Category: Ashley Fox

Could Removal of the Confederate Flag have Tangible Impacts on Health Equity?

Yesterday the South Carolina State Assembly finally agreed on a vote to take down the confederate flag from the State House. Although it took the murder of a fellow State Senator in a church to create the political will to get this done, it is a welcome change, and one that has the potential to both improve race relations and possibly even reduce racial health inequalities. While touted as an artifact of Southern heritage, the confederate flag has served as a bruising symbol not only of a painful past but also of a hateful present. Although Southern whites may claim the flag as a symbol of Southern pride, the reality is that the flag was erected in 1961 in protest of federal racial integration policy. Let’s repeat that, it was erected specifically as a symbol of Southern resistance to civil rights.  Whereas 75% of Southern whites describe the flag as a symbol…

Supreme Court Deals Final Death Blow to Republicans over Obamacare

In a 6-3 majority decision, the Supreme Court upheld the constitutionality of the federal health insurance subsidies under the Affordable Care Act that are currently being received by an estimated 6.4 million who live in states with Federally-run insurance exchanges. Most revealing was the short and curt decision, written by one of the court’s staunchest conservatives, Chief Justice John Roberts: “Congress passed the Affordable Care Act to improve health insurance markets, not destroy them,” Robertswrote.  With that, the court was in essence telling Republicans to give it a rest already.

Tax Season Heralds New Supreme Court Challenge to the Affordable Care Act

As tax season approaches, so does another Supreme Court challenge to the Affordable Care Act (ACA). This time the challenge is focused on the new tax subsidies that many Americans will be filing for in their tax returns this year. Once again, the fate of the ACA and the subsidies that millions of Americans are now receiving that have made it possible for them to more comfortably afford health insurance, rests on the decision of a highly politicized court, masquerading as an impartial arbiter of the law.

Finally Owning Obamacare?

In his much talked about State of the Union Address, President Obama finally owned his signature health care law by pointing to two of the biggest achievements of the Affordable Care Act so far: First, that in the past year, ten million uninsured Americans gained health coverage. Second, that health care inflation is at its lowest rate in fifty years. These are both important accomplishments no doubt, but more importantly for advocates of universal health coverage, Obama embraced what he termed “middle class economics”.  This was an important step in stating in clear terms a Democratic platform targeted squarely at the middle class – the median voter – who in theory should be supportive of universal coverage.

The Fleecing of Single-Payer in Vermont: Are Americans too stupid to understand universal health coverage as some health economists think?

What began with a bang in 2011 ended with a whimper last month when Governor Peter Shumlin tabled legislation that would have brought the nation’s first tax financed, unified health system to the state of Vermont. Shumlin, who narrowly won reelection in a too close to call race by vote of the Legislature, was greeted in his inaugural address by the jeers of single-payer advocates protesting his repeal of single-payer plans. Why did the Governor drop his signature health care legislation? According to Shumlin, the answer is clear- it’s the financing stupid.  The tax rate that would have had to be imposed to finance the system was too high requiring an 11.5% payroll tax on all Vermont businesses and a public premium assessment of up to 9.5% of individual income. These were tax rates that he could not he could not, in his words, “responsibly support or urge the Legislature…

Another Unsuccessful Spin for the Democrats: Implications of the Midterm Elections for the ACA

The results of the midterm elections show that the Democrats have once again allowed the Republicans to control the narrative on the health of the nation. They further squandered an opportunity to counter the false rhetoric that the country has been on the wrong path under Democratic control. The Republicans now control both the House and the Senate for the first time since 2007 and by some of the widest margins seen since 1929. Calls to replace the Affordable Care Act (ACA) are once again reverberating throughout the Capital. Despite the fact gas was under $3 a gallon, unemployment under 6%, the stock market was breaking records, and the costs of health care have been declining and millions have gained coverage under the ACA, Democratic campaigns across the country embarked on a deliberate strategy of distancing themselves from Obama and Obama’s record. While it was projected that the democrats would…

VA Needs to be Supported not Undercut

In a report released to President Obama last Friday, White House Deputy Chief of Staff Rob Nabors found “a corrosive culture” and inadequate resources contributed to the Veteran Affairs health care scandal. The allegations that led to resignation of Eric Shinseki as VA Secretary has the potential to be more than just another political scandal. Rather, it is a devastating blow for proponents of universal health coverage in the US because it raises questions about the Federal government’s ability to provide health care for veterans and their families in the US. One of the key arguments of proponents of universal health coverage is the notion health care can be provided more efficiently, effectively and fairly by the government.  Free market mechanisms lead to cost inflation, lack of access for those who cannot afford to pay, and, particularly, when for profit, the potential to compromise quality in the pursuit of profit maximization.

Bringing Sexy back to the States fixes may havemet its December 1st deadline for improving the online health-insurance marketplace, but the unrelentingly flow of criticisms over the glitches will continue to pester the Obama administration. However, what is often not mentioned in the “Obamacare narrative” is the Republican Party’s role in the bungled roll-out of the healthcare exchanges, or how well state-run exchanges are actually doing. Republican dominated states overwhelmingly opted to forgo the opportunity to design their own health care exchanges and instead to allow the Federal government to develop the Exchange. This decision was based on a political calculus that to design a state based Exchange would be seen as complying with the health reform law and contradicting the Republican party’s platform of “repeal and replace” Obamacare.

Why I wish we all had Medicaid

Medicaid, a means-tested program designed to provide health insurance to the very poor, has been pejoratively been labeled as “welfare medicine.” The program was hastily constructed in 1965 as an afterthought to Medicare, whose mandate is to cover the costs of health care among older Americans, people age 65 and up,  who have paid into this social insurance system throughout their lives. The quality of Medicaid has consistently been criticized leaving some to question whether Medicaid is “inferior” insurance and whether a Medicaid expansion is the best way to extend coverage to the working poor and near poor. But what some people don’t realize about Medicaid is that the minimum benefits covered under Medicaid are actually more extensive than the minimum benefits provided under Medicare.

Two competing visions of America: Are we a leader or laggard in health?

Good health poor healthAmong the many issues over which liberals and conservatives in the U.S. disagree is how well the U.S. rates on certain key health indicators compared with other advanced industrial countries. That the U.S. is the greatest country in the world is a common meme propagated in conservative circles whereas among liberals, the fact that U.S. infant mortality rates and life expectancy are on par with many developing countries is yesterday’s news.

Though it may be yesterday’s news to some, a new report from the Institute of Medicine provides additional confirmation for the liberal perspective finding that there is a consistent and pervasive U.S. health disadvantage compared with its peer countries on up to 9 nine different health indicators.  Specifically, compared with 16 peer countries, the U.S. ranked among the lowest on the following 9 health indicators, which contribute to a persistent health disadvantage: 1) Birth outcomes; 2) injuries (including motor vehicle accidents) and violent crime; 3) Teen pregnancy and STDs; 4) HIV/AIDS; 5) Alcohol and drug related mortality; 6) Obesity and diabetes; 7) Heart disease; 8) Chronic lung disease; 9) Disability.

But what even liberals will find interesting about this report are the reasons for the US health disadvantage, which debunk some of the more obvious reasons that might come to mind for the U.S.’s moribund position. Here are a few facts from the report:

  •  A lack of universal health care in the US is not a primary reason for the US health disadvantage. For many it may come as a surprise that health care is not a major contributor to health outcomes.  First, most of the major causes of death and morbidity identified (such as violent crime or HIV/AIDS) are only marginally influenced by the health care system. Furthermore, each of the 16 peer countries that the US is compared with has a universal health care system of one stripe or another, and yet some also cluster at the bottom near the U.S. The UK for instance, with its completely publicly financed National Health Service ranks near the bottom on multiple indicators.
  •  It is not just minorities or extreme poverty that can account for the US health disadvantage. To be clear, this is not to say that low-income individuals and minorities in the US do not suffer a greater burden of disease since they do, but rather that this on its own cannot explain why the US performs worse on average.  The report comes to this conclusion by finding that even white, insured, college-educated, upper-income groups with healthy behaviors, appear to be in worse health than similar groups in comparison countries. Research has consistently found that not only does the US fare worse on certain health outcomes, we also have wider disparities and worse health at all income levels in absolute terms compared with other countries. Furthermore, even Americans with healthy behaviors, e.g., those who are not obese or do not smoke, appear to have higher disease rates than their peers in other countries.
  •  It is not only differences in rates of risk factors like smoking and obesity that matters. Current smoking rates are actually lower in the US than other places and although the US is the heaviest of the 16 countries, obesity can only help explain some of the health disadvantage related to chronic conditions like diabetes and heart disease.
  • The only major contributor to the U.S. health disadvantage that the report can definitively agree on is that high driving rates in the U.S. contributes to our higher mortality rates for automobile accidents. High rates of inequality and our minimalist welfare state are believed to be additional contributors, but the report only reviewed existing evidence and did not test explanations in a systematic way. As usual, the report concludes with a call for more research and is intentionally light on recommendations; since it is government-sponsored report , it cannot make recommendations that might be seen as endorsing a particular policy platform (e.g., that rapacious economic policies have led to vast social inequalities in the U.S. that have harmed health).

The story is not all negative though: the US health disadvantage actually disappears at older ages. The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income. Thus, our high-tech, treatment oriented system with end-of-life issues, which makes the U.S. health care system one of the most expensive in the world, does seem to pay off towards the end of life. In addition, U.S. suicide rates do not exceed the international average and other studies find Americans to be happier than average.

I guess, in the end, perhaps conservatives have the right attitude: ignorance IS bliss.