Wednesday Morning Male Beauty

Insurance Companies: A Major Problem in America's Health Care

Having gone through proton therapy and been on an expensive medication myself during the last year, I know first hand the problems most Americans face when seeking medical treatment.  One of the biggest is the effort by insurance companies to deny coverage and/or restrict permitted medications for the simple purpose of reducing payouts. The companies that happily take your premium payments simply do not want to have to pay out claims when their insureds need medical care or expensive medications.  In my own case, everything was eventually covered after protracted confrontations with my prescription insurance carrier.  Many are not so lucky and the reality is that most of us find non-medical personnel trying to dictate our medical care.  An op-ed in the Washington Post looks at this problem which, to me, is the reason a private for profit health insurance system without a significant challenge of a public option will never best serve individuals' and families' needs.  Here are column excerpts:

We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough.

As a gastroenterologist, I often prescribe expensive medications or tests for my patients. But for insurance companies to cover those treatments, I must submit a “prior authorization” to the companies, and it can take days or weeks to hear back.

Because it ends up with the desired outcome, you might think this is reasonable. It’s not. On most occasions the “peer” reviewer is unqualified to make an assessment about the specific services. They usually have minimal or incorrect information about the patient. Not one has examined or spoken with the patient, as I have. None of them have a long-term relationship with the patient and family, as I have.

The insurance company will say this system makes sure patients get the right medications. It doesn’t. It exists so that many patients will fail to get the medications they need.

I’ve dealt with this system from the patient side, as well. My daughter has a rare genetic disorder . . . She receives applied behavior analysis therapy, an approach often used for autism, and which has been wildly successful in improving her skills and communication. But recently, our health insurer reduced the amount of therapy they thought she needed.

I probably have better access than almost anyone else can get, yet the ability of my daughter’s providers to mitigate denials for services they deem appropriate is slow and often ineffective.

My daughter can languish for months or years not receiving care that every highly qualified person who treats her agrees she needs. While we wait, the window to give her a little bit more function, a little bit less suffering and a little better life gets smaller.

Consumers have a right to appeal denials for health-care services, but regulations still largely focus on the process, not the content. For instance, insurers are required to notify you in writing of a denial, and patients have the right to an internal appeal; if that fails, some states also allow for an external review.

Insurance companies know that many patients don’t bother to appeal at all. A smaller fraction ask for an internal review, and still fewer seek or even know about external review options available in most states. Of the cases that do end up under external review, almost a third of all insurer denials are overturned. This is clear proof that whatever process insurers have to determine medical necessity is often not in line with medical opinion. A study of emergency room visits found that when one insurance company denied visits as being “not emergencies,” more than 85 percent of them met a “prudent layperson” standard for coverage.

This is a system that saves insurance companies money by reflexively denying medical care that has been determined necessary by a physician. And it should come as no surprise that denials have a disproportionate effect on vulnerable patient populations, such as sexual-minority youths and cancer patients.

When an insurance company reflexively denies care and then makes it difficult to appeal that denial, it is making health-care decisions for patients. In other words, insurance officials are practicing medicine without accepting the professional, personal or legal liability that comes with the territory.

We don’t have to put up with this. Health care in the United States is shockingly opaque; it’s time to take insurance companies out of our decision-making process.

Why Extreme Virginia Republicans Need to be Defeated

In not many days, Virginians will go to the polls and decide who controls the Virginia General Assembly. If Republicans retain control, the obstruction  we have seen for over a decade and slavish self prostitution to the gun lobby will continue and common sense gun control will be blocked - Virginia Republicans made this very clear when they shut down the special session called in the wake of the Virginia Beach mass shooting.  Many other much needed progressive reforms will likewise be blocked if Republicans retain control.  To move Virginia forward, it is essential that the Virginia GOP lose control of BOTH houses of the Virginia General Assembly.  A piece in the Virginian Pilot looks at what is at stake.  Here are column highlights:

Were the Democrats to win majorities in both chambers, it would give the party total control of state government for the first time in a generation. It would remove obstacles to long-sought policy priorities, such as stricter gun control, raising the minimum wage, passing the Equal Rights Amendment, and protecting access to reproductive care.

If Republicans can maintain control, expect the GOP to continue to stand firm against new gun laws, to hammer out the details on work requirements for Medicaid access, to reduce taxes and regulations, and to continue the fight against abortion.

Expect legislation about the future of marijuana, gambling, power generation and health care to find their way to the floor as well — their forms dependent on which party guards the gate.

Some items should proceed regardless of which party holds power, most notably the initial steps toward creating an independent, non-partisan redistricting process and to create the type of economic climate that drew Amazon to locate in northern Virginia.

Redistricting reform is key, as crooked past practices promise to have an effect on the races voters see on their ballots. Recall that earlier this year that a legal challenge to the House district maps adopted by the General Assembly in 2011 concluded with 11 districts invalidated as unconstitutional racial gerrymanders, including six in Hampton Roads.

Virginia has been operating under these illegal districts for years. And it’s imperative for the next set of maps to comport with the Constitution so the commonwealth can avoid the protracted legal battle that affected the voting landscape for far too long.

As well, both parties should be deeply concerned about the massive cost facing Virginia as a result of a changing climate and the resulting sea-level rise. Protecting this region will cost billions of dollars, as studies of resilience strategies for Norfolk and Virginia Beach aptly demonstrate.

The cities cannot pay for this infrastructure independent of Richmond, and the whole of the commonwealth has a vested interest in ensuring that Hampton Roads can mitigate the potential damage of recurrent flooding.

Hampton Roads could play the deciding role in who holds the levers of power in the halls of state government. The region has a number of closely contested races that have earned considerable attention.

Given that the outcome of these elections will chart a course for Virginia that will resonate for years to come, voters should turn out in droves on Nov. 5 — and we should be embarrassed if it does not. Commonwealth voters shouldn’t leave anything to chance, and instead spend time getting informed about local races, learning about the candidates and making plans to have their say.

What is striking from the political ads now running on television, the main GOP argument is that Democrats are lying about the records of incumbents (Chris Jones is one such liar) - hoping uninformed voters will fall for these lies - and pretending to be moderates and lying about the GOP candidates' real agenda: blocking progress on health care, pandering to the gun lobby, and blocking efforts to address climate change and rising sea levels.  And yes, there is a strong anti-gay undercurrent that GOP candidates seek to hide from voters.

In 2017 long time anti-gay extremist Del. Bob Marshall at last was sent down to defeat.  Other anti-gay, pro-gun extremist remain in office or are seeking seats in the legislature.  One incumbent who needs to be defeated is Sen. Amanda Chase who wants unlimited access to guns and subscribes to the worst anti-gay lies disseminated by The Family Foundation, Virginia's leading hate group.  Indeed, as Virginia Dogwood News reports, Chase supports electric-shock therapy on LGBT individuals to "change" them:

Chase says she opposes electroshock therapy and other torturous conversion therapy…But in 2019, Chase voted against a bill that would have banned electroshock therapy because it “violates free speech, religious liberty, and endangers children who should be able to receive helpful counsel.”

Not surprisingly, she believes religious belief outweighs non-discrimination laws of all stripes.

Chase is not alone in her extremism.  Locally in the 91st District, Republican candidate Colleen Holcomb is a far right whack job hiding behind a falsely moderate campaign website.  In contrast, her opponent, Democrat Martha Mugler would be a voice of sanity.  In the 13th District, Kelly McGinn is another anti-modernity, pro-gun, anti-gay extremist.  These candidates and incumbents like Chase need to be defeated.  It is urgent Virginians vote for progress on November 5th and send the GOP into minority status. 

Tuesday Morning Male Beauty

Pete Buttigieg's Impressive Rise in the Iowa Polls

An earlier post today noted my worries about Joe Biden and Elizabeth Warren in a general election against Donald Trump.  The same applies to Bernie Sanders who appears a significantly weakened candidate in the wake of his heart attack. While I have not picked my favorite candidate, I am certainly paying attention to Pete Buttigieg who, as USA Today has noted is rising significantly in the polls:

Buttigieg has vaulted himself into the top tier of candidates on the back of a convincing debate performance, according to today’s Suffolk University/USA TODAY poll . . . Here’s where the race stands in Iowa: Former Vice President Joe Biden (19%) leads Massachusetts Sen. Elizabeth Warren (18%), with Buttigieg capturing 13%, Sanders receiving 9%, and billionaire Tom Steyer, Minnesota Sen. Amy Klobuchar, Hawaii Rep. Tulsi Gabbard, and California Sen. Kamala Harris all tied at 3%. . . .

Among only debate watchers, Buttigieg topped the entire Iowa field with 19%, followed by Biden and Warren (tied at 17%), Sanders (9%), and Klobuchar (6%). Both Buttigieg (39%) and Klobuchar (28%) were seen as debate winners last week.

Yes, Buttigieg is young - so were many of the Founding Fathers at the time of the American Revolution - and gay, which means hard core Trump voters would not vote for him.  Neither would they vote for Warren, Biden or any of the other Democrat Candidates. He does, however, have the ability to attract non-aligned moderates and even some Republicans with his adult in the room approach to health care reform and foreign policy.   A column in the Washington Post looks at this aspect of Buttigieg's policy positions and impressive speaking skills.  Here are highlights:

The youngest candidate in the Democratic field [Pete Buttigieg], the one with no civilian experience above the position of mayor, is leading the debate on Syria and pushing one of the top-tier candidates to rethink a major strategic decision.

Buttigieg was on CNN and “Fox News Sunday” expounding on Syria. He told Fox News’s Chris Wallace:

When it comes to what is being done to not just the Middle East, for example, but to American credibility. The fact that right now people who put their lives on the line, trusting that the United States would have their back, and are now betrayed, the fact that U.S. troops in the field feel that their honor has been stolen from them by their commander in chief, how can you not be fired up about something like that?

It is worth underscoring that Buttigieg does not get many Brownie points in a Democratic primary for making a robust defense of U.S. leadership in the Middle East.

. . . Buttigieg has decided to be the grown-up, and incidentally, preserved his viability in the general election as sufficiently tough on national security.

Buttigieg candidly told Chuck Todd on “Meet the Press” that he wasn’t going to play the game of promising an immediate pullout:

We know that we need to promote stability, that we need to stand by our allies and that there will be legitimate Turkish security concerns that will also be part of the equation. But right now what’s happening is the future over there is being decided by everybody but the United States. Russia, Iran, Turkey. . . . the first order of business will be to restore U.S. credibility. Not just with regard to the Middle East but globally.

And he showed restraint when offered the opening to threaten to kick Turkey out of NATO:

Well, right now what we’ve got to do is engage Turkey as an ally. You know, I served alongside Turkish troops in Afghanistan. That alliance is important. And it’s leverage for us to make sure that we use our influence to prevent bad outcomes like the one that Donald Trump greenlighted that they’re doing right now. If they don’t act like an ally in the long-run, that’s going to have consequences.

Buttigieg declined to join Warren and others who have cheered for an immediate pullout from Afghanistan. . . . . Buttigieg pointed out, a lighter footprint with counter-terrorism capacity is “exactly what we had in Syria. A matter of just a few dozen troops, special operators in just the right places, making it possible to prevent the descent into chaos we’re seeing now. So you see, what was withdrawn from Syria is exactly the sort of thing that if we had it in Afghanistan would prevent endless war of the scale that we’re seeing now.”

On Fox News, Buttigieg again pitched an alternate path to Medicare-for-all:

I think that we have a chance to build an American majority around bold action. But it is the case that we could wreck that majority through purity tests. Look, take the example of this Medicare question. I’m proposing Medicare for all who want it. It means we create a version of Medicare, everybody can get access to it, and if you get — if you want to keep your private plan, we’re okay with that. I think that’s a better policy than kicking people off of their plan.

[O]n “Meet the Press,” he pointed out that “my plan is paid for. And we have an opportunity to get everybody health care without kicking people off their private plans and without the multitrillion-dollar hole that appears to be there, unexplained, in Sen. Warren’s plan.”

If Buttigieg is trying to position himself as the younger, more verbally adept moderate in the Democratic race, pushing Warren around and defending an internationalist foreign policy might earn him a starring role. As he shows command of policy and of the debate stage, he is making the case for his viability in the primary. And he implicitly is demonstrating that his cool, deliberate style would be a huge asset against Trump in the general election. A candidate who can go on any talk show and run a “straight-talk express” kind of bus tour with the media is one confident in his ability to be his own best advocate.

If Warren does come forward with details on her Medicare-for-all plan, Buttigieg can claim victory. Then, perhaps, he can get her to explain why it is so necessary to eliminate choice for Americans (if expanded Medicare is so great, they’ll select that under the public option) and how she is going to seamlessly reconfigure our entire health-care insurance system, going from primarily private to exclusively public payment.

Buttigieg is not the only candidate advocating a responsible internationalist role in the world, nor the only one challenging Warren. He might, however, have been the most effective and might the biggest impression with primary voters.

Monday Morning Male Beauty

Biden and Warren Can’t Avoid Their Weaknesses Forever

While both remain in the lead in various polls on the Democrat presidential nomination contest, both Joe Biden and Elizabeth Warren leave me with a sense of unease and a continued fear that neither can defeat Trump in a general election.  On Biden's part - if one overlooks his constant gaffes and age - the albatross of his son Hunter hangs over him and he refuses to fully and properly address the issue - something that plays directly into the hands of Trump and Fox News, the GOP state news channel.  On Warren's part, her refusal to admit that her health care plan would raise taxes in a very visible way is an Achilles heel that will not go away.  This, combined with her liberalism in general could likewise play to Trump's advantage. As a piece in New York Magazine notes, neither one of these candidates appears willing to address these liabilities and prepare for an onslaught by Trump should they win the nomination.  Here are article highlights:

If you paid close attention to the Democratic presidential debate this week, you noticed something that Democrats might find disturbing. The two leading candidates — Elizabeth Warren and Joe Biden, probably in that order — both faced tough questions that could damage them in the general election. And neither appears prepared to defend themselves against what is coming.

Begin with Biden, who has a simple problem with no clear solution. His son, Hunter, traded on his father’s name. In Ukraine, Hunter Biden accepted a lucrative position on the board of Burisma, a Ukrainian energy company. Burisma surely believed hiring the vice-president’s son would give it political juice with the United States government. It did not. . . . Yet this does not fully absolve either Joe or Hunter. . . . At minimum, the arrangement marginally spent down the moral capital of the American government and economy by promoting the perception that official favor can be purchased through family members of powerful officials.

Trump, of course, has degraded that moral capital a million times over with his open nepotism and self-dealing. The problem Biden faces is that it is difficult to communicate the nuance of his position. . . . . Biden’s response to this dilemma was to elide it completely. At the debate, Biden simply insisted he and Hunter did nothing wrong while deflecting the inquiry.

For human and understandable reasons, Biden is obviously reluctant to scold his troubled son in public. Yet the fact is that his son’s behavior is an albatross for the father, and all indications suggest that, if Biden wins the nomination, the damage from this relationship will only grow.

Warren, for her part, faced yet another round of criticism over her refusal to acknowledge the financing mechanism of the health-care plan she has endorsed. The political weak point of the Sanders plan is that it would move 157 million Americans off of employer-sponsored insurance and onto Medicare. In theory, this should work out great. (I would be happy to trade my employer insurance for Medicare.) In practice, this requires convincing half the country to swap their current insurance for a government plan, and to convert their health-care premiums (which are nontransparent and remitted directly by their employer, reducing their wages only indirectly) into taxes (which are paid directly). Poll after poll shows both these changes turn the abstractly popular notion of broader coverage upside down.

Warren’s strategy is to dodge both objections. She has, in the past, avoided the question of people losing their employer insurance by saying nobody likes their insurance company. . . . On taxes, she changes the question to total cost and refuses to acknowledge that taxes will go up in the swap.

Warren’s admirers consider this dodge to be clever, but the last debate shows just how politically corrosive it could become. The problem is that Sanders, who wrote the damn bill, openly admits taxes would go up.  . . . The contrast between one Medicare for All supporter honestly admitting how the plan would work, and the other one refusing to admit it, did not make her look good. It gave her opponents an opening to cast her as shady, which they seized.

Pete Buttigieg pointed out that Warren’s response was “a yes or no question that didn’t get a yes or no answer.” Biden said, “it’s important to be straightforward with them,” and Amy Klobuchar added, “at least Bernie’s being honest here.” This is not merely a problem of Warren being associated with an unpopular policy. It is a question that is corroding her reputation for honesty, which is a foundation of her outsider, truth-telling brand.

As with Biden, Warren will find the reality that Trump is orders of magnitude worse to be of little value. Republicans have a party-controlled mass-media apparatus that has trained its rank and file to support liars, but the Democrats do not.

If Biden wants to beat Trump, he needs to put more distance between himself and his son. If Warren wants to beat Trump, she needs to ditch Bernie’s health-care plan and come up with one that doesn’t have political poison pills. The question with both candidates is, what steps are they willing to take to win?

More Sunday Male Beauty

"Texodus" Bodes Badly for Republicans

Like many Republicans who ultimately became "Never Trumpers," for years George Will served as an apologist for many of the forces within the GOP base - e.g., Christofascists and others who would use religion and a perverted version of "religious freedom" as a basis to harm others while grabbing special rights for themselves.  Then, of course, there were the dog whistle racists who paved the way for the outright white supremacists who now comprise a significant portion of the party base. Both of these factions of the GOP base helped hand Trump the nomination and helped him eek out an Electoral College win despite losing the popular vote by 3,000,000 votes. Belatedly, in my view, Will is playing Cassandra for the Texas Republican Party that has grown increasingly extreme and shamelessly panders to racists and the ugliest and often most ignorant elements of the evangelicals in Texas. The problem the Texas GOP faces is what has already happened in Virginia: the population has changed racially, become increasingly suburban, and finds the GOP's racism and religious zealotry disgusting and loathsome.  In a column in the Washington Post, Will warns the Texas GOP to learn the new reality before it is too late.  Here are excerpts:

I am a classically trained engineer,” says Rep. Will Hurd, a Texas Republican . . . . And he sees portents that his blinkered party would be prudent to notice.

Hurd is one of six Texas Republican congressman who have decided not to seek reelection next year. Until this year, none of them had, since 2011, experienced the purgatory of being in the House minority. In the 2018 “Texodus,” five Texas Republican representatives retired (a sixth resigned) and two were defeated. Of the 241 Republicans in the House when President Trump was inaugurated, almost 40 percent are gone or going. See a trend?

His district, which includes 23 percent of Texas’s land and extends from San Antonio’s fringe to New Mexico’s border, is the state’s largest, encompassing all or parts of 29 counties and 820 miles of the U.S.-Mexico border. It is 58,000 square miles — almost as big as Georgia and larger than Illinois and 25 other states. It is 69 percent Hispanic and just 4 percent African American.

Hurd, an articulate, assertive 6-foot-4 former CIA operative and the only African American Republican in the House, thinks voting trends “are moving so fast” that 2020 “has nothing to do with 2016.” Just as “U.S. economic and military dominance are no longer guaranteed,” neither is Republican dominance in Texas, a state that is hardly immune to national trends.

In the 2016 House of Representatives elections, no Republican incumbent from Texas lost . . . In 2018, there were eight losses, and 16 won with less than 55 percent. . . . Nationally, Republicans are decreasingly strong where two generations ago they were especially robust — in suburbs. Texas ranks high among the states in terms of the percentage of the population that is suburban. And statewide, whites are a minority.

In Texas’s most important 2018 contest for a federal office, incumbent Republican Sen. Ted Cruz won by just three. See a trend?

If the Democratic Party can collect Texas’s electoral votes — 38 today, perhaps 41 after the 2020 Census — as well as California’s 55, it will reap 35.5 percent of a winning 270 from just two states. Then the GOP will have almost no plausible path to 270. . . .

And Hurd will repeat what he says today: Texas is “already purple.” Republicans “have to get out of our own way” because “if the Republican Party in Texas does not start looking like Texas, there will not be a Republican Party in Texas.”

LA Times: Undoing the Great Mistake of 2016

In a reasoned main editorial The Los Angeles Times makes the case of why it is absolutely essential that Donald Trump be defeated in 2020 if he manages to avoid removal from office via impeachment thanks to Senate Republicans who have sold their souls to Trump and/or are as morally depraved as he is.  In the tussle to win the Democrat nomination, too many candidates seem to forget that "Medicare for All" and other policy pitches and differences pale in comparison to the most important goal: defeating Trump and hopefully many Republicans along with him.  Here in Virginia, in 16 days Virginians can fire the opening salvo in this repudiation of Trump and everything that he and the Republican Party have come to represent: open racism, religious extremism driven by hate, not the gospels, and, of course greed and envy.  Greed on the part of the wealthy and envy on the part of those who blame others for their poor life choices (including voting for Republicans who have consistently worked against their base's economic best interests and, of course the embrace of ignorance).  In its editorial, the LA Times is too kind to Trump voters, in my view, and says they were "hoodwinked" rather than face the reality that race, religious extremism, and greed and envy were the real motivations behind their votes.   That said, here are editorial highlights:

As the 2020 election approaches, the United States is deeply and bitterly polarized, shaken by acts of random and not-so-random violence, with wages still rising too slowly, income inequality continuing to increase and the American Dream feeling more and more out of reach for too many people. Despite low unemployment and a frothy stock market, voters feel a deep anxiety about the future and a dark anger at the political system.

With just a year to go before election day, global alliances are fraying as the U.S. turns inward. The culture wars are raging on campus and off. For only the fourth time in American history, a U.S. president is being investigated by the U.S. House of Representatives with an eye toward impeachment. Immigrants are being demonized and detained . . . .

Flitting above this chaotic landscape — fomenting, provoking, preening, spewing, tweeting, blustering and bullying — is President Donald Trump, the worst, most dangerous president in modern history.

All presidential elections are uniquely consequential, but a good case can be made that the next one is the most important of our lives. The time has come to undo the great mistake of 2016 and drive Trump out of office at the ballot box. It is time to pull our country out of the illiberal abyss into which it is sinking and put it on a path toward reason and fairness and empathy and constructive engagement with the world.

Voters need to keep their eyes on the prize: defeating Trump state by state, issue by issue, vote by vote in November of next year.

But stopping him is not going to be nearly as easy as common sense says it ought to be. The country is profoundly riven: More than 60 million Americans consciously chose this [narcissistic demagogue]  president over his opponent four years ago. And many voters remain entranced — hoodwinked, in our view — by his blunt, cocky, overpromising style. He may be coddling dictators, selling off the planet to oil, gas and mining interests, cynically stirring racial resentment and animosity toward immigrants, and provoking an angry trade war with a rising China, but his base remains steadily, stubbornly supportive.

Trump is temperamentally unsuited to be president . . . . Lies, threats and empty promises are his weapons of choice; enemies are mocked and belittled while the dumbly obedient are rewarded. Ignorant and incurious, unmoved by reasoned argument, contemptuous of laws and institutions, Trump is in thrall to exactly the special interests you would expect, he is schooled at the university of Fox News, he is on a constant search for adulation and short-term advantage. He must be defeated in November 2020.

[O]n two issues, we hope the [Democrat] candidates will agree: first, that the top priority has to be defeating the incumbent, who is too irresponsible to be allowed another term; and second, that his defeat is only a first step. Even before Trump was elected, the country was divided and the old system wasn’t working. Political paralysis was already on the rise well before November 2016 . . . Anyone who is not convinced of that should just remember the name Merrick Garland.

In this series we will seek to answer some basic questions: What is our brief against President Trump and why is it so important that he be defeated? . . . We’ll begin to look at some of the policy issues arising in the race, we’ll examine the battle between progressives and moderates, and we’ll consider the importance of race and racism in the election. For Californians in particular, whose policies are especially loathed by this president and who have so often felt the brunt of his disdain, this election is supremely important.

Now is no time to watch from the sidelines. Voters must become engaged, learn the issues, choose sides, speak out. Removing Donald Trump from office in November 2020 is absolutely essential — and yet it is by no means a sure thing. So do not sit this one out. Join in, and make America America again.

Trump must be defeated and/or removed from office by any means necessary.  Hopefully, the lazy and indifferent who stayed home and failed to vote in 2016 will not repeat their mistake and will make sure they go to the polls and cast their vote against Trump and Republicans in general.