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NYC Weboy
Just your average, everyday weboy.
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NYC commented on the article |"Health care is a civil right."
Really? I think that assertion alone would result in a long, not necessarily satisfying debate.
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NYC commented on the article |"Pay for performance" or "Pay for outcomes" are both theories that have implementation issues - paying for what doesn't happen, or for getting people healthy enought not to visit a doctor, have never been fully fleshed out. In practice, pay for outcomes has been more "pay for improvement" - say, treating diabetes cases so that there's fewer compliance issues with medication, fewer hospitalizations, or such. As with many "reform" ideas floating around, the question that's lingered is how to translate an idea that makes sense in a chronic condition (like, well, mostly diabetes) to everything else. I'm not sure anyone, really, has quite come up with the answer to that.
All of which leads me to believe that the RAND study is probably meant to help healthcare providers argue against any sort of change; the problem with "pay for performance" can't be, really, that work with poorer, or needier patients will suffer... though, you could, arguably, make a case that pay for performance/outcomes won't make a lot of sense in places where outcomes are, already, very, very good. But still, to get to that point... you'd have to have a lot more snese of how pay for outcomes actually gets applied in more situations than we have now. It seems premature to make this the stumbling block.
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NYC commented on the article |As disheartening as the new research is, I think there's still a notion in this approach to food and poverty that's problematic, both from a class perspective and from a question of intent. The "food desert" research isn't nearly as thorough or as clear-cut as many like to claim, leaving quuestions about both the intent and the results of what research there is. But more crucially, there continues to be a judgment call about the choices of others implicit in the "fresh food/fresh produce" discussions that chastises people who choose - ie, are not "forced" - to eat food (eg Dorito's) they actually prefer, even if that food may not, to others, represent a "healthy choice" (it's a criticism that, for instance, is dogging that TV show with Jamie Oliver trying to impose "good food" dictates on West Virginia schools). It's great that we want to offer more fresh vegetables and meat and other options everywhere. It's still the case that many Americans won't choose them. And that includes poor people, no matter well meaning people try to "educate" others that what they want isn't "good" for them.
I remain convinced that until there's a closer examination of class motives and intent, the "food movement" will be stuck churning in place, nagging everyone about eating your fruits and vegetables, with little to show in the way of results. Trying to deal with the effects of poverty, and trying to improve life for poorer people won't succeed by trying to impose top down, or outside-in approaches to issues people face. And I think food policy is especially confused about whether its about helping people in need... or fighting the influence of corporate food providers. Both things are important... but they're not the same thing.
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NYC commented on the article |"this is a once-in-a-generation chance to pass health care reform. Like it or not, it must pass."
"The proposed health care legislation falls far short of expectations. But if the bill passes, 30 million people will no longer be uninsured. ...The bill will also accomplish two other badly needed goals -- to curb costs and to stop insurance companies from rejecting people with pre-existing conditions."
Aside from the absurdity of the first quote - yet more "vote for this legislation or everybody dies!" type urgency that's been overseold all along - the second kind of points up the real problem here: this is not a great bill. At best, it makes some marginal improvements to some forms of health insurance, while preserving or extending deeply probematic elements (like the especially poor funding and oversight of Medicaid, or the troubled elements of Medicare), none more problematic than casting in amber an employer based health system that drives much of other problems. The reason the bill is unpopular then... isn't because of Republicans. It's because Democrats used a badly managed, poorly constructed process to create a bad bill, a bill that has progressively gotten worse as political need has trumped good policy and more pointedly, good sense?
You could argue with those claims - 30 million insured? Well, 30 million will possibly have access to health insurance... but we don't know what premiums will look like, never mind services. The bill does almost nothing to curb cost of healthcare (or, really, cost of premiums), and to say we need this enormous bill to end the denial for preexisting conditions is like buying a bulldozer to kill a roach.
If Scott Brown wins - which seems entirely likely as I write - and healthcare is derailed, Democrats can only blame themselves; from the poor campaign of Martha Coakley to the manhandling of the legislative process, Democrats have, at a time of trmendous power for the party, chosen a path with abuses the power to achieve a political goal. Real health reform, real improvements that would get people better, more affordable care, are not about political gamesmanship. They are about hard choices, unpopular actions, and compromises among thoughtful leaders. We have none of that. Instead... we have this. And if it fails... it fails. And we'll have to try again, hopefully smarter, wiser, and better.
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NYC commented on the article |My doctor ex-boyfriend said that what medical schools look for, in terms of personality... is arrogance. Having worked a good bit with a variety of doctors... I'd have to say that does seem to be the common trait. My ex, who I consider to be one of the smartest, best informed, and caring medical professionals, reflects his in considerable confidence and athletic prowess. Arrogance, then, isn't necessarily a bad thing or about treating others badly (and arrogance, BTW, is not why he's my ex); but it is believing, in the end, that you have the answer or can come up with it. All of this, I think, is worth keeping in mind when we talk about healthcare reform, especially, because it explains a good bit about the real challenges we face trying to change how doctors practice, and why we shouldn't, necessarily, take the word of doctors over others on the financial or political aspects of reform, no matter how confident they sound in their opinions.
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NYC commented on the article |I think the larger point here is the rather sad sate of the Democratic Party: when serious progressives found themselves relying on John Edwards to carry the water for poverty issues... that alone should have been a warning bell. A careful examination of poverty policy proposals would also have pointed out that in terms of specifics, Edwards didn't actually offer all that much to especially cheer (and that, sadly, is another reason why his highlighting poverty as an issue probably didn't help him all that much). Both Clinton and Obama, to a lesser extent, offered more interesting, more creative notions on future attempts to address poverty issues... but still, the big problem here is that the current Democratic Party isn't interested, much, in the actual work of actually helping poor people. Which kind of makes putting poverty policy front and center pretty difficult.
The sad, frustrating reality in politics is that neither party is especially interested in poor voters or poverty policy. Both parties, in essence, want to chase a similar group of educated, well off elites. The Democrats are doing it better. And what appeals to educated professionals is policies that sound like nice, charitable acts... but don't adversely affect quality of life for the well off, or raise their taxes. It's not really tenable.
Something's got to give. But that's not going to happen by rehashing gossip from the last election, and centering the failure of poverty policy on an inherently flawed example like John Edwards. Edwards - always more "look at me" than look at anyone else - used poverty policy as a way, essentially to burnish his own cred: I was poor, therefore I will help them. It's a fairly standard-issue approach to being a Democrat, these days, and a good bit of what counts as being "progressive" ("sure, I now live in a big house in the burbs... but we struggled when I was a kid. I know what that's like."). It's a notion that's almost entirely backwards to really making poverty a focus: instead of asking nice college educated professionals to care about the poor... perhaps the more productive thing would be to look to actual people in poverty, appeal to them, and work, from their end, to solve the actual problems they have to face, on a regular basis. But hey... I heard Elizabeth Edwards is unpleasant. And that's the important thing... right?
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NYC commented on the article |A mandate will certainly decrease the ranks of the uninsured but it isn't a guarantee of lower rates or more generous services.
This should be repeated, over and over: for one thing, it is the second part of why, even if Maine followed Massachusetts, it wouldn't necessarily solve the problem.
It's worth pointing out, too, that Maine's population, unlike much of the northeast, is far more rural, older, and poor. That means solutions geared to more urban settings - where there are more hospitals (too many, in fact), and doctors - are not tailored to what isn't available on the back roads of Maine. That's why Olympia Snowe has been such a reasonable neogiator on much of healthcare - her state needs improvements in Medicaid and a smarter approach to Medicare more than most. And Dirigo is a good example of why "public plans" are not some sort of panacea: there are mistaken assumptions that the state can do healthcare cheaper than private companies... which isn't really true, especially when public plans will have to cover a wide vairety of care issues and may well have a harder time - never mind lack the institutional experience and toughness - controlling unreasonable practice costs.
Like just about every separate aspect of healthcare reforms, mandates alone aren't the answer because lack of insurance is only a small piece of a far more complicated problem - problems we have with how people get care, how we pay for it, and our failure to better educate healthcare consumers. And I think if we fail to get reform this year, a ot of it will be because politicians are still thinking politics over good policy. And that's not an answer to our healthcare problems.
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NYC commented on the article |I think Precious is brilliant... and powerful.
http://nycweboy.typepad.com/my_weblog/2009/11/precious.html
I know that some have objections, and the film is not perfect; but I've yet to see an objection (whether it's to the somewhat muddled attempt at depicting 1987 accurately, or to larger issus around how weight issues, black women and poverty are viewed in our culture) that undoes the impressive achievements Precious accomplishes on a modest budget and with a wide range of performers, fromtalented newcomers to seasoned pros. Precious, to me is what film can do at its best: challenege us, make us think,,, and most importantly, force us to feel. If you want people to understand poverty, this is a good place to start.
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NYC commented on the article |There's part of this that seems to me to underline the reminder that at this point - with Republicans well behind all across the northeast - this debate is often irrelevant. Baker could pick a lawn chair as his running mate and it wouldn't really solve his problems running in a state that's so heavily dominated by the Democratic machine. That may be somewhat less true given Deval Patrick's problems, but Massachusettes and "Republican stronghold" are very unlikely to be together in the same sentence for years to come. And Baker using Tisel to make inroads among gay voters seems farfetched, at best; Boston, Cambridge, Somerville and surrounding areas seem unlikely to be swayed by simple identity pandering.
As for Republicans learning to accept gay politicians... I'm still with "don't hold your breath." As long as the party is whittling itself down to a narrow, conservative group of the faithful, they see no need to be broad minded... and apparently no reaosn to win many elections, either. Until one or the other part of that changes, Tea Party politics will favor "purifyng" the party of anyone seen as defying the party's cultural, political, or social expectations. And gay, in that, is really a trifecta of things to oppose.
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NYC commented on the article |I tend to agree with Leigh and the article that it's hard to know what's causing what here - I suspect the real indictment here is aimed at hospitals and emergency rooms, which have been treated fairly uncritically in the midst of the health reform discussions (the "uninsured turn up in ERs" being a discussion about overcrowded results, not particularly about whether the care is good or not). ER docs and nurses work very hard and face tremendous pressures... but this data does suggest that there's reason to ask if ERs are, in fact, the best solution we've got (or are we putting, say, too much faith in high pressure, emergency situations to deliver miracles on cue?). Whether insurance or lack thereof is at the root here is hard to tell... but I think the data tends to underline the overall complexity of what we're discussing: insurance companies have been trying to cover the young, the healthy, the well employed and the well educated. What follows from that is... who they're not covering: poorer, not employed, less educated... and that they might have other issues (like, say those kids with the gunshot wounds). We are trying very hard to solve for one piece of what I think is really a far more complicated puzzle, and one result - which Massachusetts already shows - is that once the uninsured get insured, they will turn out to be sick. And in need of care that can be expensive. And that unpacks a lot of other problems.
As before, I'd feel better about saying "insurance reform is crucial" if I thought that was the solution (and that the bills in Congress actually dealt well with that, even). But I'd be happier, really, if healthcare reform were a more comprehensive discussion, one that took in a more hoistic approach to asking who winds up in an ER with major traums, why, and how there's more to solve for than just the care they're about to get... which may not help them. Without thinking bigger, we're left clutching at data points and theorizing and, well, guessing. That doesn't seem like a good answer for anything.
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