Healthy Mouths, Healthy People

 Health Care, Wonkery  No Responses »
Aug 292012
 

The Times examines how the state Medicaid budget cuts of the last few years are restricting access to dental care for many low-income adults. The inability to obtain preventive care results in more emergency room visits for tooth pain and other dental issues, which E.R.s are ill-equipped to treat. Minnesota is among the states that have cut dental coverage for adults on Medicaid, but it has also begun licensing dental therapists, mid-level professionals who can perform many procedures that dentists traditionally perform. As you might imagine, dentists are not keen on the idea.

Medicaid coverage of dental services may seem like an easily pared optional service, but the importance of good oral health cannot be understated. Gum disease has been linked to diabetes and stroke. Poor dental health can also complicate efforts to obtain employment. Let’s hope states can eventually restore some of these services.

Paul Ryan, Destroyer Of Medicaid

 Health Care, Politics, Wonkery  No Responses »
Aug 172012
 

A Paul Ryan vice presidency could have dire consequences for the poor and people with disabilities. Ryan’s plans to transform Medicare into a voucher system have been well-documented, but his proposed Medicaid reductions would cut even deeper. Between eliminating the Medicaid expansion in the Affordable Care Act and transforming the remainder of Medicaid into a capped block grant, the Ryan budget would deny health care coverage to 30 million people.

Whether Congress would enact such harsh cuts is an open question. Medicaid beneficiaries don’t possess the same political clout as senior citizens, but some elected officials may still cringe at the prospect of reducing services to their most vulnerable constituents.

The need to reform Medicaid is clear and I expect that beneficiaries like me will have to accept some reductions (on top of the reductions in personal care reimbursement we’ve already witnessed). But we would prefer not to hand the reins of power over to two men who seem to regard entitlements as abstractions disconnected from the lives of real people.

Cost Cutting

 Health Care, Wonkery  No Responses »
Jul 242012
 

Talking Points Memo has a good analysis of how the recent Supreme Court decision upholding the Affordable Care Act will affect the federal budget. According to the Congressional Budget Office, the ACA will save an additional $84 billion at a cost of an additional 3 million people left without coverage as a result of some states refusing to participate in the Medicaid expansion. This estimate doesn’t include the cost to hospitals and other providers that will still be required to treat those unfortunate enough to be poor and living in states like Texas or Florida. And the cost of repeal is approximately $100 billion. That probably won’t give pause to the more rabid conservatives seeking the law’s annihilation, but it might be a complicating factor for a Romney administration.

The CBO estimate gives some substance to conjecture about the long-term consequences of the Court’s decision. The federal government and states will realize savings while millions of people who would have received coverage will now be forced to fend for themselves.

That Didn’t Take Long

 Health Care, Wonkery  No Responses »
Jul 022012
 

Several Republican governors, including Wisconsin’s Scott Walker, are already vowing to refuse federal dollars for the now-optional Medicaid expansion. Jonathan Cohn predicts most conservative states will eventually opt into the expansion after getting an earful from hospital executives who want reimbursement for serving low-income individuals, but that it may take a few years to achieve full participation. If that’s true, millions of people could be denied access to health care simply because they happen to live in a state where Tea Party ideology holds sway. The whole point of the expansion was to bring some much-needed uniformity to Medicaid eligibility and benefits rules, particularly in regards to poor adults without children. The Court’s decision undermines that goal and gives conservative elected officials yet another opportunity to score points with their political base while delivering an unabashedly gleeful “Fuck you!” to their poorer citizens.

I do think the expansion will be universally adopted–perhaps more quickly than we realize–but not before it becomes another election-year wedge issue. And not before plenty of elected officials utter some pretty horrible things about Medicaid and the people it serves.

Beware The Spin Doctors

 Health Care, Wonkery  No Responses »
Jun 272012
 

Here’s one of the best quotes I’ve read regarding public opinion and health care reform:

The truth is that healthcare reform is a very confusing and highly technical topic. Americans may support a policy presented in one form, but not in another. Americans may approve of certain individual policies of Obamacare right now, but may not once a strenuous debate takes place. For many, Obamacare remains for the most part an abstraction, which they find hard to judge without having directly felt the effect of several key measures, such as the individual mandate.

Keep these words in mind as both political parties do their damnedest to spin tomorrow’s Supreme Court decision. Most Americans simply don’t spend much time thinking about this stuff and they really shouldn’t have to. They just know that the current health care system is increasingly broken and they want it fixed. Whatever happens tomorrow, those attitudes won’t change anytime soon.

Is Medicaid Worth It?

 Health Care, Wonkery  No Responses »
Jun 182012
 

Last Friday’s episode of the Planet Money podcast examined whether Medicaid actually helps people or whether it’s a waste of public dollars. Alex Blumberg interviews Katherine Baiker, a Harvard researcher who had the unique opportunity to compare people receiving and not receiving Medicaid after Oregon held a lottery to fill 10,000 openings in their Medicaid program. Her findings conclusively show that enrollees enjoy better health and increased financial stability, but at a significant cost because Medicaid enrollees use more health care services.

Professor Baiker cautions health care advocates against making claims that expanding Medicaid saves money (something of which I’ve been guilty of doing). Instead, we should focus on the actual improvements in health that Medicaid provides to low-income people. Policymakers can then have an honest debate about whether better health outcomes are worth the additional public dollars. It’s sound advice for us wonks. Sometimes we’re a little too eager to quantify our policy preferences in terms of dollars and cents. We fear that talking solely about the differences Medicaid can make in people’s lives might sound a little too…earnest. But we shouldn’t be afraid to sound earnest as long as we are clear-eyed about the costs associated with our positions.

Fork In The Road To Health Care Reform

 Health Care, Wonkery  No Responses »
Jun 152012
 

The Times has a handy interactive tool that lets readers game out the possible Supreme Court rulings on the Affordable Care Act. I’m also reminded that I need to set up the office pool on how the Court will rule. I’m picking Monday, June 25th as the date of the ruling and that the mandate will be struck down but the rest of the law will be left standing. If I’m wrong, you have an open invitation to taunt me in the comments section.

There Once Was An App For That

 Disability, Tech, Wonkery  No Responses »
Jun 142012
 

Ars Technica is running a thoughtful article that examines the intersection of disability, technology, and intellectual property. The story centers on an app called Speak for Yourself, which allows an iPad to be used as a communication device for people with disabilities. Prentke Romich, a company that produces specialty assistive communication devices, took notice of the app and filed a patent infringement suit against the developers. The case has yet to be decided, but Prentke Romich also petitioned Apple to remove Speak for Yourself from the App Store, which Apple eventually did. The article also profiles a family whose young daughter uses the app with much success. The family has disabled Internet access on their iPad to prevent any operating system updates that might break the app and worries about what to do if their child breaks the tablet.

Incidentally, Prentke Romich is the same company that produced the headset I’m using to write this post.

The article doesn’t pick sides and I’m inclined to do the same. The app developers seem genuinely motivated to produce an affordable alternative to expensive communication devices while Prentke Romich may have legitimate concerns about protecting its patents. But the real question concerns Apple’s role in this dispute. We often think of apps as trivial things that we use for amusement or for banal tasks like getting directions or comparison shopping. But as mobile technology becomes more powerful and more critical to our daily lives, certain apps may become indispensable to some users. Should companies like Apple have the power to unilaterally pull an app when another party complains? And if so, do we really own the apps that we purchase? Should a communications app that is essential to daily living for some be subject to the same internal policies as Angry Birds? These are big questions that have so far received little attention.

The Failed Promise Of City Wi-Fi

 Tech, Wonkery  No Responses »
Jun 072012
 

When Minneapolis began building its municipal wi-fi network in 2006, locals like me had high hopes that it would offer a compelling and affordable alternative to broadband offerings from Comcast and Qwest (now CenturyLink). But the network’s success has been underwhelming, suffering from low subscriber numbers and competition from both wired and cellular providers. The wi-fi network couldn’t match the higher speeds offered by Comcast or the ubiquitous coverage offered by the cellular companies. A wi-fi network becomes much less essential when people can get online anywhere with their smartphones.

I still think municipal broadband can be a good idea, but perhaps Minneapolis should paid more heed to other cities that abandoned their plans to build wireless networks when they realized the technology doesn’t provide great coverage or speed. Or perhaps the city should have focused on developing hotspots in public places rather than attempting to ensure access for every resident.

The Game Of Life

 Games, Wonkery  No Responses »
May 152012
 

Science fiction writer John Scalzi recently posted a great blog entry framing white male privilege in gaming terms. He asks the reader to think of life as one long role-playing game with “Straight White Male” being the lowest difficulty setting. It’s still entirely possible to lose badly on this setting, but you start the game with much better odds of success than someone playing on the “Gay Woman of Color” setting.

And no, I don’t think I’m playing at a much higher difficulty setting. My disability certainly makes the game more challenging, but I started out with the same advantages as most other straight white men. The fact that I’m living a comfortable middle-class life simply demonstrates how powerful those advantages are.

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