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Dear New Yorkers, Did a Doctor Recently Vomit on You?

By: Friday October 24, 2014 8:27 am

Ebola is not contagious the way colds and flu are

Everyone living in New York City, did Dr. Craig Spencer recently vomit or bleed directly on you? If the answer to that question is no, then you have nothing to fear from this most recent Ebola case.

Dr. Spencer understood the risk of his work to help people in Africa with the disease, so he took the appropriate precautions of checking his temperature regularly and seeking help quickly after the first sign of symptoms, while his viral load was still very low. He is now being treated appropriately. From CNN:

The doctor, identified as Craig Spencer, 33, came back from treating Ebola patients in Guinea October 17 and developed a fever, nausea, pain and fatigue Thursday. He is in isolation and being treated at New York’s Bellevue Hospital, one of the eight hospitals statewide that Gov. Andrew Cuomo designated earlier this month as part of an Ebola preparedness plan. [...]

Dr. Mary Travis Bassett, New York City’s health commissioner, said Spencer completed his work in Guinea on October 12 and left Africa two days later via Europe. He arrived at John F. Kennedy Airport on October 17. She said he exhibited no symptoms during his journey or any time afterward until Thursday morning. He had been checking his temperature twice a day.

This is the system working exactly how it should.

Ebola does not spread easily in a country with a functioning sanitation systems. Unfortunately, the nature of the disease makes people caring for the infected uniquely at risk, but everyone else has basically nothing to fear.

The amount of concern and attention relative to actual risk is out of control.

Vast Majority of Americans Have No Idea How Health Insurance Actually Works

By: Wednesday October 22, 2014 10:42 am

The American health insurance marketplace is sadly dominated by a bad mix of overconfidence combined with significant ignorance. While a majority of adults under 65 think they understand their policy, only a tiny fraction can even correctly answer a rather basic question about how much a doctor’s visit will cost them.

New data from the American Institute for Research found 61 of this group were at least somewhat confident they could choose the best health insurance plan for themselves. Yet when presented with an simplified version of an insurance plan’s cost sharing details only 20 percent correctly calculated how much a routine doctor’s visit would cost them.

In addition only half could identify the general characteristics of a health maintenance organization (HMO) and less than a quarter could do the same for a preferred provider organization (PPO).

Not surprisingly the survey found older, wealthier, more educated, and sicker people have high health insurance literacy. These are also generally the people most likely to already have insurance. As the administration tries to increase enrollment next it will likely be targeting people even less knowledgeable about health insurance than the general public.

Once again this highlights the fundamental flaw in the basic logic behind the Affordable Care Act. Even with the help of a fancy website, expecting regular people to be savvy insurance shoppers is completely unrealistic.

Just 11 Percent of Uninsured Know When the Next Open Enrollment Period Is

By: Tuesday October 21, 2014 11:25 am

We are less than a month away from the start of the next Affordable Care Act open enrollment period and shockingly few uninsured Americans know that. In the latest Kaiser Family Foundation Poll, only 11 percent of the uninsured know the second open enrollment begins in November. From KFF:

Most Uninsured Unaware That Second Open Enrollment Period Begins In November

Presumably, this number will improve noticeably as we get closer to the open enrollment period. There will be some outreach campaigns and media coverage. But it is another indication of why the basic premise of the law is deeply flawed.

For the exchanges to function well millions of people, many of them with only a high school education, are expected to be super savvy and diligent health care shoppers. They should be comparing the premiums, networks, drug plans, and cost sharing of dozens of different policies every year. Failing to do all that correctly runs the risk of them making a bad purchase that could cost them thousands.

What we have is many people who don’t understand even basic insurance terms, don’t know when the open enrollment periods are, and don’t know how the system works.

Large companies hire experts to compare all these variables for them and we yet expect a single parent working two jobs to do it as well.

Not Even Thomas Duncan’s Fiancee Contracted Ebola

By: Monday October 20, 2014 7:31 am
thomas duncan

Thomas Duncan, who died after contracting the Ebola virus, did not transmit it to the people he was living with

This story perfectly highlights how completely overblown concern over Ebola in the United States has been. Not even Thomas Duncan’s family, who he was living with prior to his hospitalization, has contracted the disease from him. From CBS Local:

As of today, 48 people are now no longer on the Ebola watch list.

After showing no signs of the virus since last being in contact with Thomas Duncan, they are the first to complete the 21-day surveillance period.

“It a real big deal,” said Dallas County Judge Clay Jenkins.

Among the 48 is Duncan’s fiancé, Louise Troh, and her family.

While Ebola is a very unpleasant disease, it is not a threat to Americans. To contract the disease you basically need to come into direct contact with the bodily fluids of an infected person with a high viral load, i.e. someone that looks really sick. Since the United States has universal indoor plumping and a functioning health care infrastructure, that is very very very very unlikely to happen.

The congressional hearings, the Ebola Czar, the campaign ads and the wall-to-wall cable news focused on the disease in the United States is way more than is justified. You should be worried about almost anything more than the possibility of catching Ebola.

The Affordable Care Act Is Poorly Designed for Dealing With Epidemics and the GOP Plan Is Even Worse

By: Thursday October 16, 2014 12:00 pm

Universal health care better protects the population during epidemics

It want to begin this post by saying the risk of America suffering from a serious and fast moving epidemic, like seen in the movie Contagion, is extraordinary small. I’ve repeatedly pointed out that the high level of concern about Ebola in the United States at this moment is unfounded, but since the media is focused on the issue of contagious disease it does provide an opening for talk about one of the big trade-offs we have made in the design of our health care system.

Our country has for years seen a push towards more “skin in the game” when its comes to health insurance. Policies often carry high deductibles and co-pays. This trend existed before the passage of the Affordable Care Act but the law was specifically design to encourage its spread. The exchanges encourage people to buy “silver plans” which have significant cost sharing and includes an excise tax on employer-provided insurance pushing companies to not provide generous coverage.

This is supposed to save money by making individual more conscious “health care consumers.” It can work in certain situations. The cost may defer some people with a sore throat from going to the doctor and most sore throats will go eventually away on their own. Of course, in the rare event of a serious epidemic that is exactly the opposite of behavior you want to encourage.

Since the risk is so incredibly small one can argue this is a reasonable risk trade-off to reduce overall spending; but there are many first world countries that provide actual universal health care for significantly less money, with low out-of-pocket costs for patients. So the trade-off isn’t really between a slightly cheaper system and one marginally more likely to detect infected individuals sooner. It was among a cheaper system, one more likely to quickly detect diseases, and allowing the health industry to make incredible profits ripping off the public. Democrats decided to mostly favor the latter at the expense of the former two.

Of course the current Republicans’ health care ideas, which are a vague combination of repeal, promise of market magic, buzzwords, and opposing mandatory paid sick leave, would be an even a worse system for dealing with rapidly spreading disease. The current plans they are discussing don’t even try to get near universal coverage.

This is something to keep in mind as you hear politicians grandstand about Ebola to score political points. Most of them actively fought against, and continue to fight against, the United States adopting a cheaper actually universal health care system that would also be much better designed for dealing with the possibility of serious contagious diseases.

Americans Are Way Too Worried About Ebola

By: Tuesday October 14, 2014 7:48 am
air pollution

People should worry more about air pollution, which causes 200,000 early deaths each year

The American public is radically more concerned about an Ebola outbreak here in the US than they should be.

According to a new Washington Post/ABC News poll 43 percent are worried that they or someone in their immediate family might catch the Ebola virus. In addition an incredible two thirds of the country is concerned about the possibility of a widespread Ebola epidemic occurring in the United States.

To put it simply this is an insane and completely unjustifiable level of fear. You are more likely to be killed by basically anything other than Ebola. The media has done a serious disservice feeding this irrational fear.

Ebola is a nasty virus but it is mainly a problem in West Africa because of bad infrastructure, serious poverty, highly inadequate health care systems, local funeral traditions, and government corruption.

Ebola is not airborne. It can only be spread by direct contact with body fluids, so there is basically no way it can become an epidemic here in the United States, with an adequate disease response system. Unless you are touching dead bodies of Ebola victims or people who appear very sick, since people are not contagious until they develop symptoms, there is basically no chance of you contracting the virus. Since only a handful of America’s trained health professional are working with the few people infected with Ebola in this country the other 99.9999% of us are fine.

Americans should be worried about almost anything else instead of Ebola. Like for example air pollution, which causes 200,000 early deaths each year according to one study, and well deserves this level of public concern.

Photo by www.TheEnvironmentalBlog.org under Creative Commons license

Almost All Americans Think Mandatory Minimums for Non-Violent Offenses are Stupid

By: Monday October 13, 2014 7:37 am

jail prisonWhen it comes to issues of criminal justice and drug policy reform, the populace continues to be way out ahead of federal politicians.

A Reason-Rupe poll last week found an incredible 77 percent support eliminating mandatory minimum prison sentences for nonviolent offenders so that judges have the ability to make sentencing decisions on a case-by-case basis. Only 17 percent oppose this change, which is serious fringe territory, yet this where many in Congress still stand.

Most nonviolent mandatory minimum sentencing laws in this country have to do with drugs. There is currently a bipartisan bill in Congress, the Smarter Sentencing Act, which would merely reduce the mandatory minimum for some nonviolent drug offense. The Congressional Budget Office has projected this would save taxpayers billions.

This deficit reducing bill is even more modest than what an overwhelming majority of Americans would support, yet it is still real danger not passing this year. Its no wonder Congress’ approval rating is in the single digits.

Vermonters: Help Us Stop Out of State Prison Transfers

By: Thursday October 9, 2014 10:43 am

Thirteen Vermont inmates at a Corrections Corporation of America (CCA) private prison in Arizona were recently thrown into solitary confinement after refusing to return to their cells and damaging equipment in the facility.

CCA is calling it a “disturbance,” but it sounds more like a demonstration. The details are reminiscent of a protest last month when 400 Dominican inmates at CCA’s for-profit federal immigrant detention center in Youngstown, Ohio peacefully opposed their treatment and living conditions for 14 hours straight.

The Vermont prisoners similarly expressed frustration with CCA’s restrictive rules and with being sent out of state, beyond the reach of family and community.

These inmates are among 500 from Vermont who have been shipped to facilities in other states. With CCA’s contract due to expire in July, Firedoglake is teaming up with Grassroots Leadership to demand Vermont Governor Peter Shumlin bring these inmates home and end interstate transfers for good.

If you live in Vermont sign and share our petition: End out-of-state private prison transfers and bring Vermont inmates home.

Not from Vermont? Use our share tool to spread the word about this campaign and help us recruit more signers to this petition.

Vermont is one of four states that has adopted this ineffective and expensive band-aid to address prison overcrowding.

Out-of-state private prison transfers put an undue financial and emotional burden on prisoners’ families while sending hundreds of millions of taxpayer dollars to for-profit prison corporations like GEO Group and Corrections Corporation of America. According to a report put out by Grassroots Leadership, interstate transfers actually increase prisoner isolation and lead to higher rates of recidivism.

The incident in Arizona isn’t the only one involving transferred Vermont prisoners. In January, the warden at the CCA-run Lee Adjustment Center in Kentucky resigned after incidents of violence put 200 Vermont inmates on a three-week lockdown. The state of Kentucky has stopped sending inmates to Lee altogether — in part because correctional reforms have reduced its overall inmate population.

We need to urge the governor to join him and end this policy before he renews the contract to house 500 inmates out of state in the coming weeks.

Sign our petition asking Governor Shumlin to end interstate private prison contracts and bring Vermont prisoners home.

Affordable Care Act Is Not Working Better Than Anyone Expected

By: Thursday October 9, 2014 9:07 am

Paul Krugman’s defending President Obama

Paul Krugman has new Rolling Stone article In Defense of Obama, but he decides he needs some historical revision for his defense. He claims the Affordable Care Act is “working better than anyone expected.” From their article:

Then technical difficulties with the HealthCare.gov website seemed to threaten disaster. But here we are, most of the way through the first full year of reform’s implementation, and it’s working better than even the optimists expected.

We won’t have the full data on 2014 until next year’s census report, but multiple independent surveys show a sharp drop in the number of Americans without health insurance, probably around 10 million, a number certain to grow greatly over the next two years as more people realize that the program is available and penalties for failure to sign up increase.

I don’t know how this could be called beyond what “optimists expected.” After all, the Congressional Budget Office report four years ago projected the number of uninsured would drop by 18 million from 2013 to 2014. It is true Republican governors refusing to expand Medicaid is part of the reason the drop in uninsured wasn’t as as big as predicted. Analysis shows that could result in 6.7 million more uninsured by 2016, but even accounting for this it looks like the numbers came just under target. President Obama’s decision to delay the employer mandate also deserves some blame, though. It is a major revenue generator and coverage expander which is still not in place yet. If Krugman really thought these CBO numbers were beyond optimistic four years he should have said something at the time.

On the positive side, Krugman does remember these CBO reports pointed out exchange premiums were slightly lower than projected four years ago, but that is partly because the overall economy has significantly underperformed from 2010-2014, and the exchanges allowed insurers to offer slightly worse packages than the CBO thought they would.

On the negative side, it is fair to say building and running the exchanges went much worse than most people predicted, and it is more difficult to help people select policies on the exchanges than was originally promised.

The drop in uninsured is slightly smaller, premiums are slightly better, and the structure is not as user friendly as was hoped. While the law is functioning better than some of the absurd Republican doomsday predictions about it, it is working roughly as reasonable experts said it would from the start.

We Should Create Two New Partisan Budget Offices

By: Tuesday October 7, 2014 8:18 am
Congress

Congress

A new concern among some Liberal commentators is that if Republicans win control of the Senate they will change how the Congress Budget Office works to make its results more pro-Republicans. Mainly it is fear they will have it adopt a form of “dynamic scoring” which assume tax cuts almost always spurs growth.

This has given me an idea. In addition to the non-partisan CBO Congress should created two new partisan budget offices, one Democratic and one Republican. They would be modeled, funded, and run just like the CBO but the employees of each would be selected only be their corresponding party leaders.

The economy is the top issue for voters and the disagreement between Democrats and Republicans on how to address it are substantial. Often the parties don’t just ideologically disagree on what are acceptable tradeoffs they often fundamentally disagree on what impact new policies will actually have on the economy. I say lets put this disagreement to a real test.

Lets have both parties choose teams of economists to make official predicts about the impact of each major bill. Lets get the parties on record. Over the years we will than be able to see how well the predictions fit reality and see if one party’s outlook is more accurate. We will have a real test of who understand the economy and what it needs better.

If Republicans truly believe dynamic scoring produces more better results they should welcome this opportunity. If they are actually right their partisan budget office would prove it by out perform the non partisan CBO and the Democratic budget office.

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