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Medicare does “NOT PAY FOR ITSELF”

In the comments section of an earlier post 1/3 of Medicare Spending is Wasted, I had stated to everyone, “Medicare does NOT PAY FOR ITSELF.” This is what I meant by that comment:

“For more than a decade the the federal government has borrowed to pay for the rising cost of Medicare. Debt-financing of Medicare will increase sharply as the population over 65 doubles from 2010 to 2030 and the number of beneficiaries over 85—with the greatest medical needs—triple.”

Note, using borrowed money to finance Medicare is not something that will happen in the future. It began more than a decade ago. Yet, as the article notes: “Members of Congress are reluctant to argue with constituents who sincerely believe that they have ‘paid for’ Medicare with payroll taxes and premiums. Most find it more convenient to tiptoe around the minefield of Medicare financings.” So the charade continues even today.

People who believe that they have paid for their Medicare with payroll taxes and premiums are terribly naïve and do not realize how much Medicare actually costs or how much “Medicare for all” would cost.

The article goes on to explain the history of how we arrived where we are today and why I make the comment on Medicare:

“In the mid-1990s, Democrats proposed to balance the Medicare budget by limiting fees paid to physicians for services, while Republicans sought to contain the costs by transferring the program to managed care insurers and capping the annual per capita rise in premium subsidies.

In 1997 the leadership in both parties agreed to a plan that would eliminate borrowing for Medicare, principally by limiting the growth in the level of fees paid to physicians. That Medicare reform, along with increasing general revenues paid by taxpayers in the highest bracket, led to a federal budget that balanced in fiscal year 2000.

The balance turned out to be short-lived. In 2001 and 2003 Congress passed debt-financed reductions in income tax rates. And in 2003 it also suspended the application of ceilings on fees set in 1997. Later that year Congress used debt to finance a new Medicare prescription drug benefit and higher payments to Medicare managed care plans.

As a result, the portion of Medicare paid for with dedicated taxes dropped from 73 percent in 2000 to 53 percent in 2010, the year that the first of the Baby Boom generation became eligible for Medicare.”

“After the 2008 election of President Obama, Democrats sought Medicare ‘savings’ for the purpose of expanding other medical services rather than balancing the budget for Medicare. In order to offset the cost of expanded PPACA medical services for families with low incomes; they placed restrictions on reimbursement rates, provided incentives for more efficient delivery of medical care, raised the Medicare tax paid by taxpayers with high-earned incomes, and applied Medicare taxation to gains from investment.”

On the other side of the political spectrum, “Republican House Budget Chairman Paul Ryan exemplifies his party’s ambivalence toward Medicare reform. He ran as the vice presidential candidate on a ticket in 2012 that attacked the Affordable Care Act’s limits on Medicare reimbursements. Yet before and after that election, he incorporated those very cost-saving measures into his own budget plans.”

Incumbents from “both parties find it awkward to even talk about the practice of borrowing to pay for Medicare. Obviously, an extra layer of interest on debt simply increases the program’s long-term cost. Any attempt to highlight that issue naturally invites the question of whether to cut Medicare costs or raise tax revenue dedicated to the program. No mainstream politician seeks to cut benefits by almost half and down to the level payable by revenues from premiums and payroll taxes. Democrats condemn any increase in payroll taxation as ‘regressive,’ while most congressional Republicans have signed a pledge to oppose any tax increase.”

Both sides of the aisle feint a reluctance to either cut Medicare benefits or increase Medicare withholding taxes and an honest discussion with their constituents regarding Medicare financing knowing full well something must be done. Indeed, it is politically expedient to kick the can or the bucket into the next decade avoiding the third rail of Medicare.

What can we do? I will answer that question in my next post.

Notes and References:
1. “Pay As You Go” Medicare Washington Monthly, Bill White, June 23, 2014

2. Maggie Mahar writes the Health Beat Blog Maggie is also the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006). Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney. Before she began writing about health care, Mahar was a financial journalist and wrote for Barron’s, Time Inc., The New York Times, and other publications. Her first book, Bull: A History of the Boom and Bust 1982-2003 (Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report.

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1/3 of Medicare Spending is Wasted

Urban Legend—

You write: That claim that one-third of Medicare spending is wasted sounds pretty questionable to me.”

This is your opinion. If you had spent the last 20 years working as a medical researcher investigating unnecessary treatment, your opinion would be of great interest to all of us; but, I’m assuming you have not done so.

Thus, you might be interested in some facts . . .

Dr. Donald Berwick, who headed up Medicare and Medicaid during the 1st half of the Obama administration has said, repeatedly, that at least 1/3 of Medicare dollars ware wasted on unnecessary tests, procedures and drugs that provide no benefit for the patient. He is only one of dozens of health policy experts who have made the same statement. (Google “Health Affairs” the leading medical journal that focuses on health policy and “unnecessary treatments” Over the past 30 years, researchers at Dartmouth have provided stacks of evidence documenting unnecessary care in the U.S.

You also write: “I doubt that treatment protocols in the U.S. are all that different from other countries.”

Again, this is your opinion. Unfortunately, you are wrong.

In other countries, doctors and hospitals tend to follow evidence-based guidelines. In the U.S. a great many doctors object to the idea of someone telling them how to practice medicine (Even though “someone” is “science”). They value their autonomy and prefer to do things the way they have always done them. Of course, this is not true of all doctors. But even when you look at protocols at our academic medical centers, you find that the way they treat similar patients varies widely.

Here , I’m not talking about how much they charge for a procedure (which also varies widely) but how many tests they order, how often they prescribe spine surgery for someone suffering from low-back pain, how often they tell a woman she needs a C-Section . . .

One big problem is that our doctors and hospitals are paid “fee – for service;” in other words, the more they do, the more they are paid.

As Dartmouth’s Dr. Eliot Fisher points out: “U.S. patients are not hospitalized more often than patients in other countries; but in the U.S., a lot more happens to you while you’re there.”

In addition, traditionally our medical schools have trained doctors to practice very aggressive medicine. The resident who orders a battery of tests is praised. Students are told “Don’t just sit there (and think). Do Something!”. Traditionally, our medical culture has been a very macho culture and it is just beginning to change.

Finally, Americans tend to think that “more is always better”. Larger servings in a restaurant, bigger cars, bigger homes, etc. And when it comes to healthcare, patients in the U.S. tend to think that “more care is better care.” They are wrong. Every medical product and service carries some risk. If it provides no or little benefit, the patient is exposed to risk without benefit.

When medical protocols in the U.S. are compared to how medicine is practiced in other countries, researchers have found: —- Much unnecessary spine surgery. The rate of back surgery in the U.S. is five times higher than in the UK. Studies have shown little difference in long-term outcomes for patients who undergo back surgery compared to those who select non-surgical treatment.

The U.S. does more testing than other countries. For instance, the number of MRI and CT tests for every 1,000 people in 2010 was double the average in other OECD countries. Comparatively, there were also more tonsillectomies, caesarean sections and knee replacements. Regardless of how much more nearly every procedure, scan and drug costs; it’s nothing compared to how out-of-whack the medical heroics thrown at Americans in the last stages of life The Cost of Health Care: A Country-by-Country Comparison

Colonoscopies are prescribed and performed more frequently than medical guidelines recommend and are given preference over less invasive tests that screen for colon cancer. Those less invasive tests are not only routinely performed in other countries, they’ve also been proven to be just as effective by the U.S. Preventative Services Task Force.

“We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.

In the U.S. many more patients die in ICU’s getting futile care. This is a painful, lonely way to die. In other countries, more patients are treated in hospices or allowed to go home where nurses and even doctors visit them.

Half of all heart surgeries (using stents) do no good. We know which half! But stent-makers and other providers have turned this into a big business.

– Our drug companies enjoy 20% profit margins.

– Our device-makers boast 16% profit margins.

We are over-medicated (particularly older people), and undergo too many surgeries that involve very expensive devices. Medicare covers virtually everything (even drugs that have been shown to be dangerous–until they are taken off the market). If it does not cover all of the newest treatments and products lobbyists would howl– and Congress makes sure that heads roll.

This is one reason why we don’t want to give everyone 40 to 65 a chance to enroll in Medicare. No one could afford it. (This idea was considered in the late 1990s. Do you have any idea how much 40-65 year olds would have to pay for our extraordinarily inefficient and wasteful Medicare system? On top of that and like people over 65, they would have to pay hefty sums for MediGap to Medicare advantage — private insurance plans that cover all of the things that Medicare doesn’t.

Medicare is now beginning to cut back, and over time it will refuse to pays for unnecessary surgeries (heart surgeries, unproven prostate cancer surgeries, and some hip and knee replacements, unless the patient has tried physical therapy first–and losing weight, if possible. (Some people just can’t lose weight, even under a doctor’s supervision.)

Medicare will also stop covering every new drug that comes on market, setting up a formulary and only paying for drugs that are effective — and cost-effective. The same will be true of devices.

Then — and only then — we might talk about letting people 40-65 sign up for Medicare, though in many cases, research on quality of care suggests that they would be better off with the best of our non-profit insurers: Kaiser, Geisinger, etc.

Medicare is a highly politicized bureaucracy and inevitably, Congress dictates what it can and can’t do. Medical guidelines should be set by medical researchers and doctors who have no financial interest in the outcome.

Maggie Mahar is the originator and author of the Health Beat Blog. Maggie wrote “Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006),” and was the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney.

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Obamacare Enrollment (part 2) Who Will Remain Opposed to Obamacare in 2015? “Zero-Sum Thinking”

In 2015, I predict that Obamacare enrollment will soar, matching 2014’s success.

This may seem counter-intuitive. After all, in recent months, the public’s perception of Obamacare seems to have soured. The Henry J. Kaiser Foundation’s health care tracking poll for July reveals that 53% of those surveyed last month said they view the Affordable Care Act unfavorably—a jump of 8 percentage points since June.  July’s results mark the first time since January, that more than half of all Americans opposed the health reform law

Is this because people who have enrolled in the Exchanges are unhappy with the insurance they purchased?

No.

Most People Who Signed Up for  Obamacare Are Happy

Just one month earlier a Kaiser Foundation poll showed that “71%” of those who have enrolled in insurance plans that comply with Obamacare’s rules “rate their coverage as excellent or good overall,” and “more than half (55%) say it is an excellent or good value for what they pay for it.”

This is in part because in the Exchanges, middle-income as well as low-income customers qualify for government assistance to help cover premiums. As a result, 87% of customers have received subsidies that come in the form of tax credits.

Nearly six out of ten of Obamacare’s new customers were previously uninsured, Kaiser reports, while the remainder are “plan-switchers” – people who previously had individual market coverage and switched to new coverage after Jan. 1.  This group includes people who had their old policies cancelled as the ACA’s requirements kicked in, as well as people who switched for other reasons, including the availability of premium subsidies.

No surprise, customers who were forced to switch to a plan that meets Obamacare regulations are not as pleased as those who were previously uninsured. Yet nearly half of the “switchers” acknowledge that after using the tax credit, their new, more comprehensive Obamacare plan costs less than their old policy. This means that they are getting more for less. And I would predict that as they use their new policies ( and discover, for example, that preventive care is free)  many will become more enthusiastic.

Here is  the bottom line: “As a whole,” Kaiser observes, “enrollees are more likely than the public overall to have a favorable view of the ACA: they are roughly evenly split between positive and negative views (47% favorable vs. 43% unfavorable). By contrast, views among the general public are more negative than positive (38% favorable vs. 46% unfavorable.)

In other words, people who have had direct experience with Obamacare are more likely to support it. Those who have only read about reform are more likely to be opposed

What Determines Whether A Person Approves or Disapproves of Reform? 

A close look at the polls reveals that how someone feels about Obamacare has far more to do with his or her politics than with any direct knowledge of the program. Sixty-nine percent to Democrats view the Affordable Care Act favorably, compared to only 14 percent of Republicans.

The majority of those Republicans have never shopped the Exchanges because they don’t need Obamacare. Many work for an employer who offers generous benefits. Indeed, of the 15 million 20-somethings who have stayed on a parent’s employer-based plan, 63% identify themselves as Republicans. This is because Republican parents are more likely to have health benefits at work. Other Republicans who own their own businesses often fund their own medical care with money that they have tucked way in tax-advantaged health savings accounts. Finally, some Republicans shun the ACA’s marketplaces because they want nothing to do with government social programs–even if they might qualify for subsidies.

What Many Republicans Don’t Know About Obamacare

Since many have never priced policies in the Exchanges, Republicans are inclined to believe the misinformation that reform’s opponents have planted in the media, including the myth that Obamacare is “unaffordable.”

In truth, last year, after using his tax credit,  the average Exchange customer paid $82 a month for coverage. Many people shell out more for cable TV.

Here’s an overview of what various Exchange customers paid last year:

Somehow, the mainstream media rarely broadcasts these numbers. It’s easier to just quote a pundit’s claims about “sticker shock.” And sadly, as I have reported, these days, many journalists don’t have the time—or in some cases, the desire—to fact-check what their sources are saying. But as I suggested in part 1 of this post (URL) those who have enrolled in Obamacare are beginning to tell their friends. Word-of-mouth will play a major role in driving 2015 enrollments.

Zero-Sum Thinking

Meanwhile, it seems that the less someone knows about Obamcare, the more likely he is to disapprove.

Why?

Not long ago, Robert Blendon, a public opinion analyst at the Harvard School of Public Health, told ABC that “negative views about the law are driven by people who already had insurance”—in most cases, through their employer. “They worry that the coverage expansion will raise their premiums or compromise the quality of care they receive.”

‘Rightly or wrongly” he added, “people who are not directly aided by [Obamacare] are worried.”

When I asked Blendon to expand, he pointed to a recent advertising survey done by Kantar Media showing the large number of negative Obamacare ads running on commercial outlets.  Kantar estimates that since the Affordable Care Act passed in 2010, $445 million has been spent on political TV ads mentioning the law, and spending on negative ads has outpaced positive ones by more than 15 to 1.

Those ads have reached  wide audience, and in his e-mail, Blendon observed: “They all focused on what the risks are to middleclass individuals” who already have coverage. For example, some fret that if more people are insured, their doctors’ waiting room might be crowded.

In this way, Republicans have encouraged “zero-sum thinking” (the assumption that if someone else gains something, you may well lose something): “If more low-income families are insured, there won’t be enough doctors and nurses to take care of my me and my children.”

According to Blendon the advertising assault on the Affordable Care Act draws on lessons Republicans learned during the Clinton administration about harnessing “the ambivalence the middle class has about big reform” to win midterm elections.   They assume that “big reforms” won’t help them—and might cost them something.

I agree, though in this case I would say we’re not talking about the middle-class (defined as households earning roughly median income, or $52,000) Half of all Americans earn more than median income, half earn less. Upper-middle households, earning more than, say, $70,000, are more likely to enjoy employer-based coverage, in large part because they are more apt to be able to afford their share of the premium. (In 2012, 86% of families with joint income over  $75,000 enjoyed employer based coverage, vs. 31% of those bringing home $50,000 to 74,000 and just 12% of those earning $40,000 to $49,000.

As More People Experience the Reality of  Obamcare, Attack Ads Become Less Potent

Nevertheless, even the GOP is beginning to realize that the number of Americans who feel so economically secure that they feel ambivalent about government assistance for the middle-class is shrinking. More and more families realize that they–or their adult children–might well need Obamacare. As Bloomberg News recently reported, the fact Republicans have cut way back on ads that attack Obamacare in North Carolina, Louisiana and Arkansas is “a sign that the party’s favorite attack against Democrats is losing its punch.” 

What California Tells Us About the Future of Obamacare

Meanwhile, support is increasing in one state that has been particularly successful in enrolling the uninsured—California. Since the launch of the state’s health insurance exchange, Covered California, and the expansion of MediCal, the insurance program for low income people, California has extended coverage to more than 3 millions state residents, helping to cut the rate of the uninsured by half.

Meanwhile, state polls reflect growing awareness of the benefits of the ACA. The San Jose Mercury News reports;  “The nation’s new health care law is surging in popularity in the Golden State, according to the Field Poll, which finds more Californians today — of all political stripes — support the Affordable Care Act than at any time since it was signed into law four years ago.

The poll of 1,535 likely voters from June 26 to July 19 showed that 56 percent of registered voters say they support the law, while 35 percent are opposed.” Support is up six points from last year.”

Here, let me suggest that it’s worth remembering the old saw: ““Whatever is going to happen, will happen first in California?”

The biggest increase in support (or the largest reduction in opposition) is coming from those groups that were previously opposed or evenly divided.” the San Jose paper reported. “GOP support is up 5 percentage points from last year. And fifty-six percent of voters with no party preference, favor the law—up two percent from a year earlier.”

All in all, this seems an early indication that when it comes to health care reform, familiarity breeds support.

Originated at Health Beat Blog – Maggie Mahar

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Obamacare Enrollment 2015: How Many People Will Sign Up Next Year? (Public Support for Obamacare Is About to Turn a Corner) Part 1

Thanks to the Affordable Care Act, some 10 million previously uninsured adults gained coverage during the open enrollment period that began on October 1, 2013. Last month, the New England Journal of Medicine reported that the share of Americans who are “going naked” has plummeted from 21 percent in September of 2013 to 16.3 percent in April of this year.

Even though open enrollment officially ended on March 31, 2014, people are continuing to sign up. Anyone who experiences a major life change (getting divorced, losing a job, having a baby) can still purchase insurance on the Exchanges this summer. Others are dropping out because they landed a job, married someone with insurance, or turned 65.

Earlier this month, Aetna told Investor’s Business Daily “the degree of attrition was “scary” and “unexpected,” and as a result, enrollment is “shrinking.” But enrollment expert Charles Gaba soon put that rumor to rest. Perhaps Aetna is losing customers, but overall, enrollment is holding up. Indeed, ultimately, the Congressional Budget Office (CBO) projects that by the end of 2014, 12 million formerly uninsured Americans will be covered either by the Obamacare insurance they purchased on the Exchanges or by newly expanded Medicaid programs.

On November 15, a new open enrollment period begins. Now the big question is this:

Will the ACA Be As Popular In 2015 As It Was In 2014?

Over at the Huffington Post, Jeffrey Young is pessimistic. In a post headlined “Why Obamacare May Have Trouble Signing Up As Many Uninsured Next Year,” he quotes Richard Onizuka, the CEO of the Washington Health Benefit Exchange saying “we got the low-hanging fruit” last year. The people who most needed healthcare signed up right away. These include folks with pre-existing conditions, who had been shut out of the market under pre-Obamacare rules.

By contrast, in this second round of enrollment, Young points out that reformers will be trying to sign up people who are not desperate for insurance, and who may be harder to reach, including: “Hispanics . . . people who have less education, live in remote rural areas . . . don’t have Internet access or don’t consume news.”

Moreover, Young notes: “public opinion about the law itself is negative.” Indeed, nationwide polls show that approval ratings for Obamcare have been sinking in recent months. Reform appears less popular than it was when enrollment began in October of 2013. As a result, Young believes that enrollments will tumble: The CBO now predicts that just 7 million Americans will gain insurance in 2015.

But as I will point out in my next post, there are indications that in states where Obamacare enrollments have been most successful–including Red states – the Affordable Care Act (ACA) may be about to turn a corner, even among Republicans.

This explains why Republican Party leaders who decide how to spend campaign dollars have begun backing away from ads attacking Obamacare. The GOP senses that, going forward, bashing Obamacare will no longer be the best way to bash Obama. Too many people are finding out why reform is a good deal.

Ten Reasons Why Obamacare Will Cover Another 10 Million in 2015

Usually, I agree with Young—his analysis of health care reform is both fact-based and shrewd. But in this case, I’m not persuaded. I can think of at least ten good reasons to expect that another 10 million will either purchase Exchange insurance or join Medicaid’s rolls next year.

The millions who have already signed up are now telling friends and neighbors about the benefits of Obamacare — including the fact that 87% of them received government subsidies that helped cover premiums. Polls show that while many Americans don’t trust the media’s conflicting reports about Obamacare, they do believe the information they receive from friends and relatives.

Word-of-mouth will dispel rumors that continue to confuse potential customers. For example, In July a Kaiser Foundation poll revealed that 37% of those polled thought that under the Affordable Care Act, people had no choice of policies. They believed that anyone who bought coverage in an Exchange was shoved into one government-run plan.

Amazing, when Enroll America conducted a survey in April, just after the first enrollment period ended, it discovered that 26% of those who had not signed up still had not heard that the government was offering financial assistance to low-income and middle-income people who bought coverage in the Exchanges. Those who did enroll were twice as likely to know about the subsidies (56% vs. 26%). In the months ahead, millions will learn more about true cost Obamacare as friends talk about what they are paying for their policies.

Many will find that premiums are lower than they were in 2013, in part because more insurers will be selling policies on the Exchange, increasing competition. I recently received a letter from my insurer telling me that, next year the premium on my zero-deductible Exchange plan will be falling by 10%. As state regulators make final decisions about which increases they will and won’t approve, I will be writing more about how many insurers are dropping rates.

In 2015, the Refuseniks will have to pay a fine that rises from 1 percent of yearly household income or $95 per person (whichever is greater) to 2 percent of household income or $325 per person. A family of four earning $70,000 would have to fork over $1,400—and receive nothing in return.Or that same family can sign up for a subsidy, pay part of the premium and wind up with comprehensive insurance that includes free preventive care, and caps out-of-pocket costs.

This fall, it will be far easier to use the online websites than it was in the fall of 2013. By the end of the first enrollment period, most sites were working smoothly (though by then many would-be customers had given up). This year, there should be many fewer glitches because the administration has persuaded Mikey Dickerson, the Google engineer credited with fixing bottlenecks on the Healthcare.gov website last spring, to become the government’s full-time IT czar.

The “navigators” charged with helping customers find plans that meet their needs, either in person, or on the phone, will be that much more experienced, and many will have received more training. There will also be more bi-lingual navigators available.

Over the next year, more states will expand Medicaid. Political pressure is mounting: states that refuse to take the federal dollars that Washington is offering are leaving too much money on the table, and voters are hearing about it. In North Carolina, for instance, local newspapers are reporting that, over the next decade the state risks missing $51 billion in federal payments. Hospitals would get $11.3 billion of that amount. At present, North Carolina hospitals are threatening to lay off workers. If North Carolina expands Medicaid, another 400,000 Americans would be insured under the ACA. And that’s just one state.

As low-income people who have joined Medicaid talk to their neighbors, more will become aware that the rules for eligibility are changing. We’re likely to see a major impact in the Latino community where language barriers have blocked government efforts to spread the word.

More young adults will find out that they can sign up for a parent’s employer-based insurance and stay on it until they turn 27. A Deloitte survey of young adults reveals that in April, 45% still had not heard about this Obamacare benefit.

The Kaiser Foundation’s July poll reveals that most people who actually signed up for Obamacare rate their policies as “excellent” or “good.” This, along with what I know about how the ACA is helping millions, is the major reason why I am convinced that as the newly insured share their experience with others, public support for health care reform will climb—especially among those who most need it.

As I will explain in part 2 of this post, some affluent Americans who don’t need the ACA or its subsidies (because they already are covered by employers) may be inclined to remain nervous about Obamacare. But Americans who are wealthy enough to feel that they and their adult children are economically secure are a shrinking minority. This is the one good thing that can be said about growing economic inequality.

Originated at Health Beat Blog

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Polarized Politics Led To Cantor’s Defeat– and Cochran’s Victory. Why the “Uncommitted Center” Is So Important (Cantor part 2)

Part 1; Cantor’s Defeat and What It Does Not Mean

When House Majority leader Eric Cantor lost his seat to ultra-conservative David Brat, the Washington Post’s Ruth Marcus summed up the majority view among political pundits: “The episode offers a disturbing commentary about the poisonous, polarized state of American politics.” 

I cannot agree. I don’t think “polarization” is toxic.  To the contrary, as the poet William Blake once wrote “Without Contraries, No Progress.”  Conflict can clarify issues, and help us move forward.  Indeed, the clash of opinions is a time-honored way of testing their validity.

Do you remember the 1990s, a decade when it became difficult to tell the difference between Democrats and Republicans? While Republicans headed toward the far right, Democrats moved right of center. During his second term, Bill Clinton started to sound all too much like Ronald Reagan, as he set out to “reform welfare,” forcing single mothers to go to work, even though we weren’t offering them affordable day care. After leaving the White House, Clinton reclaimed his position as a stand-up liberal, but at the time, the distinction between Democrats and Republicans was badly blurred.

Today, the difference between the two parties is clear.  I wouldn’t say that Democrats are ultra-liberal, but conservatives have moved so far to the right that Democrats had no choice but to take a stand on critical issues including: global warming, gun control, the need to raise the minimum wage, and universal access to health care.

By contrast, in the 1990s, Congressional Democrats were “lukewarm” on health care reform. As Paul Starr reports in his newest book, Remedy and Reaction, Senate Finance Committee chairman, Daniel Patrick Moynihan, Democrat of New York, actually stood up to say, “We don’t have a health care crisis.”

But by  2010,  the crisis was obvious, and Democrats came together. Pelosi and Harry Reid marshaled the votes, and Congress passed legislation which, while far from perfect, is solidly progressive: Low-income and middle-income Americans receive the subsidies they need; insurers can no longer discriminate against people suffering from pre-existing conditions, and preventive care–including contraception–is free.There is much more work to be done, but at last, we have begun.

Since then, Congressional Democrats have not had the votes to pass much-needed legislation in other areas.

But at least President Obama is no longer the compulsive compromiser that he appeared to be during his first term in office. I see this as progress. As I have argued in the past, on some issues compromise is not an option.  Too much is at stake.

On the ground,voters are as divided as their elected representatives.  Politically active Democrats have begun to move  left of center while Republican voters have become more conservative. The Pew Research report that I discussed in the first part of this post reveals that a decade ago, only 10% of politically engaged Republicans took a conservative stance on almost all issues. Today, 33% express consistently conservative views. At the other end of the political spectrum, almost forty  percent of committed Democrats are consistent liberals, up from just 8% in 1994. The overall share of Americans who express consistently conservative or constantly liberal opinions has doubled over the past two decades from 10% to 21%. .

“As a result,” Pew reports, “ideological overlap between the two parties has diminished. “Today, 92% of Republicans are to the right of the median Democrat, and 94% of Democrats are to the left of the median Republican.”.

“Republicans and Democrats are more divided along ideological lines – and partisan antipathy is deeper and more extensive – than at any point in the last two decades. And a new survey of 10,000 adults nationwide finds that these divisions are greatest among those who are the most engaged and active in the political process.”

Is Polarization A Threat to the Nation?

Most pundits are appalled.
“It’s a poisonous potion,” writes Bloomberg’s Mark Silva:

“Increasing Ideological Uniformity.

“Partisan Animosity.

“Stir it up:  and what you have is ‘Political Polarization.’

“The antipathy cuts both ways” Silva adds.

On that last point he is right.  As Pew points out, the share of Republicans who have very unfavorable opinions of the Democratic Party has more than doubled over the past 20 years – from 17 percent to 43 percent. Similarly, the share of Democrats with very negative opinions of the GOP also has more than doubled – from 16 percent to 38 percent. . .

“There are actually people who view the other political party as a ‘threat to the nation’s well-being’” Pew notes, “with 27 percent of Democrats saying this of the Republican Party, and 36 percent of Republicans saying this of the Democrats. Those numbers, too, have essentially doubled during the past two decades.”

“Pew calls it ‘a rising tide of mutual antipathy,’” Silva observes.

Let me be clear: l Like Silva, I too, abhor the extremes where sheer anger replaces reason.. (I cringe whenever I hear a good friend say that Dick Cheney should be “put up against a wall and shot.” He says this quite often.)

But I would point out that arch-conservatives seem much angrier than liberal Democrats. This is why Republicans come out to vote, particularly in mid-term elections, in much larger numbers. Rage sends them to the polls.

What I find most disturbing is that these conservatives seem to loathe, not just liberals, but anyone who they view as “Other”:  People who are dark-skinned, poor, foreign, gay, or a feminist who stands up for a women’s rights is  deemed “Not Us.”  This mixture of xenophobia, racism, homophobia and misogyny is what I find truly frightening.

The Disengaged Center – Nearly 40% Of All Americans

Most importantly, what  Silva ignores is that while committed Republicans have headed further right, and committed Democrats have shifted to the left, only 61% of Americans are committed to either party.

The Pew poll reveals that fully 39% belong to an uncommitted center: “Many of those in the center remain on the edges of the political playing field, relatively distant and disengaged, while the most ideologically oriented and politically rancorous Americans make their voices heard.

Those in the center are quieter, less likely to vote, and less likely to make political contributions. These are the people who say “I just don’t pay much attention to politics.” Or, “I’ve given up on politics and politicians.”

But according to Pew, while many in the center do not vote, they do have opinions. “These centrists are not moderates. Those in the center hold strong views on various issues,” the Pew report explains. “The difference is that they are not consistently liberal or conservative.” An over-riding ideology does not determine all of their decisions.

For example, some favor gun control, but are opposed to health care reform. On immigration, their views are mixed. Pew’s research reveals that “all told, 37% of non-ideological Americans support drastic changes in America’s immigration policies.”  Some favor deportation of all unauthorized immigrants while others support immediate citizenship if certain conditions are met.”

Because they are not blinded by a single ideology, their minds are open to listening to rational arguments on various issues. This is why we need them at the polls.

On this point, I am hopeful. As conservatives move further and further to the extreme right, more and more Americans are becoming alarmed. As a result, we may well see more disengaged, disaffected, and discouraged citizens beginning to pay attention to politics.

Mississippi

This is exactly what happened Tuesday, in Mississippi, where veteran Republican Senator Thad Cochran beat back a challenge by State Senator Chris McDaniel, a Tea Party favorite.

On June 3, Cochran, an establishment Republican who has served in the Senate for 24 years, lost the Republican Senate primary to Chris McDaniel, a former talk radio host and Tea Party–backed state senator,

Because neither won 50 percent of the vote. the race went into a runoff. At that point, most observers assumed that Cochran would lose.  With his intense support from passionate Republicans, combined with wide backing from national Tea Party groups, McDaniel was the favorite.

But in the last three weeks of the race, Cochran began to reach out to black voters. He was betting that African-American Democrats might well come out to vote against McDaniel, who is  well known for his New Confederate views. (A Southern reactionary, McDaniel laments how the country has changed, since the days before civil rights legislation passed. He misses the “Old South”.) On his radio talk show, he also had made     racist and sexist remarks that I find too offensive to repeat.

Cochran’s strategy proved shrewd. In the run-off, African-American turnout in the 24 counties with a black population of 50 percent or more was up almost 40 percent from the primary.

Make no mistake: Cochran is a conservative Mississippi Republican. Black Democrats know this. But as one voter said: “One of the other white men is going to get in there. We need to choose.”  By turning out for Cochran these liberals made sure that a rabid, racist conservative would not have a vote in Congress.

You might wonder: How could Democrats vote in a Republican runoff? In Mississippi, which does not register by party affiliation, any registered voter can vote in the Republican runoff election as long they did not vote in the Democratic primary during the first round of balloting on June 3.

Most African-Americans didn’t bother to vote for Travis Childers, the winner of the Democratic primary.  They didn’t think he stood a chance. Thus, they were free to cast a ballot for Cochran.

At Cochran’s satellite office in Hattiesburg, Stacy Ahua, 25, a black field organizer, managing a get-out-the-vote operation explained Cochran’s strategy to the Washington Post: “Some of our people forgot to come out for that first vote and we’ve really tried to get things moving. I think everybody now understands the stakes, whether you’re Democrat or Republican, Catholic or Baptist.”

Exactly. This is what right-wing extremists are now doing nationwide: defining what is at  stake. I thank them.

No surprise, McDaniel’s supporters are livid that African Americans sealed their candidate’s defeat. Already, they are talking about a write-in campaign on his behalf. This  could split the Republican vote.

At the same time, success may persuade African Americans and other Mississippi liberals  to turn out for the mid-term elections. And,  if there is no write-in campaign,  right wingers who are furious at Cochran may refuse to vote. In other words,  Travis Childers might stand a chance. He  is a conservative Democrat, but still the GOP would have one less seat in the Senate.

Convincing Americans That It’s Worth Taking the Time to Vote: The Argument for Partisanship

Writing in the American Prospect, Paul Starr recently made the argument that “if Democrats are going to convince their supporters it is worth the trouble to vote . . . . they need to advocate policies that make as loud and stark a contrast as possible with those of the Republicans. Obama’s belated emphasis on raising the minimum wage and increasing overtime pay are good examples of the approach. Taxing the 1 percent to finance broadly distributed benefits also fits this description. . .

“Such policies will predictably be described as class warfare,” Starr acknowledges. “But . . . the objective is actually to get back to an income distribution more like the level that prevailed in the Eisenhower administration. The entire political and legal spectrum has been moved so far to the right that what used to be centrist only seems populist.”

But in recent years, the zeitgeist has turned. .Both the issues and the candidates are more sharply defined than in the past. As a result, Starr notes, “voter turnout in the 2004 and 2008 elections returned to levels America hadn’t seen in 40 years. Fox News and MSNBC stir up the emotions not just of their devoted viewers, but of those who abhor them; liberals and conservatives alike may be more inclined to vote.

In an earlier piece Star argued: “Democracy needs passion and partisanship provides passion.” Yes.

In Some Cases Compromise Is Not Possible

But do we really want “passionate” partisan representatives in Congress? Don’t’ we want to elect politicians who will compromise with each other?

Not necessarily.

On the face of it “compromise” sounds eminently reasonable, and very often, it is appropriate. When it comes to negotiating tax rates, we may be able to “split the difference’—at least in some cases.

For example: until very recently, the Federal government taxed estates over $1 million. Now the IRS collects a tax only if the estate exceeds $5 million. (In 2013 this change cost us roughly $13 billion in government revenues.) Some conservatives would like to abolish the tax altogether; liberals would be inclined to go back to taxing amounts over $1 million. I could see both sides reaching middle ground by agreeing to tax estates over, say, $2.5 million.

But sometimes we can’t meet in the middle. Some values just are not negotiable.

Below, a short list of issues where Republicans and Democrats disagree, and I would argue, compromise is not possible.

Gun control:  When as are talking about the slaughter of innocents, we cannot “split the difference” with the NRA. There is no reason for civilians to own automatic and semi-automatic weapons. And no one should be able to buy a firearm of any kind without a thorough background check.

Medicaid Expansion: The right to healthcare is a universal right, not a matter of states’ rights. The notion that poor adults should have access to medical care in some states, but not in others, is untenable. Once again, what is at issue here is not money, but blood.

Immigration reform: Do we really want to send Honduran 15-year-olds back to a homeland where they are likely to be maimed, killed, or enslaved by a gang?  (See part 2 of this post)  We must offer asylum to those who are at risk, just as, over the years, we offered protection to at least some European Jews (far too few), as well as some Russian dissidents. Skin color or ethnicity should not affect that decision.

As for children who were brought here by undocumented parents years ago, the idea of sending them back to a country that they don’t know is impossibly cruel. Finally children who grew up here should not be barred from attending college because they are labeled “illegals.” We need more educated workers.

Raising the Minimum Wage:  We know that children in the U.S. go to bed hungry because a parent cannot earn enough to feed them. Food stamps run out before the end of the month. And, if we  lift the minimum wage, we can assuage union fears that more immigrants will depress the average American’s paycheck.

Global warming: On this topic right-wingers are not only a threat to the nation, they’re a threat to the globe. Two-thirds of Americans (67%) say there is solid evidence that the earth has been getting warmer over the last few decades, a figure that has changed little in the past few years. Yet conservatives have managed to block action.

Nevertheless we should thank right-wingers for highlighting the issues. Voters are no longer simply talking about candidates’ personalities. We are facing basic differences in what we think is “right” and “wrong.”

A Pew Research Center survey of “American Values” reveals that when it comes to rock-bottom moral questions, liberals and conservatives simply don’t agree. In particular, Pew reports, when Republicans are asked about government regulation and involvement in our lives, they are more adamant than ever before: Individual rights should be paramount; the government should not interfere.

By contrast, progressives tend to believe that government has a responsibility to regulate with an eye to the “common good”–and to tax and spend with the goal of creating a fairer, more egalitarian society.

Ultimately, their positions illustrate the tension between two political goals: freedom and equality. Conservatives favor freedom; liberals are more concerned about equality.  The reason we have two parties is so that voters can choose.

Can’t we have both freedom and equality? Of course–but in some cases there is a conflict between individual rights and what is best for society as a whole. Then, voters must decide.

On such critical questions, I would argue that we are not looking for a mid-point between “right” and “wrong.”  Either we expand Medicaid for everyone—including childless adults–or we don’t.

In a democracy, our elected representatives should reflect what the majority of Americans think is truly just—including the 40% who are not card-carrying conservatives or liberals.

And in fact, recent polls suggest that most U.S. citizens do have clear views on these issues. The majority favor stricter gun control laws;  think that illegal immigrants should be allowed to stay in this country and eventually apply for citizenship; support a proposal requiring companies to cut greenhouse gas emissions that cause global warming even if it means higher utility bills; believe that we should raise the minimum wage  from $7.25 to $10.10–or higher and support Medicaid expansion

Why then is Congress gridlocked on these questions? Because only a minority of Americans vote , particularly in midterm elections that decide the fate of so many Senators and Representatives.  Thus Congress reflects the beliefs of some Democrats and Republicans at each end of the political spectrum, but not the will of the majority.

Originated at Health Beat Blog

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Cantor’s Defeat—What It Does Not Mean

Shocked by House Majority Leader Eric Cantor’s defeat in last week’s Virginia primary, many in the media have decided that this “earthquake” has re-shaped the political landscape.

Immigration reform is dead, they say, and tea party radicals are far stronger than many suspected.

Meanwhile, the alarmists warn, political polarization has divided the country, poisoning our democracy. On that last point they are half-right; Republican voters have moved to the far right, while politically active Democrats are beginning to shift toward the left.

But polarization is not a threat to the Republic. Debate can clarify the issues– and underline what is at stake. Conservatives are making it clear what they are willing to sacrifice for the sake of their ideology, and mainstream Americans are becoming alarmed. “The nomination of someone like Brat—who would like to slash Social Security by 2/3—could bring them out to vote in  mid-term elections.

As I will argue in part 2 of this post, a national debate on what are, ultimately, extraordinarily important issues, could  strengthen the nation. In Congress, Republicans and Democrats remain gridlocked.

In  mainstream America many citizens are disengaged. “I’m just not interested in politics,” they say. Or, “I’ve given up on politicians.”‘

A democracy needs a passionate, engaged electorate. Indifference is what will poison the Republic.

Cantor’s Loss Does Not mean that “Immigration Reform is Dead”

The conventional wisdom says that, until recently, President Obama had been waiting for the House to act on immigration reform. Supposedly, Eric Cantor, the House Majority leader, was open to some sort of compromise on an overhaul of immigration law, and this is why he lost the primary.

Not so fast.

First, this is not all up to the House. Obama could use his executive authority to limit deportations.

Speaking at a fundraiser the day after the primary, President Obama said: “It’s interesting to listen to the pundits and the analysts and some of the conventional wisdom talks about how the politics of immigration reform seem impossible now. I fundamentally reject that.”

An Army of Refugee Children Flood Our Borders–What Should We Do?

Even as the president spoke, thousands of children from Central America continued to surge across our border, seeking an escape from the violence and poverty of Central America.

Once minors get into the U.S., they typically turn to immigration agents for protection. Under U.S. law they must be held pending arrangements for deportation or release. They have no rights to representation, though Legal Aid attorneys have been trying to help many.

On Fox Special Report with Bret Baier, political analyst Brit Hume paid tribute to these lone childrens” struggle and their courage: “The immigrant children illegally crossing American borders by the thousands have triggered a logistical, humanitarian and law enforcement crisis to which current US immigration policy has no satisfactory answer.

“It may be tempting to call for their deportation,” he added, “but that ignores an important consideration: what the minor children, most of them unaccompanied by adults, had to go through just to get here.

“Nearly all are from Guatamala, El Salvador and Honduras, three countries plagued by extraordinary levels of drug and gang violence. Honduras now has the highest per capita murder rate in the world.”

“I have seen some of these kids,” Hume told his audience. “A youth home where I serve on the board here in Virginia has taken in dozens of them.  They are remarkable kids from what I have seen of them.  They are well behaved. When meals are served some of them weep at the fact that they’re eating better than their families can back home.  They wait till all are served before they’ll eat. They turn up at prayer services.  . . .  They potentially could make an enormous contribution to this country if we can find a way to house them and care for them and let them stay”. (Hat-tip to Digby for calling attention to Hume’s impassioned speech.)

The flood of young refugees, crossing into this country daily– and overflowing holding centers—casts a spotlight on their plight, making it clear that illegal immigration is not a problem that we can ignore. We just don’t know what to do with these children.

One Boy’s Story

“‘Where I live, parents are obligated to give a son to the gangs,’” Carols, a 17-year-old from Honduras told Bloomberg, while fighting back tears.

An uncle who tried to defy the criminals paid with his life.

Another child showed Bloomberg his right hand: before he fled Honduras, a gang had accosted him on the street and amputated the tips of two fingers

“If you want to live, you have to leave your family,” a third 16-year-old confided.

“Carlos’ journey of 1,700 miles (2,700 kilometers) took about a month by bus and foot,” Bloomberg reports. When he arrived in northern Mexico, just a quarter mile from the border, he  explained that he hasn’t decided whether he’ll try to reach an uncle in Houston clandestinely or voluntarily surrender to border agents.

“’If I do that, they could deport me,” Carlos explained

“That could be fatal” the reporter observed.

Pressure on President Obama

In the U.S., reform advocates continue to press Presidebt Obama to lower the number of deportations, and to extend amnesty to the parents and guardians of “Dreamers”—children who have been in this country for five years.

“Just because Cantor lost doesn’t mean that all of those other conversations and criticism of immigration goes away,” Julian Zelizer, a Princeton University historian recently told CNN.” The likelihood was that the President was planning to use executive action anyway regardless of what happened to Cantor.”

I’m at all certain that Obama was poised to act.  Friday, White House representatives disappointed reformers by saying that “they are still leaving the window wide open for Congress to pass an immigration bill by the end of the summer — before the White House makes moves to implement more limited fixes on its own.”

Kevin McCarthy- The Man of the Moment

But Majority Whip Kevin McCarthy, the California Republican who is replacing Cantor as the Majority Leader of the House, could emerge as an unlikely reform advocate.

McCarthy hails from California’s 23rd congressional district, an area that is 35% Latino, and where the local business community depends on immigrant labor to pick local crops.

We have spoken with Congressman McCarthy and his staff about immigration reform and its importance to our local and regional economy,” Cynthia Pollard, president and CEO of the Greater Bakersfield Chamber of Commerce recently told CNN.

“I led a delegation of several other business leaders in a meeting with Congressman McCarthy last fall in Washington, D.C., to discuss the issue,” Pollard added. “He expressed . . . his commitment to a step-by-step assessment and overhaul of the system that is clearly broken.”

Indeed, McCarthy has said that he favors extending legal status to undocumented immigrants, if not full citizenship.

No surprise, the immigrants’ advocates are ready to turn up the heat: “As the person responsible for scheduling House votes, when it comes to immigration reform, McCarthy will either be a hero or a zero,” Frank Sherry, executive director of America’s Voice, an immigration reform advocacy group recently told CNN.

“He can save the GOP from itself by quickly scheduling a vote on historic legislation that the majority of the House, the country and even his district supports; or he can squander the opportunity . . . The future of the GOP may well hinge on his choice.”

According to CNN “immigration groups that have staged sit-ins at McCarthy’s district offices in the past vow they are poised to do so again if they sense he’s unwilling to tackle reform.”

Clearly, immigration reform is not dead.

To the contrary, in some ways I’m more hopeful than I was before Cantor lost his primary. At most, Cantor’s support for reform was lukewarm.  In fact, there is a strong argument to be made that Cantor lost, not because he was ready to compromise on immigration, but because his supporters didn’t turn out to vote. They thought he had the election locked up.

McCarthy, on the other hand, is going to be feeling serious pressure from businessmen back home, and they, along with the flood of young refugees from Central America, will keep the issue front and center.

Finally, it’s worth remembering that last January McCarthy was the first member of House GOP leadership to support legal status for undocumented immigrants.    He  pointed out that: “42 percent of the people who are here illegally came here legally on a visa.” He believes that “we need a guest workers program.”  He also co-sponsored the ENLIST Act, with fellow Californian Rep. Jeff Denham, which would have provided a pathway to citizenship for certain undocumented youth who serve in the military.

Granted, if McCarthy supports virtually any type of reform, House Republicans who are up for re-election and fear Cantor’s fate will feel obliged to take a very hard line—even if that means standing up to their new majority leader.  But when Rupert Murdoch is begging his party to act on immigration reform, you know that Republican opposition is cracking.

My guess is that the debate over immigration will come to a head either toward the end of July, or during the midterm elections.

Cantor’s Defeat Does Not Mean that the Tea Party is Alive and Well

Since Cantor took a drubbing, more than one commentator has insisted that David Brat’s win is proof that “the tea party is resilient.”

This theme goes hand in hand with the notion that immigration reform is dead. “Now many in the Beltway will simply say immigration is untouchable because the tea party wants it that way and if the tea party can beat Cantor it can beat anyone” one pundit declared.

Not true.

First, it is important to recognize that Brat was not supported by the National Tea Party. His cheerleaders represented a small fringe group in one Virginia district. And Virginia’s 7th district is not just another Republican district. For 43 years it has been a GOP stronghold. The last Democratic congressman elected from the 7th left office in 1971.  Since then, gerrymandering has only intensified political passions in that neck of the woods.

Secondly,  Brat himself is not a typical tea party activist who believes in small government.Consider his views on a range of issues:  Reportedly, Brat supports slashing Medicare and Social Security payouts to seniors by 2/3.  He wants to dissolve the IRS. He doesn’t fear global warming. And he doesn’t believe in the “common” good.

Will he express these views during the campaign? If he does, it is possible that alarmed centrists (particularly seniors) could come out in force, handing victory to his Democratic opponent, Jack Trammell.

I am not saying that this will happen But  Brat is an inexperienced, unpredictable politician who might do or say anything.

For example, he has called for extreme cuts to funding for education. On “You.Tube” he explained: “My hero Socrates trained Plato on a rock. How much did that cost? So the greatest minds in history became the greatest minds in history without spending a lot of money.”

(Aristotle and Plato on a rock? Imagine what Jon Stewart could do with that as a model for how we should redesign our public schools.)

Nor is Brat simply another right leaning economist. His CV shows that his scholarly work includes “God and Advanced Mammon — Can Theological Types Handle Usury and Capitalism?” and “An Analysis of the Moral Foundations in Ayn Rand.”

How many grass roots tea partiers talk about Ayn Rand, Mammon and Usury?

In sum, Brat is not a garden-variety Tea Partier. A fringe candidate, he was elected by a fringe of the electorate in an unusually conservative district.

As Ezra Klein has pointed out: “Eric Cantor wasn’t beaten by the Tea Party. . . “CANTOR’S LOSS LAST NIGHT CAME AT THE HANDS OF ABOUT 5 PERCENT OF HIS CONSTITUENTS.” [his emphasis]

Some have suggested that Brat will embolden other Tea Party types to crawl out of the woodwork and run for office.  But I doubt that we’ll see many Brat look-alikes joining Congress.

Professor Brat is sui generis  Or to put it another way, he is somewhat unhinged. In this, he reminds me of Sarah Palin. I can’t help but wonder: can he see Russia from Richmond?

Originated at Health Beat Blog, Maggie Mahar

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The “Cholesterol Con”– Eggs

In the past, I have written about the “cholesterol con” (part 1), the widespread  belief that high levels of “bad  (LDL)  cholesterol” can cause heart attacks. As I have explained (part 2), the myth has generated enormous profits for many commercial interests, including companies that peddle statins. (Please read both parts of the post.)   No surprise, manufacturers  have poured millions of dollars into perpetuating the myth, and  thus have succeed in convincing a great many Americans that they should avoid high-cholesterol foods–including eggs.

According to Harvard University’s Harvard Heart Letter, however, it is not the cholesterol in eggs or other food that’s a major culprit. It’s saturated and trans fats (which our bodies may convert to artery-clogging cholesterol).

Today, as my husband, son, daughter-in-law and I celebrated Father ‘s Day with a brunch that featured “perfect scrambled eggs” (here is the recipe), fresh fruit and mini-bagels, I regaled them what I had just learned by reading  “Heart Sisters.” (Okay, “regaled” is the wrong word. My son and husband are not quite as interested in healthcare topics as I am. But my daughter-in-law—who is from the South, has lovely manners, and a kind heart — is always extremely interested in what I have to say.)

On Heart Sisters, Carolyn Thomas (a Mayo-Clinic trained heart attack survivor) lays out what Harvard’s cardiologists tell us about the egg:

“Fact: Eggs are a good source of nutrients. One egg contains six grams of protein and some healthful unsaturated fats. Eggs are also a good source of choline, which has been linked with preserving memory, and lutein and zeaxanthin, which may protect against vision loss.

“Myth: Eating eggs is bad for your heart. The only large study to look at the impact on heart disease of eating up to six eggs per week (reported in the April 2008 issue of the American Journal of Clinical Nutrition) found no connection between the two. In people with diabetes, though, egg-a-day eaters were slightly more likely to have developed heart disease than diabetics who rarely ate eggs.  (Ed. note: Quelle surprise . . . this study was done on men only).

“Fact: Eggs do have a lot of cholesterol. The average large egg contains 212 milligrams of cholesterol. As foods go, that’s quite a bit, rivaled only by single servings of liver, shrimp, and duck meat. Your daily cholesterol maximum intake should be below 300 mg.

“Myth: All that cholesterol goes straight to your bloodstream and then into your arteries. Not so. For most people, only a small amount of the cholesterol in food passes into the blood. Saturated and trans fats have much bigger effects on blood cholesterol levels.

“So if you like eggs, the Harvard Heart Letter says that eating one a day should be okay, especially if you cut back on saturated and trans fats, plus dietary cholesterol from other sources such as red meat.

“Other ways to enjoy eggs without worrying about cholesterol include not eating the yolk, which contains all the egg’s cholesterol.” (Note: II personally like to have two eggs for breakfast poached, soft-boiled or fried in just a little butter two or three times a week. I eat mainly the whites just dipping them in the runny yolk. In this way, I consume just one yolk–MM.

Happy Father’s Day.

Originated at: Health Beat Blog

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A Patient’s Story–How Much Can or Should– Your Doctor Tell You About Potential Risks?

AB Introduction: For a while now, Angry Bear has been featuring some of Maggie Mahar’s articles about Healthcare, the PPACA, and costs. Besides being a former 20th Century Foundation Fellow Maggie’s has also written as a financial journalist for Barron’s, as well as articles for Time Inc., The New York Times and other publications. Her first book, “Bull: A History of the Boom and Bust 1982-2003” (Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report and her latest book “Money-Driven Medicine: The Real Reason Health Care Costs So Much” touches on the squander and the waste found in delivering healthcare in the US. For more on her books, click here.

Besides writing at Angry Bear, Maggie has her own blog The Health Beat from which this article was originally published.

Below a non-fiction story from Pulse: Voices from the Heart of Medicine, “an online magazine of personal experience in health.” Pulse is both a magazine and an online community that provides a chance for patients, doctors, nurses, social workers to come together, and share their experiences.

The magazine’s founders write: “Despite the large numbers of health magazines and medical journals, few openly describe the emotional and practical realties of health care. We at Pulse believe that our stories and poems have the power to bring us together and promote compassionate health care. “ Pulse was launched by the Department of Family and Social Medicine at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, New York, with help from colleagues and friends around the state and around the country (Subscriptions are free: You will find the home page here.

At the end of the story, see my note, asking HealthBeat readers: “What Do You Think: Should the patient have sued the doctor?” Would she even have a case?

Collateral Damage

By Brenda Scearcy

Dr. Robert’s office felt right to me, with a musical birdsong soundtrack, soft lighting and fresh green tea, and I had my best friend in tow: piece of cake. In this serene atmosphere, I was sure that I’d find out what to do next to finish treating my endometrial cancer.

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Longevity and Long-Term Care: The Medical Crisis of the 21st Century : Part 2 Update: Maggie Mahar will be doing a radio interview at 12:30 PM The Attitude with Arnie Arnesen 94.7 FM WNHN Concord NH

Maggie Mahar at The Health Beat Blog discusses Alzheimer’s care and the alternatives.

Throughout the 20th century, most Americans saw “longevity” as a goal. If we took care of our bodies, we reasoned, we could “live longer and better.”

But in the 21st century, I suspect that some of us will learn to fear “longevity” the way we now fear cancer.

This is the second in a series of posts that will explore the anguish that some experience when they live into their late eighties and nineties–and how we, as a society, can address the hardships of “old, old age.”

Senile Dementia

Thanks to better diets, exercise, and advances in medical knowledge, more and more of us are living to four score and seven. But the downside is that in too many cases, our bodies are out-living our minds. As I note in the post below, since 2011, 40% of the increase in Medicare’s outlays can be attributed to spending on Alzheimer’s patients.

Why is the incidence of Alzheimer’s (AHD) spiraling? Because we are less likely to die of heart disease or strokes, millions of Americans are living long enough to be diagnosed with senile dementia. One could say that longevity is the proximate cause of Alzheimer’s.

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The Next Plague: Alzheimer’s

The Next Plague: Alzheimer’s

In the 1970s and 1980s, a plague called AIDS swept through this country. Like a medieval scourge it was mysterious, incurable, and ruthless as it killed those who were far too young to die.

Now, baby-boomers have reason to fear a new scourge: It won’t cut them down in their youth, but if they dodge heart disease and beat cancer they may find themselves trapped in their bodies, watching their minds dissolve.

Did you know that a woman who is now 65 stands a 20% chance of dying of Alzheimer’s? (See Michael Kinsley’s essay in the New Yorker.)

On Bloomberg View Matthew C. Klein has put together a booklet of “visual data” titled: “How Americans Die.” These stunning interactive graphs will startle you. For instance, were you aware that suicide has recently become the leading cause of violent death in the U.S.?

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