Can Democrats and Republicans at Least Agree to Fix the Roads?

It’s no surprise that President Obama’s jobs bill did not make it through Congress. It is now being broken into smaller bills so that each proposal can be considered individually, which is probably what should have been done in the first place. Now that both parties have done their political posturing, I hope that some items in the bill will get the consideration they deserve.

Like the original stimulus bill, the new jobs bill proposes spending on infrastructure projects. This is spending that creates immediate jobs and provides long-term benefits to businesses.

“The Cost of Doing Nothing” by Kathy Caldwell, president of the American Society of Civil Engineers, in the Oct. 2011 issue of  Science points out that deficient surface transportation infrastructure would cost U.S. businesses an added $430 billion in transportation costs by 2020, and billins more in export revenue would be lost. “Nearly all sectors will suffer, but those associated with technology and innovation would probably be the hardest hit,” Caldwell wrote.  She continued:

“To meet the many infrastructure challenges, more financing is needed. Now that the American Jobs Act has failed to pass Congress, there is discussion of breaking the bill into pieces that should be easier to pass. The proposed act includes $50 billion to modernize road, rail, and air transportation systems, and it would establish a National Infrastructure Bank to leverage public and private capital toward these endeavors. This level of priority and investment is needed, or the United States will continue its downward slide.”

 I agree. If Democrats and Republicans can’t even agree that we need to fix the roads, then our democracy truly is broken.

“The Cost of Doing Nothing” by Kathy Caldwell. http://www.sciencemag.org/content/334/6054/289.full

Why All Americans Should Have Health Insurance

As opponents of the Affordable Care and Patient Protection Act continue attempts to overturn, defund, or otherwise derail the law, it’s important to remember that the law addresses a crucial need to provide insurance coverage to all Americans.

The list below is a bit long, but these are just a few of the studies that demonstrate that Americans without health insurance have worse outcomes than those with insurance. It’s worth noting that some studies show Medicaid recipients also have worse outcomes, which some researchers speculate may be due to lapses in coverage. Please browse these excerpts from the articles' abstracts and note that all are from peer-reviewed medical or scientific journals. You may still think the Affordable Care Act is bad legislation, but repealing it without replacing it would cost lives.

Am Surg. 2010 Oct;76(10):1108-11.

Does health care insurance affect outcomes after traumatic brain injury? Analysis of the National Trauma Databank.

Alban RF, Berry C, Ley E, Mirocha J, Margulies DR, Tillou A, Salim A.

Cedars-Sinai Medical Center

Increasing evidence indicates insurance status plays a role in the outcome of trauma patients; however its role on outcomes after traumatic brain injury (TBI) remains unclear. A retrospective review was queried within the National Trauma Data Bank.... However, when controlling for confounding variables, the presence of insurance had a significant protective effect on mortality ... indicating insured severe TBI patients have improved outcomes compared with their uninsured counterparts.

Gynecol Oncol. 2011 Jul;122(1):63-8.

Insurance status and racial differences in uterine cancer survival: a study of patients in the National Cancer Database.

Fedewa SA, Lerro C, Chase D, Ward EM.

American Cancer Society

To examine the impact of race and insurance on survival among a large cohort of uterine cancer patients from the National Cancer Database (NCDB).... Patients without private health insurance had worse uterine cancer survival that may be improved through future health care reform aimed at improving access to preventive services and adequate treatment.

Am J Med. 2010 Aug;123(8):741-7.

Health insurance and cardiovascular disease risk factors.

Brooks EL, Preis SR, Hwang SJ, Murabito JM, Benjamin EJ, Kelly-Hayes M, Sorlie P, Levy D.

The National Heart, Lung, and Blood Institute

Compared with those with health insurance, the uninsured receive less care for chronic conditions, such as hypertension and diabetes, and experience higher mortality.... The treatment and control of hypertension and hypercholesterolemia are lower among uninsured adults. Increasing the proportion of insured individuals may be a means to improve the treatment and control of cardiovascular disease risk factors and to reduce health disparities.

Ann Surg Oncol. 2010 Dec;17(12):3104-11.

Health insurance status affects staging and influences treatment strategies in patients with hepatocellular carcinoma.

Zaydfudim V, Whiteside MA, Griffin MR, Feurer ID, Wright JK, Pinson CW.

Vanderbilt University Medical Center 

Lack of health insurance is associated with poorer outcomes for patients with cancers amenable to early detection. ... Uninsured patients with HCC are more likely to present with late-stage disease. Although insurance status did not affect chemotherapy utilization, Medicaid and uninsured patients were less likely to receive surgical treatment.

Cancer. 2010 Sep 1;116(17):4178-86.

Insurance status and survival disparities among nonelderly rectal cancer patients in the National Cancer Data Base.

Robbins AS, Chen AY, Stewart AK, Staley CA, Virgo KS, Ward EM.

American Cancer Society

Among patients with colorectal cancer, insurance status is associated with disparities in survival as well as differences in stage and treatment. 

Am J Respir Crit Care Med. 2010 May 1;181(9):1003-11.

An official American Thoracic Society systematic review: the association between health insurance status and access, care delivery, and outcomes for patients who are critically ill.

Fowler RA, Noyahr LA, Thornton JD, Pinto R, Kahn JM, Adhikari NK, Dodek PM, Khan NA, Kalb T, Hill A, O'Brien JM, Evans D, Curtis JR

American Thoracic Society

One in three Americans under 65 years of age does not have health insurance during some portion of each year. Patients who are critically ill and lack health insurance may be at particularly high risk of morbidity and mortality due to the high cost of intensive care.... Patients in the United States who are critically ill and do not have health insurance receive fewer critical care services and may experience worse clinical outcomes. Improving preexisting health care coverage, as opposed to solely delivering more critical care services, may be one mechanism to reduce such disparities.

Am J Surg. 2010 Apr;199(4):554-7. 

Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma.

Greene WR, Oyetunji TA, Bowers U, Haider AH, Mellman TA, Cornwell EE, Siram SM, Chang DC.

Howard University College of Medicine

Penetrating trauma patients with insurance still had a greater risk of death than blunt trauma patients without insurance.... Insurance status is a potent predictor of outcome in both penetrating and blunt trauma.

J Trauma. 2010 Jan;68(1):211-6. 

Does insurance status matter at a public, level I trauma center?

Salim A, Ottochian M, DuBose J, Inaba K, Teixeira P, Chan LS, Margulies DR.

Cedars-Sinai Medical Center 

It has previously been demonstrated that a lack of insurance impedes access to health care services and may affect outcome after acute medical events. ... Despite being younger and less severely injured, uninsured trauma patients had a significantly higher mortality rate.

Have a Heart, Use Your Brain

A quote that’s falsely attributed to Winston Churchill goes, “If you're not a liberal when you're 25, you have no heart.  If you're not a conservative by the time you're 35, you have no brain.”

The problem with the current conservative movement is that it lacks both a heart and a brain.

The conservative movement has no brain. Many conservatives (like Rick Perry) choose not to believe the overwhelming scientific consensus on climate change (1). Others (like Michelle Bachmann) make dangerous and ignorant claims that vaccines are unsafe, despite studies that have proven these claims to be false (2).

The conservative movement has no heart. Republicans in congress opposed health care reform and made no effort to propose an alternate system that would provide health coverage to all Americans. Some Republicans are trying to overturn the Affordable Care and Patient Protection Act in the courts. Research has shown that each year 45,000 deaths are associated with lack of health insurance in America (3), but opponents of health care reform want to repeal the act without replacing it. At the Tea Party–sponsored debate in September, audience members cheered a suggestion that an uninsured patient be left to die (4).

Any Republican who veers from the heartless/brainless platform is attacked by fellow conservatives. Rick Perry has been vilified because Texas provides educational opportunities to children of illegal immigrants. Mitt Romney has been criticized for passing health care reform in Massachusetts and for acknowledging the reality of man-man climate change. To appease the conservative GOP base, Romney has since been forced to adopt a more heartless position on health care and a more brainless position on climate change.

Americans need leaders with hearts and brains. The conservative movement seems determined that we get neither.

References

(1) http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=05192010

(2) http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine

(3) http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/

(4) http://abcnews.go.com/blogs/politics/2011/09/tea-party-debate-audience-cheered-idea-of-letting-uninsured-patients-die/

Get the Facts About Obamacare

I recently attended a presentation about the Affordable Care and Patient Protection Act at a hospital in the medical center here in Houston. The speaker, a physician, was explaining to other physicians how various provisions of the law would affect patient referrals, patient care, and reimbursement for hospitals.

He told the audience, “If you think you’re against ‘Obamacare,’ look at the individual provisions of the act and consider which ones you’re really against.”

We should do the same thing. Consider the provisions of the law, and ask yourself if you really want politicians or activist judges to do away with them:

Effective in 2010:

•Prohibiting Insurance Companies from Denying Coverage of Children Based on Pre-Existing Conditions.

•Prohibiting Insurance Companies from Rescinding Coverage.

•Eliminating Lifetime Limits on Insurance Coverage.

•Allowing Patients to Appeal Insurance Company Decisions.  

•Providing Small Business Health Insurance Tax Credits.

•Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole.”

•Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions.

•Extending Coverage for Young Adults up to Age 26.

•Expanding Coverage for Early Retirees.

•Increasing Payments for Rural Health Care Providers.  

•Strengthening Community Health Centers.

Effective in 2011:

• Prescription Drug Discounts for Seniors.

•Providing Free Preventive Care for Seniors.

Effective in 2012:

•Linking Payment to Quality Outcomes.

•Using Electronic Health Records to Reduce Paperwork and Administrative Costs.

•Providing New, Voluntary Options for Long-Term Care Insurance for Disabled Adults.

Effective in 2013:

•Expanding Preventive Health Coverage.

•Increasing Medicaid Payments for Primary Care Doctors.  

•Providing Additional Funding for the Children’s Health Insurance Program.

Effective in 2014:

•Prohibiting Discrimination by Insurance Companies Due to Pre-Existing Conditions or Gender. •Eliminating Annual Limits on Insurance Coverage.

•Ensuring Coverage for Individuals Participating in Clinical Trials.

•Tax Credits to Make Insurance Affordable for Middle Class Americans.

•Establishing Affordable Insurance Exchanges.

•Increasing the Small Business Tax Credit.

•Increasing Access to Medicaid

•Requiring Individuals who are Able to Take Responsibility by Purchasing Insurance.

Effective in 2015:

•Paying Physicians Based on Value Not Volume.

Source: http://www.healthcare.gov/law/about/order/byyear.html

Conservatism Lacks Compassion

When George W. Bush ran for president in 2000, I was attracted to his candidacy because he described himself as a “compassionate conservative.” Most Americans agree, at least in general, with the conservative principles of free markets and that the government should not be wasteful, and most Americans are compassionate in that they do not want others to do without food or medical care.

The problem with the current conservative movement is its lack of compassion. A prime example of this lack of concern for the public good is Texas Governor Rick Perry’s opposition to setting up an insurance exchange that would benefit many people here in Texas.

Yahoo News reported:

But when Republican state Rep. John Zerwas tried to move legislation to set up an insurance purchasing pool required by the national overhaul, he ran into a veto threat from Perry.

The purchasing pools — called exchanges — are one of the key features of Obama's law. Close to 4 million Texans stand to gain coverage under the law, nearly half of them through exchanges.

Run by the states, exchanges would let consumers buy coverage from a choice of private plans. Most individuals and families participating would be eligible for federal tax credits to lower their premiums.

Exchanges are supposed to open in 2014. If a state doesn't act in advance, the law authorizes the federal government to set up and run its exchange. And since the Texas legislature meets only every other year, this past session was seen as perhaps the state's only opportunity.

But Zerwas said Perry told him he was concerned that moving ahead with the exchange legislation would undermine a multistate lawsuit against the federal overhaul that Texas is part of, not to mention creating other political problems. The lawsuit challenges the constitutionality of the law's requirement that Americans obtain health insurance — the so-called individual mandate — an issue on which lower courts have split. …

"The position (Perry) was taking veers into some political considerations," said Zerwas. "He felt it would not ring well with some of the constituents and grassroots out there, and frankly, he was concerned it could potentially weaken the arguments in the lawsuit." (http://news.yahoo.com/perry-says-no-obamacare-whats-plan-163317444.html)

 I’m not sure whether Perry’s opposition to the Affordable Care Act is truly ideological or merely political, but a compassionate person would value people’s health more than either of those concerns.

We, the Corporations

Mitt Romney recently made headlines with his statement, “Corporations are people.” This reflects the Republican Party’s staunch defense of tax breaks for corporations and the 2010 ruling by the Republican-dominated Supreme Court that corporate campaign donations should be considered free speech.

In keeping with the Republican Party’s current preference of corporations to flesh-and-blood citizens, I’ve taken the liberty of updating a few quotes from the great Republican leaders of the past:

Abraham Lincoln: “Government of the people corporations, by the people corporations for thepeople corporations, shall not perish from the earth.”

Theodore Roosevelt: “We have room for but one sole loyalty and that is a loyalty to the American people corporations."

Dwight Eisenhower: “Politics ought to be the part-time profession of every citizen who would protect the rights and privileges of free people corporations and who would preserve what is good and fruitful in our national heritage.”

Ronald Reagan: This idea that government was beholden to the people corporations, that it had no other source of power, is still the newest, most unique idea in all the long history of man's relation to man.

Where the Religious Right Is Wrong

Texas Governor Rick Perry is attending a prayer meeting this week at Reliant Stadium in Houston along with several right-wing religious leaders, including Tony Perkins and James Dobson.

Please note that I use the term “religious leaders” rather than “Christian leaders” or “ministers.” I make this distinction because—while I would never question the faith of a fellow Christian—the leadership provided by Dobson and his ilk is anything but Christian.

Instead of encouraging followers to follow Jesus’ teaching (see Matthew 22:37-39), they focus their energy on opposing gay marriage or on trivial issues like school prayer.

Likewise, right-wing politicians consistently support tax cuts for the rich and oppose programs to help the poor.

Consider the following Bible verses—all from Christ himself—and then consider the actions of right-wing politicians and religious leaders like Perry and Dobson.

…Sell everything you have and give to the poor…

-Luke 18:22

But when you give a feast, invite the poor, the maimed, the lame, the blind, and you will be blessed,

because they cannot repay you. You will be repaid at the resurrection of the just.

-Luke 14:13-14

You cannot serve both God and Money.

-Matthew 6:24

They devour widows’ houses and for a show make lengthy prayers. These men will be punished most severely.

-Mark 12:39-41