Mandate

The American Catholic has answered the most cited arguments against the Catholic Church's refusal to cover birth control for it's employees in an article called the 10 Most Cited Arguments in Favor of the HHS Mandate.  I've rebutted their most pertinent "answers" below:

10. Yes the Catholic Bishops have spoken in favor of universal health care, I guess it just depends on what you consider "health" and it would fall back to the usual and customary use of the word.  Is birth control "health" care? Society can debate it and find a consensus (that word again). Why am I paying for knee or shoulder surgery for teens who play football or 50 y/o's who downhill ski?  It's immoral I tell ya!

5. The Jehovah's Witness analogy is actually very close to the point. Jehovah's Witnesses are arguing that blood transfusions are elective just like contraception, and these decisions are respected to the point that Jehovah's who are in dire need die for lack of blood.  Why should they pay for coverage for a benefit they will never use and think immoral? Isn't this the same argument made by Catholics about birth control? The second part of the answer is closer to the mark--- why are employers involved in health  insurance at all? It's an anachronism that should be eliminated; my employer does not pay for my auto insurance, so why my health insurance? (More on this at the end of this post.)
 
The writer lists the "side" effects of hormonal contraception but does list the health benefits: lower incidence of ovarian cancer, lower incidence of endometrial cancer, higher hemoglobin levels (less anemia), fewer missed work days from menstrual disorders, lower incidence of ectopic pregnancies, greater feeling of well-being and less worry about unwanted pregnancies. If we are going to be complete, let's be complete and not commit lies of omission.  I realize that this a superfluous argument to true believers: if one believes they are sinning by using birth control, then none of this matters compared to an eternity in hell.

The fact is that contraceptive pills are not a singular entity called "birth control", they fall under the broader classification called "hormonal medication" (I'll leave out IUD's and sterilization for the purpose of this discussion), and hormonal manipulation is used to treat a plethora of diagnoses including prostate cancer (depo-provera and luprolide), premenstrual dysphoric disorder (cyclic hormones), and endometriosis (provera, luprolide, cyclic hormones), among others. Should my employer be allowed to refuse to pay for all hormonal medication?

I'm not sure what the ramifications would be if every employer could pick and choose what benefits are covered by their health insurance plan. After I get my gall bladder taken out would I then discover that my employer belongs to a religion that has a special devotion to bile storage organs and thus has chosen not to cover cholecystectomies, leaving me with a $7,000 bill? What if my employer is a Christian Scientist? How responsible should individuals be for reading all the fine print of every policy? A less facetious argument might surround Lipitor, the cholesterol-lowering medication, and it's analogs, which many medical authorities feel are overprescribed and not without side effects every bit as problematic as hormonal medication. Should my employer have a say in whether my Lipitor is covered?  

1. "98% of Catholics use birth control." Yes, that number seems high, just factoring in the 10% of Catholics who are likely lesbian lowers it to 90% (although I would refrain from invoking Glenn Beck for any serious discussion). Does the Catholic Church have a number? My informal sampling of family and friends is above 50%.  (I know of many patients, friends and family members who use or have used birth control to avoid pregnancy due to the teratogenic effects of other medications they were taking. Is this okay with the Church? According to conservative Catholics: No, they are going to hell. This has led some to re-think their faith in the Church altogether, but that's another story.)  Okay, it doesn't matter--- I'll buy that, and it goes back again to the question as to why any employer is buying my health insurance in the first place.


My further comment:  Employer based health insurance is an anachronism left over from the wage freeze of 1943 when employers could not legally raise salaries so they offered other benefits to entice workers. It's unnecessary now and should be fazed out.  Maybe President Obama is playing eleventy-dimensional chess to make the US population realize how divisive the process of universal health will become without government-supplied and regulated health insurance. Obama and the Democrats chose not to include such a public option in the Affordable Care Act, but maybe this was a circuitous master plan to get citizens (finally) screaming for a Medicare-for-all option like other developed nations have-- like a reverse-psychology approach to waken the masses from their slumber. I doubt it, but who knows?


The bottom line: Catholics now pay for birth control all the time by contributing tax support to Medicare and Medicaid. This is the precedent that would argue for birth control in a public option, universal health Medicare-for-all plan, if it were ever instituted.  Why are they complaining now? In addition, insurance regulation historically requires coverage for any therapy that is determined to be safe and effective.  Using the "safe and effective" standard, birth control (hormones, IUD's and sterilization) meet criteria as a reasonable intervention.   

TED talks = "intellectual fraud"

Something I've thought for years but never could verbalize so eloquently. From Kent Sepkowitz at Daily Beast.  Read the whole thing.

An excerpt:

Nowadays, though, TED spells trouble for several reasons. First it doesn’t celebrate a love of smart people really; it celebrates a love of smart-style people. Just as kosher-style food looks and kinda acts like the real thing, but isn’t, so too are the diplomats of TED U kinda full of it. TED provides the Cliff Notes versions of the talks right there on line (TED quotes), little gnomic cyber-samplers (“If we study what is merely average, we will remain merely average” and “I share, therefore I am”) you can sprinkle around without really understanding a drop of the work that stands behind the claim.

As such, TED is a direct descendant of another American favorite: the get-better-quick scheme...

[snip]

TED and their entire Starship Enterprise world feed directly into many people’s instinctive distrust of the intellectual (and the Santorumians’ absolute contempt). With the provocation, TEDdies are dragging down with them actual American intellectuals (yes they exist). These are the real gym rats who fret their way through daily confusion and panic, hostile never-ending scientific turf wars, and lousy funding to squeeze out a drop of truth – people who scare us not because they are cool but because they are so frantically intense and of a single lumpish piece. Not that the TEDdies care about the trouble, really. They already are getting their slides together for the next big powwow.

.

Stewart...

Just watch:

The Daily Show with Jon Stewart
Get More: Daily Show Full Episodes,Political Humor & Satire Blog,The Daily Show on Facebook

In under 4 minutes he succinctly:


1. Points out the absurdity of the Senate


2. Points out the absurdity of employer-based health insurance


3. Pokes fun at his secular Jewish ethnicity


4.  Relishes in his notoriety of being part of the Senatorial record


5. Reprises old jabs at Newt and Trump


6. Mocks infomercials as a staple of our fatuous consumer culture


Genius.

Taibbi on Breitbart

Matt Taibbi of the Rolling Stone has written an obituary of his ideological antithesis Andrew Breitbart, which he subtitles "Death of a Douche".   Aside from the gratuitous reference to a feminine hygiene product, I guess I don't really understand Taibbi's beef with his buddy Andy. Taibbi praises his style:

For instance, it would be dishonest not to tip a hat to him for that famous scene when [Breitbart] hijacked Anthony Weiner’s own self-immolating "apology" press conference.

....And Taibbi feels that Breitbart has done some decent investigative work:

But there’s no way to watch the raw footage and not grasp how totally nuts some of this ACORN "counseling" was. We have to give Breitbart that.

And Matt goes on to say that while they disagreed about Taibbi's place within the "media-complex", Breitbart's sense of humor was admirable. Really?

This article by Taibbi reinforces one of my previous impressions that he adores the game, being a player, and Taibbi cares less about what side he happens to be on. Like Breitbart had said, you have to pick a side and go to war, and all these guys have a mutual respect for whomever can wheedle themselves into the media spotlight. Taibbi loves the fact that Breitbart paid attention to him, no matter if that attention was negative, no matter that Breitbart appealed to racism and hatred for personal gain.

The legacy of Andrew Breitbart is not completed, and it will be mixed to be sure, but for Taibbi to give such a glowing appraisal of his tactics, his personal attributes and his "career" is disappointing. Even if I agreed ideologically with everything Breitbart presented, his style and demeanor lower the discourse into the gutter and was designed to create discord: obfuscation without clarity, heat without light. Breitbart's mastery of the dog whistle to appeal to the lizard brain is reminiscent of the great propagandists of the modern age-- Lee Atwater, Karl Rove, Dick Morris-- and it is nothing that should be praised. It's akin to praising Jeffrey Dahmer for his dissection skills.

While I enjoyed reading Griftopia, I maintain that Taibbi is not serious about fixing anything or reporting important events as much as he's interested in demonstrating his rhetorical skills for his fans. At least Cesca has the conviction to lay it out truthfully and without pretending that Breitbart was nothing but a self-promoter who would destroy anyone and anything for superficial recognition, even if the fame were infamy.

Cesca:

Andrew Breitbart’s slash-and-burn pursuit of his own career destroyed countless lives and livelihoods. Innocent bystanders in the public debate — noncombatants as I sometimes call them — were crushed by Andrew’s mendacity, his obsessive careerism and his unethical business practices. Workers at ACORN and everyone who that organization sought to help have been crushed. The war against Planned Parenthood was started by Andrew Breitbart and that’s led to its defunding by both Congress and Komen. Who knows how many women will ultimately be hurt by Breitbart’s scams and prank videos. I have nothing positive to say about him.

I Agree.

Breitbart

I prefer to keep quiet rather than speak ill of the dead.  So let's allow Andrew Breitbart's body of work to speak for him.


On the day Ted Kennedy died, Mr. Breitbart had no problem with his Twitter account. From ThinkProgress on August 26, 2009:

Early this morning, news broke that Sen. Ted Kennedy had passed away after serving in the U.S. Senate for nearly 50 years. Soon after, conservative commentator Andrew Breitbart began a sustained assault on Kennedy’s memory, tweeting “Rest in Chappaquiddick.”

Breitbart unapologetically attacked Kennedy, calling him a “villain,” “a big ass motherf@#$er,” a “duplicitous bastard” and a “prick.” “I’ll shut my mouth for Carter. That’s just politics. Kennedy was a special pile of human excrement,” wrote Breitbart in one tweet.

When Politico’s Michael Calderone highlighted Breitbart’s attacks in an article called, “Not all Kennedy critics hold fire,” a pleased Breitbart tweeted:

Classy guy.  He will be missed.
Not.

QOTD

Quote of the day: 




 I tell you, we are here on Earth to fart around, and don't let anybody tell you different. 


--- Kurt Vonnegut

Rick Santorum, professional blowhard

“President Obama said he wants everybody in America to go to college. What a snob! There are good, decent men and women who go out and work hard every day and put their skills to test that aren’t taught by some liberal college professor trying to indoctrinate them. Oh I understand why he wants you to go to college. He wants to remake you in his image. I want to create jobs so people can remake their children into their image, not his.”  


--- R. Santorum, Feb 2012


___________________________________


“And so tonight, I ask every American to commit to at least one year or more of higher education or career training. This can be community college or a four-year school; vocational training or an apprenticeship.  But whatever the training may be, every American will need to get more than a high school diploma.  And dropping out of high school is no longer an option.  It’s not just quitting on yourself, it’s quitting on your country — and this country needs and values the talents of every American.”  


--- B. Obama, Jan 2009, first speech to joint session of Congress

Will someone please fire Bud Selig already?

First he ignored steroids in baseball while statistics are demolished by anabolic behemoths, then he endured Congress nosing around the issue inflicting us with their faux outrage, finally he gets a "policy" about performance-enhancing drugs... which is most recently summarily screwed up in it's management and enforcement.

Please put Bud Selig out of his misery.

Why was Ryan Braun's positive pee test result leaked (bad pun, I know) to the public last fall? Why were we told that he had herpes? Who mis-handled Braun's urine sample? What possessed Selig to agree to an outside arbitration panel if the case was so clear? Why is nobody asking these questions of Major League Baseball?

Baseball is not under any compulsion to protect Constitutional rights, the players belong at the discretion of the League and agree to abide by the rules of the League, but on the other hand the players don't need to be harassed either. Braun either used steroids or he didn't: if he did, he should be suspended, if didn't then he should never have been impugned.

Major League Baseball, the solely American sport, has needed a commissioner for quite a while.

Bush appointee rules against DOMA

From Politico:

Another federal judge has found unconstitutional a key part of the Defense of Marriage Act, the federal law that forbids providing federal government benefits to same-sex spouses.

U.S. District Court Judge Jeffrey White, who sits in San Francisco and was appointed to the bench by President George W. Bush, issued the ruling Wednesday afternoon in a case involving federal judicial law clerk Karen Golinski's request for benefits for her female spouse. White said the stated goals of DOMA, passed in 1996 and signed by President Bill Clinton, could not pass muster under a so-called heightened scrutiny test or even a lower "rational basis" threshhold.

"The imposition of subjective moral beliefs of a majority upon a minority cannot provide a justification for the legislation. The obligation of the Court is 'to define the liberty of all, not to mandate our own moral code,'" White wrote. "Tradition alone, however, cannot form an adequate justification for a law....The 'ancient lineage” of a classification does not render it legitimate....Instead, the government must have an interest separate and apart from the fact of tradition itself."
...
In White's ruling, he also gave an unusual back of the hand to the Chief Judge of the 9th Circuit, Alex Kozinski, who ruled at an earlier administrative stage of the dispute that federal personnel managers had authority to cover Golinski's spouse as a nonspousal member of her family. White called that reasoning "unpersuasive."

Related:

“I think that freedom means freedom for everyone…Any kind of arrangement they wish.”  –Dick Cheney, in defending Maryland’s gay marriage movement.

California’s Proposition 8 gay marriage ban is “utterly without justification” and stigmatizes gay men and lesbians as “second-class and unworthy…This case could involve the rights and happiness and equal treatment of millions of people.” — Ted Olson, GWB’s former Solicitor General.

Bush-era officials seem to be to the left of both Clinton and Obama with regard to same-sex marriage rights.

Stewart on GOP AZ debate

I could not keep my eyelids up for the whole "debate"-- no problem, Stewart summarized it and I defy you not to laugh out loud:




 Clown show.

QOTD

Quote of the Day:


A great many people think they are thinking when they are merely rearranging their prejudices.


~ William James