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Smoking is All About Poverty

by run75411

Smoking is All About Poverty 

I raised the issue of why the elderly pay more than smokers for healthcare insurance since growing old is a natural occurrence and smoking and its associated disorders is self-inflicted. I raised it after STR said smokers are being robbed and I pointed out the elderly non-smokers and smokers pay 3 times the lowest cost insuree as determined by the MLR. Coberly believes there should be Medicare for all. The idea is a great one once we get a Congress who will support it. Even with a Senate majority of Democrats and faux Democrats, any alternatives to the PPACA went nowhere. For now and until Congress gets more sympathetic to its constituency, we have the best which can be conjured up today. With her reply, my fellow healthcare writer and expert in healthcare answered my post to one of her articles:
Me: I am crying crocodile tears for smokers paying 50% more than the lowest cost insuree. This is a tough pill to swallow for smokers who self-inflict this damage to themselves. The 50% premium for smokers pales in comparison to the 300% above the lowest cost insure, the elderly will pay for just being old a condition which is unavoidable. Come on Louise, you can not be serious.

Maggie Mahar: Most people don’t know the vast majority of adult smokers in the U.S. are low-income, didn’t complete high school, and leading very stressful lives. This is why they smoke. As a recent study of smokers in New Orleans and Memphis quotes one of the research subjects:

“”So many things fill your mind and you go through so much, you need your cigarette to smoke to calm down and get things off your mind,” says one of the participants, quoted in an article about the study in the March/April issue of the American Journal of Health Promotion.

In our study, cigarette use was defined as a ‘buffer’ for dealing with multiple demands, financial insecurity and daily hassles,” say Bettina M. Beech, Dr. P.H., M.P.H., of the University of Memphis, Department of Psychology and colleague.

More affluent better-educated Americans are far more likely to quit smoking than low-income very poor Americans for several reasons.

1) they have a reason to want to live. If you’re a black male who can’t find work, can’t put enough food on the table to feed your kids, and worry about what’s going to happen to them on the street, you’re angry, depressed and stressed. You are far more likely to engage in self-destructive behaviors –smoking, drinking, drugs. No matter how hard you try, chances are slim that your life is going to improve.

2) if you’re poor you cannot afford the nicotine patches and other drugs that making stopping so much easier for more affluent people. You probably also don’t have a doctor to prescribe these things. Louise is right– we need free smoking cessation clinics. The VA and Kaiser have both shown that they work. Of course poor people would like to quit smoking. A recent study in New York state shows that they spend 25% of their income on cigarettes. So why don’t they save up that money and buy a nicotine patch? Depression and stress sap a person’s will–and their ability to hope. Even if they stop smoking, they know that their lives are not going to suddenly get better. As the U. of Santa Clara points out on its Ethics home page:

penalizing individuals for unhealthy behaviors could result in great injustice and social harm.”

While 18 percent of U.S. citizens with incomes above the poverty line smoke, the figure almost doubles to 33 percent for those with incomes below the poverty line. A one-dollar cigarette tax would have a strongly regressive effect on the low incomes these individuals receive. Consider the added problem of tobacco addiction and the probable result of a tax is not less smoking or lower health care costs, but fewer dollars spent on nutritional food and other essentials – conceivably leading to more illness and higher health care costs.”

By charging smokers more for insurance, you increase the chances that they won’t be able to afford it. Given the choice between cigarettes– which they are addicted to and which they associate with relief of stress–and insurance, they’ll choose the cigarettes. Bottom line, when we blame smokers for smoking, we are blaming the poor for being poor. Tobacco companies know why people smoke.

Consider this confidential internal Philip Morris report:

Lower class panelists smoke more and are much more likely to be smokers than upper class panelists…”

It also found that lower class people tend to smoke non-filtered cigarettes (tend to “avoid health filters”) and that they also tend to avoid 100 millimeter-length brands. The writers also observe that lower class people have more incidence of poor mental health, hypothesizing that people use smoking as a “strategy” to combat the stress of low class status as well as poor mental health:

…the incidence of poor mental health is greatest among the lower class…To the extent that smoking is one of the available strategies people can adopt to combat stress, we therefore would expect greater incidence of smoking among the lower social classes.”

This is why in recent years, tobacco ads have targeted low-income people and African Americans. (Btw–they’re right, smoking is also associated with mental health problems.)

Me: I had to reconsider my stance on smokers being let off easy  given the weight of the evidence presented on why smokers should not pay more. “Health Wonk” Health Beat  blog

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The future of YOUR health insurance premiums

by Maggie Mahar

run75441: Maggie Mahar writes on future insurance premium increases something consistently arises in the debate on the PPACA. The complete post can be found at

The future of YOUR health insurance premiums

Today, many Americans are asking, “Will my premiums go up in 2014?”

There is no simple answer.

According to Families USA, the Affordable Care Act (ACA) will have a positive effect on the typical family’s budget. Using an economic model that can factor in all provisions of the Act, Family’s USA estimates that by 2019, when the law is fully implemented, “the average household will be $1,571 better off.”
Even high-income families will save: thanks to rules that limit co-pays, and reward providers for becoming more efficient, “those earning $100,000 to $250,000″ will spend $779 less on medical care.”
But these are “averages.” They don’t tell you whether your premiums will rise or fall.

The answer will depend on: your income, your age, your gender, whether a past illness or injury has been labeled a pre-existing condition, who you work for, and what type of insurance you have now:

If you work for a large company:

The ACA will have a “negligible” effect on your premiums says the Congressional Budget Office (CBO).
This doesn’t mean that your costs won’t climb in 2014. As long as medical product-makers and providers continue to raise prices, premiums will edge up each year.

But in 2012 average premiums for employer-based insurance rose by just 3 percent for single coverage and 4 percent for families, a “modest increase” when compared to 8 percent to 12 percent jumps in past years. And on average, employee co-pays and deductibles remained flat.

Granted, a 3 percent to 4 percent increase still outpaces growth in workers’ wages (1.7 percent percent) and general inflation (2.3 percent) percent). But as reform reins in spending, annual increases for large groups could fall to 2 percent – or less.

If you work for a small company with more than 50 employees:

Your boss will be more likely to offer affordable benefits, in part because, if he doesn’t, he will have to pay a penalty.

Moreover, he will find insurance less expensive. Today, small businesses pay 18 percent more than large companies because the administrative costs of hand-selling plans to small groups are sky-high.
But starting in 2014, businesses with fewer than 100 employees will begin buying insurance in exchanges where they will become part of a large group, and eligible for lower rates.

Finally, some companies with fewer than 25 employees will receive subsidies that cover 50 percent of what they lay out for insurance.

If you work for a small firm where many employees are older, female, or suffer from a pre-existing condition:

Your premiums may well fall. Today, most states let insurers charge small firms more if many of their workers are older or are women.  They also can jack up premiums if just a few workers fall ill or are injured.

This post originally appeared on To find out more about the importance of where you live, whether you are a woman, whether you are young (20-something to 30-something) or older (in your 50-65), your income, and your health status please click there.

Or if you like, you can return to HealthBeat to comment. run75411

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Healthcare Reform; Socialism or Fascism?

by Run75411

Healthcare Reform; Socialism or Fascism?

Whole Foods CEO John Mackey in 2009 originally called President Obama’s healthcare plan a form of Socialism while writing an op-ed for the Wall Street Journal:

“The problem with socialism is that eventually you run out of other people’s money.” Margaret Thatcher”

and added to Thatcher’s statement:

“While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system,” he wrote.

Mackey joins other CEO’s (Papa Johns, Olive Garden, Applebees, etc.) (Raising the Cost of Pizza 10 to 14 cents); who refuse to understand the need for healthcare reform, support a commercial healthcare insurance and industry solution even though both have done little to voluntarily rein in costs, are willing to penalize their employees for the PPACA, and ignore the results of doing nothing and associated increased costs. Since Hillarycare (1994), the industry has ignored increasing costs and has not provided solutions to mitigate them. As shown in Figure 1 annual healthcare cost has grown much faster than inflation. Figure 4 shows the increase in House hold expenditures since 1994 when Hillarycare was considered.

“American Healthcare since 1994” Center for American Progress

Recently during an NPR interview, John Mackey changed his opinion calling the PPACA fascism instead of Socialism:

“Technically speaking, it’s more like fascism. Socialism is where the government owns the means of production. In fascism, the government doesn’t own the means of production, but they do control it — and that’s what’s happening with our health care programs and these reforms.” Obamacare Is Fascist, Not Socialist

In a short period after labeling the PPACA as fascism, John Mackey reconsiders his words after a public uproar and retracted his name-calling of President Obama as a fascist and the PPACA as fascism. All of this from a Liberal now turned Libertarian.

The term fascism today stirs up too much negative emotion with its horrific associations in the 20th century,” he said. 

“I believe that, if the goal is universal health care, our country would be far better served by combining free enterprise capitalism with a strong governmental safety net for our poorest citizens and those with preexisting conditions, helping everyone to be able to buy insurance. This is what Switzerland does and I think we would be much better off copying that system than where we are currently headed in the United States.Whole Foods CEO Regrets . . .”

It has only been since the passage of the PPACA (see S&P Healthcare Indices) has the healthcare industry begun to rein in costs as reflected in Medicare, Medicaid, and SCHPS through efficiencies. Much of this is due to the healthcare industry rapidly preparing for the 2014 final implementation of the PPACA. More will come after 2014.

You would think this would be enough? At the same time, the Republicans are calling for cuts to the three programs to lower deficit spending; the President is offering to consider modest cuts and shows willingness to sell-out the citizens to achieve his Grand Deal. Cuts in any of the programs will do nothing to lower healthcare industry cost as these programs are a reflection of the industry. In the end, such a Grand Deal will lay the burden of healthcare costs on the elderly, the poor and the children of this nation. The “I Made This” John Mackeys of the world who became rich as a result his customers buying from Whole Foods will absolve themselves of any social responsibility.

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Terrorism and the Debt Ceiling…

No, not what you might think.

I think that the entire discussion about the debt ceiling is simply comical, akin to building a house, customizing it, but then refusing to pay the contractor.

But something else struck me today. Now, I am a health services researcher and health policy wonk, but when President Obama said they would not ransom the budget today, it got me thinking about ransoms, and what that terminology means.

I think I understand the GOP goals now. It’s an end game of Financial terrorism. McConnell and those that are doing this are committing an act of financial terrorism.

I know, I know, that’s rather strong language, so let me explain my reasoning:

Terrorism is a weapon used by people who understand that they will lose a real power struggle and therefore is derived from a position of weakness. They do not have the actual resources to wage a real battle.

Most people think of terrorism as a form of violence, using guns, weapons, or bombs. But this sort of thinking is myopic in it’s limited scope. Terrorism I would expand to include any use of power by a group to frighten, expose, or scare another group into a different action, with the secondary goal of achieving political goals.

Terrorists often gauge success of their actions based on media coverage of their propaganda and of the fear mongering through psychological warfare that results in panic.

When President Obama said that he would not negotiate on this issue, and that he would not bend towards this ransoming of the good faith and credit of the US, he really cannot. The US government already has a policy of not negotiating with terrorists whether they be foreign, OR domestic.

So let’s be honest and call this what it is…….financial terrorism.


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SCOTUS Chastises Congress and the Executive Branches

by run 75411

Update:  Beverly Mann adds this note lifted from comments:

The Supreme Court is rarely in session. It’s seasonal, part-time work. They usually hear argument in 10 cases a month, seven months a year. In December, they didn’t hear even that many.
There’s really sooo much that can, and should, be said about the issue of (virtually universal lack of) access to the Supreme Court, and its repercussions. Roberts’ bizarre, cutesy annual report is … oh … I don’t know …characteristically hubristic?

SCOTUS Chastises Congress and the Executive Branches

A pencil and piece of paper was all Clarence Earl Gideon needed to state his case of being denied council in court after being accused of robbery and sentenced to prison. Gideon did get a review of his case under a violation of his 6th Amendment rights to council. Today it is near to impossible for the same to occur and the probability of achieving a review by SCOTUS would be akin to a grain of sand on a Florida beach. The highest court in the nation reviews issues and issues opinions for an ~85 cases/year few of which would be of the same stature as Gideon’s. It is all about who gains access to the court. Filing a petition is no easy task and the cost of which runs ~$3,000 for a dozen or so copies. The days of Gideon are long gone.

Why would I bring this up on an Economics board? Most recently Chief Justice Roberts got into the Congressional/Executive fray and their battle over finding a solution to the hypothetical fiscal cliff.

Our country faces new challenges, including the much-publicized ‘fiscal cliff’ and the longer-term problem of a truly extravagant and burgeoning national debit,” he wrote. “No one seriously doubts that the country’s fiscal ledger has gone awry. The public properly looks to its elected officials to craft a solution.” 

Chief Justice Prods Congress to Resolve Budget Talks and Control National Debt,
Roberts goes on to add;

The federal judiciary makes do with a budget appropriation of about $7 billion, he wrote, “a mere two-tenths of 1 percent of the United States’ total budget of $3.7 trillion.”
“Yes,” he went on, “for each citizen’s tax dollar, only two-tenths of one penny goes toward funding the entire third branch of government!”

That is notable cost control and Roberts cites how much it costs each citizen to have access to SCOTUS. The Robert’s SCOTUS saw an ~ 64 cases last year which is down from the typical 75-85 cases seen yearly and down even further from the 1963 cases reviewed by SCOTUS. By reviewing fewer cases, the Roberts SCOTUS controls costs and further reduces the probably of another Gideon achieving review. This is not true cost control, his waxing elegantly on how SCOTUS achieves reduced costs is suspect, and comes at the expense of the citizenry. Instead of working 8 hour days (if they were hourly), SCOTUS now works 7 hour days and produces less.

Less throughput and a selective one at best.

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Raising the Price of Pizza 10 to 14 cents. . .

by Bill aka run75441

Raising the Price of Pizza 10 to 14 cents. . .

Will pizza and food prices really have to increase to cover healthcare costs for the mostly young employees of the Olive Garden’s, Denny’s, and Papa John’s restaurants?

A 10 to 14 cents increase per pizza is being proposed by Papa Johns’ to pay for the PPACA. At the same time, Papa John’s is advertising a 2 million-pizza giveaway with the help of Peyton Manning “Two Million Free Pizzas” (must be a freebie?). Not sure myself how I might decide to account for the cost; but, here is a try; free pizza for 2 million NFL fans to increase sales, . . . cut employee hours to avoid the PPACA and keep the price, . . . raise prices 10 to 14 cents per pizza to have healthcare insurance for the restaurant staff, . . . or maybe a kind of half cheese/half sausage combo. . . healthcare and free pizzas with Peyton Manning promoting the social responsibility of Papa John’s?

Maggie Mahar at The Health Beat Blog “Can US Businesses Afford Obamacare?” points to an interesting article by John Padua of Managed Care Matters discussing who bears the healthcare reform cost if restaurant owners opt out while Forbes Caleb Melby runs the numbers and questions the increased costs suggested by Papa’s John’s CEO “Papa John’s Obamacare Math” .

The issue(s): The Affordable Care Act dictates that full-time employees (30 hours or more per week) at companies with more than 50 workers need to be provided health insurance. CEO John Schnatter has further claimed that some employers will cut employee hours to avoid providing them with healthcare.

The Cost: John Schnatter estimates that Obamacare will end up costing his company $5-8 million annually.

The Price Increase: 10 to 14 cents per pizza

Checking John Schnatter’s Math: Last year, Papa John’s International captured $1.218 billion in revenue. Total operating expenses were $1.131 billion. If Schnatter’s math is accurate (Obamacare will cost his company $5-8 million more annually), then new regulation translates into a .4% to .7% expense increase. It is difficult to set that ratio against the proposed pie increase and across all sizes given size and topping differentials, but many of their large specialty pizzas run for $16. Remarkably, a 10-14 cent increase on a $16 pizza falls in a comparable range of .6% to .9%; but, the cost transference becomes less equitable if you are looking at medium pizzas which run closer to $12, meaning a .8% to 1.15% price increase.

Lets say that Papa John’s sells exactly half medium/half large specialty pizzas. Averaging the ranges for both sizes, then averaging that product yields a .86% price increase — well outside the range of what Schnatter says Obamacare will cost him.

So how much would prices go up, under these 50/50 conditions, if they were to fairly reflect the increased cost of doing business onset by Obamacare? Roughly 3.4 to 4.6 cents a pie.

3.4 to 4.6 cents does not seem like such a huge increase to bear by either customer or the business and if the advertising is done right; it might prove more positive than giving away 2 million freebie pizzas during the NFL season . . . a little like Schooner Tuna in the movie “Mr. Mom,we are in this together for the long haul.'” What customer would not buy into this?

The Issue(s): From the annals of I made this; “Everyone is looking for a way ‘not‘ to provide insurance for their employees. It is essentially a huge tax on all us business people,” declares Denny’s RREMC Franchise Owner CEO John Metz on Fox News. To offset costs further, John adds; “he also will slash most of the staff’s time to fewer than 30 hours per week” to start January 2014.

Talk about giving a long notice for plant closures to employees. What happens if franchise owner sidesteps the insurance provision of the PPACA and cuts hours to fewer than 30? John Padua of Managed Care Matters says the cost falls back on the US citizenry, employees, and customers of these restaurants.

If companies do not provide insurance for low-paid workers, we taxpayers have to. That is the way Obamacare works; folks with incomes below 400% of the FPL can get subsidized coverage. If restaurants cut workers’ hours so as not to insure employees, all of us taxpayers get to pay for their health insurance. These companies are avoiding their responsibility and increasing our tax burden. “The Cost of Obamacare -14 cents per pizza”

The Cost: Maggie Mahar raises the question in her “Can They Afford It???” post. Metz employs 1,200 associates at his Denny’s RREMC franchise. Taking the extreme case of all 1200 employees going into the state exchange and being subsidized up to 400% of FPL; by slashing everyone’s hours to 28, Metz avoids the $2,000 penalty (~$2.34 million in total) for those going into the state exchange.

The Price Increase: 5% surcharge to all meals in 40 Denny’s in Georgia, Florida and Virginia. (note: I wonder how that will appear on the bill?)

Checking The Math: The CBO (which forever appears to be anti-healthcare reform) found in a recent study, 2014 comprehensive healthcare insurance could be had at $3,400 for an employee up to 30 years of age and single. Understanding we are not talking about writing off Metz’s employee expenses from his corporate income tax yet and knowing the PPACA requires an employer to pay 65% of the employee’s healthcare insurance, the $3,400 per person (down from a projected $6,700 without the PPACA) now becomes $2,210 per person.

Denny’s franchise owner Metz is angry with Obama, the PPACA, and his employees. Granted, the example is as much an extreme as Metz’s knee jerk reactions and posturing; but, it points to the overall fallacy in the too-much-healthcare- cost is a drag on my business argument. Both of these entrepreneurs did take grief for their stances. Denny’s CEO John Miller did call john Metz to discuss his stance and John Schnatter has been called out in various blogs and is the subject of multiple boycotts.

Much of this sounds like sour grapes starting with SCOTUS affirming the PPACA and is carryover from the re-election of Barack Obama to the Presidency. Some have protested the validity of the PPACA claiming it was immoral to force business owners to pay for employee healthcare insurance. In an email exchange, John Paduca answers:

“In response to your query as to when it became an employers’ responsibility to provide health insurance, that would have occurred when PPACA was passed, signed into law, and upheld by the Supreme Court. Laws run this country, not morals. If ‘morals’ did, we never would have invaded Iraq or water-boarded prisoners or interned Japanese Americans or overturned legitimate governments in Africa and Central America or supported the Shah of Iran. ‘Morals’ are personal; laws are societal.”

Maybe it is just Republicans having to cancel their airline tickets to Boston for the celebration on November 7th which has placed both Johns in a bad mood. Or could it be pent up anger with the very people who elected Barack to The White House for a second term? You know, those 47 percenters who might make up the bulk of the restaurant workers.

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Hospital Consolidation and ACO’s

Jason Shafrin over at the Healthcare Economist points to this recent paper over at the RWJF. Interestingly the authors find that hospital consolidation increases prices and could decrease quality. Something that many of us have considered in the past.

In concentrated markets, the effects were even more pronounced with price increases over 20% noted.

Competition was noted to increase quality under an “administered” pricing system, ala the NHS in the UK. The evidence for competition increasing quality in a market system was much more mixed.

I have thought this for some time, and have even wrote about the concepts of leverage in the past. For example, I have cited a BNET article before. When one examines the the health markets in Milwaukee and Chicago, which are both midwestern cities, and geographically close to each other, one finds higher prices in Milwaukee, with providers not accepting less than 200% of Medicare. Which does not seem intuitive, as there is far more market competition in the health insurance industry there. In Chicago, one insurer, BC-BS, is rather dominant and prices are lower, with providers accepting 112% of Medicare on average. It would seem to make sense that increasing the leverage of the hospitals and providers through the mechanism of consolidation will increase prices. The same thing happens in Milwaukee, which has no dominant insurer, and therefore is unable to exert leverage over the hospital systems in Milwaukee.

The ACO models as proscribed by the ACA will increase consolidation. By developing an accountable model of care delivery, providers will attempt to consolidate to increase quality and minimize risk exposure in the sense of decreasing reimbursements.

The problem with the RWJF paper, as it rightly notes, is that the study does not really examine integrated health care systems. When you look at consolidation with true vertical and horizontal integration, it is my belief that quality improves even in the absence of competition. True integration in the case of Mayo Clinic and Kaiser also lowers prices.

In essence, I don’t think the problem is consolidation…..I think the problem is consolidation in the absence of integration.

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New Report on Getting the Best Care

by Run 75441

New Report on Getting the Best Care

Both Matthew Yglesias at Slate and Sarah Kliff at WonkBlog and a host of other sites have posted some interesting results coming out of a recent study by the Institute of Medicine  Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.

Unfortunately as a lowly and unpaid (99% of the time) blogger, I do not have access to the entire report. What I do have is a abstract of what the report is about and some of the charts placed on Wonkblog.

We spend $750 billion on unnecessary health care. Two charts explain why. This report documents much of the whys to a much needed Healthcare Reform in the numeric of it. Phillip Longman in his book The Best Care Anywhere touches upon a similar transition in the VA administration and the experiences of his and Timothy Noah’s wives in being treated for cancer. Unfortunately, the best named hospitals and the best insurance does not guarantee the best care. Too much is spent inefficiently on the wrong type of care.


The second series of chart is an accounting of how some of these expenditures are made within the system. Again, this is something which Phillip Longman touched upon with his book on the VA and how they overcame the inefficiencies. Sarah Kliff at Wonkblog calls it creating an environment in which it is easy to create waste. When healthcare and its associated industries were not the monsters in cost, no one paid attention to the cost, loss of efficiency, and the lack of quality outcome in treating patients. We spent for the services and not the outcome with the results being a higher cost.


Constantly targeted within today’s healthcare system is the cost of treating the elderly. While it is true as we grow older, the costs of treating us increase due to our aging and failure to care for ourselves. Within the system it is easy to have increased waste as treatments and records may not be logged to computer leading to duplicate treatments and a lack of coordination amongst way to many doctors in treating patients. It has happened where a group of consulting doctors can be describing treatments when the oncologist knows there is little more to be done.

What does the IOM recommend? I will leave you with Sarah Kliff’s post on Wonk Blog to find out. What’s Possible for Healthcare

Getting back to today’s politics between Romney and Ryan vs Obama, would you want more of the same? More of today’s private market with its rising healthcare cost is precisely what is being advocated by Mitt Romney and Paul Ryan. More to come.

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The war against women

by Maggie Mahar    (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.

As the Republicans Take Tampa, Consider What a GOP Victory Would Mean for Women’s Health

For decades, Republicans have opposed abortion. This, we know, and so it comes as no surprise that Mitt Romney, the Party’s presidential candidate, has called “Roe vs. Wade“ one of the darkest moments in Supreme Court history.”

But what some call the “war against women” is escalating. This year, the Republican platform calls for a constitutional amendment that would make abortion illegal.

In 1976, the GOP blueprint acknowledged that “the question of abortion is one of the most difficult and controversial of our time,” and the Party called for “a continuance of the public dialogue on abortion,” which it called a “moral and personal issue.” Just eight years ago, the preamble to the Republican platform declared: “we respect and accept that members of our party have deeply held and sometimes differing views.” But today, there is no such language in a platform that calls for “a human life amendment to the Constitution,” and declares that “abortion is detrimental to women’s health and well-being.”

Meanwhile Alabama, Arizona, Idaho, Indiana, Kansas, Louisiana, Nebraska, North Carolina, Oklahoma, and Ohio all have passed legislation outlawing abortion after 20 weeks, even though, as the Center for American Progress’ Emillie Openchowski points out “complications are sometimes discovered after this point in a pregnancy that could cause serious harm to the woman. In those states, a woman would be forced to continue the pregnancy, no matter the risk to her health.” This is frightening.

While Republicans parade women across their Tampa stage– and avoid talking about what they have quietly embedded in the Party platform–it seems a good time to consider what a Republican victory would mean for women’s health.

Turning Back the Clock: Contraception

Susan Faludi’s Pulitzer-prize winning 1991 book, Backlash, is subtitled: “The Undeclared War Against American Women.” Twenty-one years later, it seems the war is out in the open . As a recent New York Times editorial observes: “Having won on abortion, social conservatives are turning to birth control.”

The Affordable Care Act (ACA) promises women access to contraception without co-pays, an idea which enjoys widespread popular support–at least among women. Nationwide 80% of women voters support the idea, according to a June survey by Hart Research Associates. An earlier Hart poll revealed that 77% of Catholic women and 72% Republican women approved of free birth control. By contrast, just sixty percent of all men embrace the proposal. Still, that’s a majority.

Who, then, actually opposes making birth control available to all women, regardless of income?
The extreme conservatives who now run the Republican Party have made their feelings clear. In February, House Speaker John Boehner, stood on the House floor, and promised to overturn any rule requiring employers to pay for birth control for their workers:

“It must not stand and it will not stand,” delcared Boehner, who believes that bosses who object to birth control should not be forced to cover contraception. Senate Minority Leader Mitch McConnell, R-Ky, along with Senators Kelly Ayotte, R-N.H.; Roy Blunt, R-Mo.; Marco Rubio;, R-Fla.; and John Thune,quickly joined in, arguing that this provision is a threat to religious freedom.

The right-wingers who now control the GOP seem to view contraception as a “women’s issue” that should be decided by men. Thus, at a House Oversight Committee hearing, House Republicans convened a panel on denying access to birth control coverage with five men– and no women.

As for Republican presidential candidate Mitt Romney, in a Fox interview just last Sunday, he said: “of course women have a right to use contraception”– if they can afford it.

In March Romney told a Town Hall meeting that if “a woman wants access to free birth control” she “should vote for the other guy,” adding, “there are a lot of things that we have in our society that we may like,” but that government should not be paying for.” This suggests that “the Pill” is a luxury, like a $75 blouse.
Romney also has endorsed the “Blunt amendment” that would let any employer drop health insurance coverage for contraception and other health services on religious or moral grounds.

Here we are not just talking about Catholic colleges and hospitals. President Obama is making special provisions to accommodate their concerns. But the Republican “Blunt amendment” would go further, to include private companies such as Hercules Industries, a Denver-based heating and air conditioning company.

Co-owner Andy Newland objects to birth control, and in July, the company obtained an injunction from a federal court, allowing it to delay complying with the law until three months after the case is decided.

The Cost of Contraception
According to Fox News’ Greg Gutfield, “Anybody can afford birth control.” In July, he asked his audience, “How much more affordable can you make it? . . I mean, do we–should we start up like a ‘buy the pill’ campaign? Like ‘feed the children’ where we make sure we all adopt one woman and pay for her pills?”
Gutfield is, of course, wrong about the cost. In recent years, birth control has become extremely expensive for low-income women, even if they are insured. Co-payments for pills typically range between $15 and $50 per month, and for other contraceptive devices, such as IUDs, co-pays and other out-of-pocket expenses can reach into the hundreds of dollars.

“Since the average American woman wants to have two children,” Planned Parenthood points out, “she‘ll spend approximately five years pregnant, postpartum, or trying to have children, but 30 years trying to prevent pregnancy. That can add up to thousands of dollars spent on prescription birth control.”
Little wonder that, according to a recent survey, more than one-third of American women voters have struggled with the cost of prescription birth control at some point in their lives, and, as a result, have used birth control inconsistently. Planned Parenthood reports that “this number rises dramatically among younger women, with more than half (55 percent) mentioning a time when they could not afford to use birth control consistently.”

Thus, “In the U.S., half of all pregnancies are unintended.” Inevitably, a great many uniplanned pregnancies end in abortion. “If we are serious about reducing the unacceptably high rate of unintended pregnancies in this country, we need to get at the root cause and take practical steps to increase access to affordable birth control,” Planned Parenthood observes.

Without the Affordable Care Act– What Women Would Lose
The GOP platform states that a Republican President would use his waiver authority “on his first day in office” to halt progress in carrying out the Affordable Care Act. Romney has pledged to repeal health reform during his first 100 days in the White House.

This means that insurers selling policies in the individual market would be able to continue charging a women at least 30 percent more than they would charge a man for exactly the same policy–even if the coverage did not include maternity benefits.

Women also would lose free access to a list of preventive services that the ACA requires that insurers offer without co-pays, and without applying deductibles.

For women, the essential preventive services include: free screening for cervical and breast cancer; breastfeeding support, supplies, and counseling; well-women visits, prenatal care, screening and counseling for sexually transmitted diseases, including HIV; screening for gestational diabetes; and screening and counseling for domestic partner violence.

Planned Parenthood and Title X
Mitt Romney has pledged that he will “get rid of” Planned Parenthood, an organization that operates nearly 800 health centers throughout the United States, offering sexual and reproductive health care for the nearly three million women and men who visit these centers each years. While helping women avoid unintended pregnancies, Planned Parenthood also provides roughly 770,000 Pap tests and nearly 750,000 breast exams annually, along with more than four million tests and treatments for sexually transmitted infections. At sometime in their lives, one in five American women have found help at Planned Parenthood.
During his Sunday interview on Fox, Mitt Romney reiterated his desire to defund the organization, arguing that taxpayer dollars should not fund abortion.

Here is the truth: abortion constitutes only 3 percent of Planned Parenthood’s services and abortion is covered by private funds. Federal dollars are not used.

Mitt Romney’s fiscal plan also proposes eliminating Title X—the main federal family-planning program supported by President Nixon and then-Congressman George Bush Sr. at its creation in 1970. Title X does not pay for abortions, but it prevents abortions and unintended pregnancies by the hundreds of thousands each year. It also pays for cancer screening and some abstinence counseling for teenagers.
In Texas Republican Governor Rick Perry already has rejected Title X money, assuring that countless poor women in his state will be denied access to all reproductive health care, from birth-control pills to Pap smears.

Misogyny: The Elephant in the Room
That both Bush and Nixon supported Title X serves as a reminder of how much the Republican party has changed. As New York Magazine’s Frank Rich points out in a marvelous piece titled “Stag Party”: “For much of its history, misogyny was not the style of the party of Lincoln. For most of the twentieth century, the GOP was ahead of the curve in bestowing women’s rights

Today, many Americans under 40 have no idea how different the GOP (not the mention the country as a whole) was 25 or 30 years ago.

Rich takes us back, reminding us that Republican presidential candidate Barry Goldwater (who in 1964 was considered ultra-conservative) was married to a woman who had been “inspired by birth control pioneer Margaret Sanger.” Thus, Peggy Goldwater “would help build one of the nation’s largest Planned Parenthood affiliates.”

Barry Goldwater favored abortion rights. “‘I think the average woman feels, My God, that’s my business,’ and that’s the way we should keep it,” he said late in his career.
Rich goes on to reveal that “Prescott Bush, the Connecticut senator who sired a presidential dynasty, was another Sanger enthusiast and treasurer for the first national Planned Parenthood fund-raising campaign. His son, George when a congressman in the sixties, was an ardent birth-control advocate and the principal Republican author of the trailblazing Family Planning Act of 1970.

“Capitol Hill colleagues jokingly nicknamed him ‘Rubbers.’”

Even Richard Nixon, that much misunderstood liberal Republican, favored the Equal Rights Amendment and in 1972 signed the Equal Employment Opportunity Act to strengthen the policing of workplace discrimination.”

But Nixon was nothing if not a study in anguished contradictions. “At the tail end of the Nixon presidency,” Rich notes, “the GOP started backing away from its traditional beneficence on women’s issues.” In a telling shift, “Nixon vetoed a bipartisan bill enabling child care for the millions of mothers then rapidly joining the workforce.”

Looking back, the timing makes sense. Both Watergate and Nixon’s “enemies’ list” foreshadowed the deepening parenoia that would lead to a purge with the Republican party itself.
Granted, it would be two decades before the GOP’s “Big Tent” collapsed. The liberal and moderate Republicans who I had admired in the 1970s and 1980s (Nelson Rockefeller, Lowell Weicker, and Charles Mathias, to name a few) would disappear. But it was not until the 1990 that the long knives came out, and moderates began to be sliced out of the party. Some gave up and retired.

Why did Nixon kill the childcare bill? Rich explains: “His veto was accompanied by a jarring statement that child care would threaten American families by encouraging women to work,” The inspiration for this unexpected reactionary broadside came . . . from political strategists eager to exploit the growing backlash against the sixties feminist movement.”

Backlash–As Male “Influence and Power” Declines

What we are seeing in the GOP today is a continuation of the pay-back that Susan Faludi described in her 1991 book, Backlash.

Conservatives like to claim that “The War Against Women” is a metaphor manufactured by Democrats as they prepared for the 2012 election. This simply is not true. Long ago, women such as Faludi saw that herd of elephants coming our way.

In fact, as Rich points out, in 1996 “Tanya Melich, the daughter of a state senator in ultraconservative Utah” who grew up “to be a stalwart New York Republican and a 1992 Bush convention delegate, wrote a book titled The Republican War Against Women. “These days,” he writes, “her eyewitness account of her party’s transformation seems more pertinent and prescient than ever.”

The anger that Republicans direct toward women that can be traced to the “women’s movement” of the 1960s. Men feared that women would take their jobs. Husbands were threatened; once their wives had some financial independence, they might decide to strike out on their own. Fathers realized that the “Pill” would give their daughters sexual freedom: marriage could become a choice, not a necessity.

Worst of all, as women gained power, both in the workplace and in government, this could mean that men would find themselves having to answer to the likes of Elizabeth Warren. (In 2009, when Warren, who is now running to recapture Ted Kennedy’s Senate seat for the Democrats, questioned Treasury Secretary Timothy Geithner about 13 billion dollars Goldman Sachs got out the back door of AIG –“Do you know where the money went?” — her tough, probing questions made jaws drop– including Geithner’s. Geithner would later express opposition to her possible nomination to head the Consumer Financial Protection Bureau.)

In Backlash, Faludi quotes Seymour Martin Lipset and Earl Raab, two political scientists who have explored the “politics of backlash”: “The reaction” is driven by “groups which are declining in a felt sense of importance, influence and power,” they explain, “Unlike classic conservatives” Faludi adds, “these ‘pseudo conservatives,’ as Theodore Adorno dubbed them…are not so much defending a prevailing order as resurrecting an outmoded or imagined one.”

She also quotes the historian Richard Hofstadter: “‘America has largely been taken away from them and their kind, though they are determined to try to repossess it and to prevent the final destructive act of subversion.’”

In other words, they are afraid, and when people are “on the run,” some turn mean.
Conservative white men know that the demographics are against them. Before long, they will be outnumbered, and in future years, more and more African Americans, Latinos, Asians and women of all races will be in positions of power.

Let me be clear: I am not talking about majority of white men. My husband, his brother, my son, his father (my ex-husband), and a great many men who I know either personally or professionally do not fit this mold.
But, without question, some white conservative men saw Barack Obama’s election in 2008 as a sign that the country “was being taken away from them.” To Mitch McConnell, Obama’s re-election would constitute what Hofstadter terms “the final destructive act of subversion.”

In a sense, those who feared the rise of feminism in the 1960s were right. The women’s movement would never be snuffed out. Instead, it became part of our culture. Today many fewer women call themselves “feminists.” The vast majority of younger women simply assume that they have a right to work, to assume positions of power in the larger world, to control what happens to their bodies. This is the legacy of the Sixties.

The Violence against Women Act

Women also take it for granted that they have a right to protection against the rage that sometimes threatens them–and their children– in their own homes.

Nevertheless, this year, House Republicans felt free to block renewal and expansion of the Violence Against Women Act (VAWA), a 20 -year-old law that offers shelter and counseling to women who have been beaten or sexually assaulted by spouses or partners.

In the past, renewal was not even in question. But today, “Some conservative groups view the Violence Against Women Act as “a slush fund for feminist causes that harms men unfairly and encourages the dissolution of marriages,” the New York Times reported .

Last week, I wrote about how and why Republicans were able to block the VAWA on HealthInsurance.Org. Conseratives claim that Democrats “politicized” the issue by turning it into a fight over illegal immigrants, Gays and Lesbians. I do not buy that argument. Nor did all seven Republican women in the Senate. They voted to renew the bill.

That post also explains why it is so important that, in November, women–and men who like women–come out to vote. The turnout, not just in the Presidential contest, but in many Congressional races, will determine who takes over Washington.

Before going to the polls, check out this piece, showing how your elected representatives havevoted on heatlh care reform. Those votes will help you measure where they stand on protecting women’s health.

cross posted with  Healthbeat blog

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The Elephants are Still Thirsty

by Run 75411

The Elephants are Still Thirsty

In my earlier post on Carrying Water for Elephants I explained how the $716 billion in planned reductions to Medicare was calculated, who it impacted, and from where it originated.

The $716 billion is far larger than the initial $449 billion first reported. In 2010, the CBO arrived at an estimate of savings of ~$449 billion starting from 2012 onwards and covered 6- 7 years from when the bill takes full effect in 2014 to 2019. The second estimate of savings was the result of John Boehner’s request for a review of the costs and gains realized from the repeal the ACA in its entirety. The second review covered the period from 2014 to 2022 and resulted in the $716 billion. “Medicare Cuts: What is the Fight About?” Brookings Institute

Above the explanation of how the $716 billion calculated; I presented Ezra Klein’s pie chart explaining where the reductions were made. Not one of the reductions comes from reductions in Medicare benefits to recipients which as I also explained is denied the PPACA. In last night’s Republican Convention Paul Ryan again claimed the reductions to providers are actually cuts in benefits to Medicare recipients and the reductions are being used to fund the PPACA. Neither statement is true; but then, Paul Ryan is a Republican VP candidate who hopes to confuse the voters with supposition and conjecture. Paul should be made to explain what he will do with the reductions achieved from similar reductions he has proposed for Medicare . . . maybe more tax breaks for the 1 percenters???

There is no amount of water Paul Ryan or Mitt Romney can carry to quench the thirst of this elephant of misrepresentation.

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