Weekly Pulse: End-of-Life Counseling Returns, But Death Panels Still Nonsense

by Lindsay Beyerstein, Media Consortium blogger

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Weekly Pulse: Egg Salad Surprise! Congress Votes to Clean Up Food Supply

by Lindsay Beyerstein, Media Consortium blogger

It’s a Christmas-week miracle! The Senate, in a vote that astonished everyone, brought the Food Safety and Modernization Act back from the dead on Monday, as Siddhartha Mahanta reports in Mother Jones. The bill, which will enact tougher consumer protections against E. coli and other deadly contaminants in staples like eggs and peanut butter, died in the Senate last week when the omnibus spending bill it had been folded into kicked the bucket.

At Grist, Tom Philpott explains the initial demise, and the basis for the ultimate resurrection of the bill. The House passed the bill on Tuesday, having already passed it twice before.

President Obama is expected to sign the bill into law, which will usher in the first major overhaul of the country’s food safety system in more than 70 years. Food poisoning strikes 48 million Americans (1 in 6), lands 128,000 in the hospital, and kills 3,000 ever year, according to CDC figures released last week. Now that’s something to talk about with your relatives around the holiday dinner table.

Wisconsin clinic backs off 2nd trimester abortion care

A clinic in Wisconsin has reneged on its commitment to provide second trimester abortion care, as Judy Shackelford reports in The Progressive. Shackelford is outraged that the Madison Surgery Center walked back on its promise to patients. She knows first hand how important later term abortion access can be.

Shackelford found herself in need of a second trimester abortion when she developed a blood clot in her arm during her second, much-wanted pregnancy. She decided to terminate rather than risk leaving her 7-year-old son motherless. It was hard enough to find an abortion provider when she needed one, but if she needed the procedure today, she would have nowhere to turn.

Teen birth rate at record low

The birth rate for women ages 15-19 fell to 39.1 per 1000 between 2008 and 2009, the National Center for Health Statistics announced Tuesday. Many commentators, including Goddessjaz of feministing attribute the drop to the recession. The economy seems to be an important factor because birth rates dropped in all age groups, not just among teens.

Predictably, proponents of abstinence-only-until-hetero-marriage are trying to take credit for the falling birth rate. It’s not clear why they think ab-only is finally starting to work after years of unrelenting failure. Perhaps it was Bristol Palin’s electrifying performance on “Dancing With the Stars”?

Get the government out of my Medicare

We’ve become accustomed to the ironic spectacle of senior citizens on Medicare-funded scooters decrying the “government takeover of health care.” Medicare is wildly popular, even among those who decry “socialized medicine.” When the Affordable Care Act is finally implemented, it won’t feel like a government program, either. Paul Waldman of The American Prospect wonders if this “private sector” feel will undermine support for the program:

The Republican officials challenging the ACA in court have characterized its individual insurance mandate as an act of tyranny ranking somewhere between the Stalinist purges and Mao’s Cultural Revolution. But in the “government takeover” of health care (recently declared the 2010 “Lie of the Year” by the fact-checking site PolitiFact), Americans will continue to visit their private doctors to receive care paid for by their private insurance companies. The irony is that if the ACA actually were a “government takeover,” people would end up feeling much better about government’s involvement in health care. But since it maintains the private system, conservatives can continue to decry government health care safe in the knowledge that most people under 65 won’t know what they’re missing, or in another sense, what they’re getting.

If people don’t realize that they’re benefiting from government programs, they are less likely to support those programs. In an attempt to deflect Republican criticism, the Democrats assiduously scrubbed as much of the aura of government off of health reform as they could. This could prove to be a disastrously short-sighted strategy. If health reform works, the government won’t get the credit, but rest assured that if it fails, it will take the full measure of blame.

Funding for community health centers at risk

One of the lesser-known provisions of the Affordable Care Act was to expand the capacity of community health centers (CHCs) from 20 million to 40 million patients by 2015. This extra capacity will be key for absorbing the millions of previously uninsured Americans who are slated to get health insurance under the ACA.

CHCs have been praised by Democrats and Republicans as an affordable way to provide quality health care. However, state budget crises are threatening to derail the plan, as Dan Peterson reports for Change.org. States must contribute to the program in order to qualify for federal funding. However, state funding for CHCs has plummeted by 42% since 2007. So far this year, 23 states have cut funding for CHCs and eight have slashed their budgets by 20% or more.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Rasmussen Polling Irregularities - A first post

It's already well established that Rasmussen polls are consistently to the right of other polls, and this is often explained in terms of legitimate differences in methodological minutiae. However, looking at the a large database of Rasmussen polls, it seems that their pro-republican bias, or House Effect, is not monolithic. There seems to be evidence that Rasmussen's house effect is much larger when Republicans are behind, and that it appears and disappears quickly at different points in the election cycle.

 

See graphs and more below the fold or at StochasticDemocracy.com

 

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New Statistical Profiles of Immigrants and Hispanics in the U.S. Just Released

The Pew Hispanic Center just released updated statistical profiles of immigrants (38 million foreign-born residents) and Hispanics (47 million) in the U.S. The profiles include a large spectrum of information such as occupation, industry, income, poverty, or educational attainment by race and ethnicity in 2008, and how that compares to 2000.

The data is available at here.

Read more at The Opportunity Agenda website.

The unknowable lightness of being

Cross-posted at River Twice Research.

Each month, the Federal Reserve releases its latest minutes of its last meeting along with its projections of economic activity (www.federalreserve.gov). The minutes just released indicate that its prior forecasts have been tweaked a bit, with update projections for unemployment over the next two years, GDP growth, and inflation. As new data become available, the hundreds of economists at the Fed revise and recalculate numbers, which means that any forecast rarely lasts more than a few months.

And yet, the Fed's forecasts - along with the World Bank, the International Monetary Fund, the Office of Management and Budget, the Congressional Budget Office and various others - are used to frame every single meaningful discussion about the economy. They become the fodder for media reports, for budgetary decisions made by companies, and for individuals who digest the sound-bites - "Fed predicts unemployment will level off at 9% next year" - that shapes their sentiment. Investors also turn to these signposts as markers to navigate a complex world.

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