Good News & Bad

Major news today for two attempts at universal health coverage, San Francisco and Massachusetts.

First, the bad (or good, depending on how you look at it): Massachusetts receives additional federal funding for its health plan. I see this as a bad, and so does Kevin, M.D., because it indicates that the state is having problems funding the program on its own. And it most definitely is.

The plan’s rapid growth has generated fiscal pressures. The legislature and Mr. Patrick filled a health care spending gap that approached $200 million for this fiscal year by increasing the tobacco tax by $1 a pack, levying one-time assessments on insurers and hospitals, and raising more money from businesses that do not contribute to their employees’ insurance. The state expects to spend $869 million on subsidized coverage this year.

It's great the government gave them to money to continue the program, but bad that they needed it to begin with. It's not exactly replicable on the federal level if a small state can't do it. As Kevin writes, "If enacted nationally, who will bail out Washington?"

The good: A panel of US Court of Appeals judges rule in favor of San Fran's universal health plan, by saying that the charges on businesses who don't provide health insurance to workers are constitutional. I've liked this program from the beginning because it provides very basic health insurance (so basic, by definition, it's not health insurance) to city residents. Given the groundbreaking nature of the ruling, we'll have to wait and see how/if it holds up in high courts.

I should trademark my blog name

Today I attended a blog launching event for Disruptive Women in Healthcare(TM), a blog created and promoted by the CEO of Amplify Public Affairs. The event and the blog bugged me on a variety of levels.

1) They started the event 40 minutes late. That is just rude.
2) The blog's name is trademarked. I don't think I've ever seen this before, and I think it runs counter to everything a blog stands for. Blogs are supposed to be about openness and collaboration and the sharing of ideas, and trademarking implies just the opposite. It screams, "This name is mine, don't you dare try to use it in anyway." It screams corporate.
3) At the event, each of the "guest bloggers" as they are called (this is their name for all the bloggers, of which there about about 20) in attendance talked for a couple of minutes about why they are a "disruptive woman" and what their first post is about. This took all of 20 minutes, and then they didn't take any questions. This wasn't exactly a hostile crowd. [In fact, I would say it seemed most everyone knew each other.] Why wouldn't they take questions? Were they afraid they'd get asked something tough/uncomfortable? Blogs are about having a conversation... why wouldn't they get that conversation started at the launch?

The whole thing smacks of being corporate. I know there are corporate blogs out there (I run one), but I do think there should have been an attempt to be less so. I think they wanted to come off as, "look we know how to run a corporate blog," and really I left thinking that they know nothing about the purpose of blogs at all. To be honest, they didn't even give a great explanation as to why only women are writing it. That women can change the health care landscape is a given, it's not a reason for launching a blog.

Overall, though, I think it's a great concept, I just wish it had been started by someone a little more knowledgeable about blogs and a little more open to openess. To see all those powerful women up there talking about their views on health care was great. I think it has great potential, I just hope its brainchild doesn't screw it up.

In Massachusetts, you better hope nothing's wrong with you

Lots of coverage today of a Boston Globe article citing the difficulties of Massachusetts residents in finding a primary care doctor, with waits for appointments as long as 100 days. Luckily, the government sees what a problem this is and is taking action:

Now, as the state's health insurance mandate threatens to make a chronic doctor shortage worse, the Legislature has approved an unprecedented set of financial incentives for young physicians, and other programs to attract primary care doctors. But healthcare leaders fear the new measures will take several years to ease the shortage.

I personally agree that action needs to be taken ... but not just in Massachusetts; it needs to happen across the country. There was a study recently that found that the number of medical students entering primary care or internal medicine is dropping, which over time is going to lead to even less access. If people with decent health insurance (I would consider myself one of them) have difficulty find a physician to see them within a decent period of time, the government needs to step in and increase the incentives for medical students to become PCPs.

See additional coverage here, here and here.

"Sweet icing on a bitter cake"

I'm a little late on this, but author Susan Faludi wrote a New York Times op-ed about Hillary's speech on Tuesday at the DNC. What she wrote really resonates with me (I had some of the same ideas in the post I wrote directly after the speech) and it's nice to know I'm not the only one. Here's some highlights:

MUCH has been made of the timing of Hillary Clinton’s speech before the Democratic National Convention tonight, coming as it does on the 88th anniversary of women’s suffrage. Convention organizers are ... pay[ing] homage to the women’s vote in particular and women’s progress in general. By such tributes, they are slathering some sweet icing on a bitter cake. But many of Mrs. Clinton’s supporters are unlikely to be partaking. They regard their candidate’s cameo as a consolation prize. And they are not consoled.

“I see this nation differently than I did 10 months ago,” reads a typical posting on a Web site devoted to Clintonista discontent. “That this travesty was committed by the Democratic Party has forever changed my approach to politics.” In scores of Internet forums and the conclaves of protest groups, those sentiments are echoed, as Clinton supporters speak over and over of feeling heartbroken and disillusioned, of being cheated and betrayed.

The despondency of Mrs. Clinton’s supporters — or their “vitriolic” and “rabid” wrath, as the punditry prefers to put it — has been the subject of perplexed and often irritable news media speculation. Why don’t these dead-enders get over it already and exit stage right?

Shouldn’t they be celebrating, not protesting? After all, Hillary Clinton’s campaign made unprecedented strides. She garnered 18 million-plus votes, and proved by her solid showing that a woman could indeed be a viable candidate for the nation’s highest office. She didn’t get the gold, but in this case isn’t a silver a significant triumph? ... Many Clinton supporters say no, and to understand their gloom, one has to take into account the legacy of American women’s political struggle, in which long yearned for transformational change always gives way before a chorus of “not now” and “wait your turn,” and in which every victory turns out to be partial or pyrrhic.

For all the talk of Hillary Clinton’s “breakthrough” candidacy and other recent successes for women, progress on important fronts has stalled. ...Today, the United States ranks 22nd among the 30 developed nations in its proportion of female federal lawmakers. ... Women's real annual earnings have fallen for the last four years. ... Women’s numbers are stalled or falling in fields ranging from executive management to journalism, from computer science to the directing of major motion pictures. ...

Again, many daughters of a feminist generation seem pleased to proclaim themselves so “beyond gender” that they don’t need a female president. ... As it turns out, they won’t have one. But they will still have all the abiding inequalities that Hillary Clinton, especially in defeat, symbolized. Without a coalescing cause to focus their forces, how will women fight a foe that remains insidious, amorphous, relentless and pervasive?

via Broadsheet.

A Mass. mess

Just as I got on my high horse yesterday to tout the greatness of Massachusetts' health care plan, it comes to light that tens of thousands of state residents, most of who are involved in Commonwealth Care, a state-run program, have been dropped from their plans. According to the Globe:

The state's eligibility documents are complex, advocates said, leading some patients to have their insurance terminated - even though they are eligible for coverage - because they made mistakes filling out the forms. Mail sent by the state to the wrong address is also cited as another reason coverage is dropped.

In other instances, the state misinterprets information on the forms and mistakenly bounces people out of the program, advocates said.

Patients terminated by the state can unknowingly rack up thousands of dollars in medical bills only to discover that those expenses will not be reimbursed. The only way they can get the money back is to sue the state.

Said the office manager of a hospital who helped one her employees navigate the system: "I would consider myself a fairly educated person," Smidy said, "and I got confused."

The state responded that it is working to upgrade its computer systems and that should fix some of the programs. We'll see. It's problems like this that make me wonder if the U.S. as a whole could ever run a government health program, let alone the ONLY government program.

[See WSJ Health Blog for additional coverage.]

18 Million Cracks

I saw Hillary give her concession speech two months ago in D.C. I admit it, I cried. My sister who came with me, she cried. The middle-aged woman standing next to us, she cried, too. And even as I review the text of her speech to post below, I tear up.

...[W]hen I was asked what it means to be a woman running for President, I always gave the same answer: that I was proud to be running as a woman but I was running because I thought I’d be the best President. But I am a woman, and like millions of women, I know there are still barriers and biases out there, often unconscious. ...

I ran as a daughter who benefited from opportunities my mother never dreamed of. I ran as a mother who worries about my daughter’s future and a mother who wants to lead all children to brighter tomorrows. To build that future I see, we must make sure that women and men alike understand the struggles of their grandmothers and mothers, and that women enjoy equal opportunities, equal pay, and equal respect. Let us resolve and work toward achieving some very simple propositions: There are no acceptable limits and there are no acceptable prejudices in the twenty-first century.

You can be so proud that, from now on, it will be unremarkable for a woman to win primary state victories, unremarkable to have a woman in a close race to be our nominee, unremarkable to think that a woman can be the President of the United States. And that is truly remarkable. ...

Although we weren’t able to shatter that highest, hardest glass ceiling this time, thanks to you, it’s got about 18 million cracks in it. And the light is shining through like never before, filling us all with the hope and the sure knowledge that the path will be a little easier next time. That has always been the history of progress in America. [emphasis mine]

Her speech today, and in June, marks the end of something spectacular. But, taking a step back, it shouldn't be. It shouldn't be unusual in this day and age for a woman to run for president. I shouldn't be this upset that a woman lost, knowing it's another 8 years before another woman (or the same!) will have the chance to run again.

We like to think we live in a society without sexism, and I think a lot of people fool themselves into believing its true. And even I -- despite spending a decent amount of my working years as a professional feminist -- managed to become complacent.

Her loss is a slap in the face to women. It's like I'm being told to get back in the kitchen. I don't want a glass ceiling with 18 million cracks in it. I want no glass ceiling at all.

Even tonight, as I watched the coverage on MSNBC directly prior to her speech, some man came on (I'm not sure who) and said that former Hillary supporters were just waiting for Hil to give the word and then they'd be fine with voting for Barack. Because obviously I've been waiting around for someone to TELL me to vote for Barack. I'm just a silly woman who can't make up her own mind, I need to be told what to do (even if by Hillary). To that, unnamed political commentator, I say fuck you. Fuck. You. Part of me really wants to give up on the Democratic Party in general (despite being told its the "women's party" I'm starting to have my doubts) and become an Independent ... but then I remember its my registration as a Democrat that let me vote for Hillary at all.

So when Hillary asked her supporters tonight: "Were you in this campaign just for me?" I have to honestly answer, "Yes, yes I was." If I wasn't, I wouldn't tear up every time I see or hear you. If I wasn't, I wouldn't still be this upset. If I wasn't, I wouldn't feel like your loss was my loss. And despite my love and idolism of you, I simply cannot support your request that I "must support Barack Obama." Sorry, Hil.

No love for the mandate

The Health Care Blog had an interesting piece today comparing Joe Biden's health plan when he was in the primaries (I barely even remember him being an option, to be honest) to Obama's current plan. According to HC blog:

Both cover the usual list of Democrat health care touchpoints -- making coverage affordable with subsidies to people and businesses, creating new public options to supplement private offerings, preventing insurers from denying coverage to the sick, emphasizing prevention and chronic disease treatment, etc., etc., etc., yada yada and so forth.

Neither plan, significantly, follows the Hillary Clinton proposal for mandating coverage for all people. Neither does the vaporous plank on health care in the Democrat's party platform draft.

This makes me sad. I guess you consider Obama's statement that he'd support a single-payer system at some point in the future as his support from universal coverage, but I don't think that goes far enough. I mean, I get it. It's political doomsday to support a mandate (look at Hil now) but really look at Massachusetts. I admit that I haven't looked closely the personal effect of its mandate, or the effectiveness of the coverage, but the resulting increase in coverage is remarkable.

Oh well.