Archive for the ‘health care’ Category

Institute of Medicine Report Calls for More Funding for Research into LGBT Health Issues (and Quotes Renowned Expert)

March 31st, 2011 No comments

This ABC News story links to the IOM Report, which is like a blast of warm energy after the Bush Administration’s policy of declining to fund any studies related to LGBT health issues. The Report is a sophisticated effort, even if it does underestimate the challenges in collecting data relating to sexual orientation.

Oh, and the story quotes me.

Tribe Baits Scalia

February 9th, 2011 No comments

That’s surely what liberal Professor Laurence Tribe is doing here, right?

Given the clear case for the [health care] law’s constitutionality, it’s distressing that many assume its fate will be decided by a partisan, closely divided Supreme Court. Justice Antonin Scalia, whom some count as a certain vote against the law, upheld in 2005 Congress’s power to punish those growing marijuana for their own medical use; a ban on homegrown marijuana, he reasoned, might be deemed “necessary and proper” to effectively enforce broader federal regulation of nationwide drug markets. To imagine Justice Scalia would abandon that fundamental understanding of the Constitution’s necessary and proper clause because he was appointed by a Republican president is to insult both his intellect and his integrity.

Two predictions:

(1) Scalia, as obvious a partisan as you’ll ever find, will vote to strike down the law; and

(2) He won’t be able to resist taking on Tribe, probably in that nasty-clever way that he’s perversely perfected.

This should be good. (By “this” I mean Scalia’s response, not the possibility that the law will actually be struck down. I still don’t think that’s likely, and it would be a disaster for both the Obama Administration and the country.)

Gay Rights and False Choices

September 24th, 2010 No comments

In this week’s column over at, I have a serious mad going on over a question asked at a dinner party: “Which would you rather have, gay rights or health care?”

I mean, really.

Google’s Decision to Pay Taxes on Benefits to Same-Sex Partners: The Infinite Regress Problem, and Other Fairness Issues

July 1st, 2010 2 comments

Google, like a small but growing number of other progressive organizations, has announced that it’s going to start paying the income taxes that its employees must pay on the value of the health care benefits that go to their same-sex partners. This is (sort of) welcome news, but it doesn’t completely work. Here’s why:

Say that Martina works for Google, and that the value of the benefits to her same-sex partner is $6,000 per year. Now imagine that, in Martina’s tax bracket, she would be taxed $1,500 (25%) on that amount. So now Google will pay that $1,500. But here’s what the stories aren’t saying: The $1,500 is itself taxable to Martina. So she now has to pay $375 (25% of $1,500) on that amount. Bottom line: She’s still paying more than her married, opposite-sex counterpart. I suppose Google could try to fix this by paying her $1875 instead ($1500+$375), but then she has to pay the tax on that amount, and so on.

I don’t expect Google or anyone else to follow this infinite regress all the way down, but my analysis demonstrates that even commendable, employer-driven efforts at equality are just patches on indefensible governmental discrimination. This tax inequity was a target of the health care reform bill, but it died when the House and Senate got together to reconcile the differences in their respective bills.

One other point, expanding on the parenthetical aside above that Google’s move is “sort of” good news: As I’ve mentioned before, there seems to me little reason for employers and insurers to tie benefits to marriage in the first place. Why not simply give each employee an equal amount in health care benefits to use as they see fit? Then those in other kinds of arrangements — elderly siblings sharing an apartment; unmarried cohabitants raising kids together, and so on — would have coverage. That’s real health care reform.

That Didn’t Take Long!

April 16th, 2010 No comments

Earlier today, I wrote that the right-wing fringe hadn’t expressed opposition to Obama’s humane Memorandum directing HHS to create rules requiring hospitals to respect the decisional autonomy of their patients, by letting them choose their own visitors — even though one major effect of any such rule would be to respect same-sex couples.

Now, blundering in from the periphery comes Peter Sprigg of the Family Research Council, who denounces the rule for a confusing mash of reasons, apparently including general opposition to Obama doing anything relating to health care (a good chance to oppose HCR, in another context), and some idea that the move contributes to a redefinition of marriage. But then there’s this exchange, towards the end of an on-line exchange where Sprigg was buffeted about by a score of e-mail conversants. Watch him just give up the ghost:

Mr. Sprigg — I can hardly see how someone could deny a hospitalized person the compassionate and therapeutic benefits of a visitation by their partner.

In opposing this measure, aren’t you putting your dogma before your humanity? Are you seeking to publicize your agenda? You really need to examine the question: what would Jesus do?

Peter Sprigg: Let me re-emphasize that I do NOT oppose allowing people to visit their homosexual partners in the hospital. I just think that provisions to allow that should be based on the general principal of patient self-determination, and not based on a redefintion of “family” or “marriage.”

The President’s memorandum actually does appeal to that principle, and is not focused only on same-sex couples.

So why not just leave it alone? Because the Family Research Council — which, to reanimate the Coffee Talk Lady, is “neither pro-family, nor based on sound research, nor a council” — can’t resist piping up whenever the common humanity of gay and lesbian people is respected, however meagerly. Let’s not forget that these fringies do us a favor with their tone-deaf absolutism.

Not Just for Gays: Hospital Visits and Respect for Autonomy

April 16th, 2010 No comments

Last night’s surprise action by President Obama was a heartening and welcome development. In a two-page memo to HHS Secretary Kathleen Sebelius, Obama requested that the Secretary promulgate rules that will increase the chances that the wishes of lesbian and gay hospital patients respecting visitation and decision-making will be respected rather than ignored. From the memorandum:

It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

So far, I’ve not seen any criticism of this move from the right. I don’t expect much (but please let me know if you find any), because mostly everyone has conceded this point: “Oh, I’m in favor of gay people being able to visit each other in the hospital.” It’s an easy bone to throw us to make homophobia seem tolerant, and it has the benefit of feeding into the perception they’re trying to sustain that gay people are “sick.” So it’s a brilliant, unassailable — and overdue — move by the President.

What little criticism I’ve seen has come from the gays our ownselves. Here’s Andrew Sullivan:

There is something about the well-meaning liberal mind that is often admirably eager to help the needy, but balks at offering the recipients what we really want: simple equality. The latest move – giving Obama an easy win, the gay lobby a role in mediating the transaction – perpetuates the victimology that sustains the Democrats and their interest groups.

If we had marriage equality, we’d need no-one’s compassion. We’d just be able to live our lives. Why won’t the president help us do that?

As someone who’s written both windy law review articles and blog posts arguing for marriage equality for the past decade plus, I’m not going to disagree about the importance of “simple equality” which would make a great number of other issues disappear. (And it really is simple.) But read the Memorandum closely and you’ll see that the requested change goes far beyond marriage equality: The idea is to allow people to designate the person of their choice (either “on the spot” or through advance directives) to visit them in the hospital.

Yes, this will help those of us in same-sex relationships to avoid some of the horrors that our community has suffered, such as the inhumane and just inexplicable case that unfolded in Florida recently. But it will also help people in all kinds of relationships that the law doesn’t recognize, and never will. That respect for individual autonomy and decision-making in the most challenging circumstances is the great accomplishment of this Memorandum, and it shouldn’t go unacknowledged.

One more point: There’s a limit to what a President can accomplish all by himself, but these Executive Orders and Memoranda should be coming fast and furious. Obama could have issued this Memorandum immediately after taking office. While that would have been too late for Janice Langbehn and Lisa Pond in Florida, there have doubtless been many others since January 2009 who could have been at their partners’ side during those terrible final hours. What a needless shame.

The Woozy Blogger (Questions the Entire Medical Profession)

April 2nd, 2010 No comments

In light of  my usually relentless blogging, I’d guess that my absence for much of the past week came as a surprise. Here’s what happened….

Last Wednesday night, I had no sleep. The kidney stone that I thought I’d passed (with evidence to show for it) seemed to still be plaguing me. So I called the doctor, who thought that a piece of it was still in there, and causing me continued pain. Oh, guess what….he had a cancellation for surgery the next day (Friday), and told me that “this had been going on long enough.” He wanted to go in and get the rest of it.

So, while millions of others were packing cars, coolers and kids for the Labor Day weekend, I was presenting myself for surgery at Pennsylvania Hospital. The process begins with a “welcome-to-prisoner-of-war” series of escalating depredations: surrender your valuables;1 strip completely and put on two back-and-front, graying gowns that you can’t tie up; wait in a large room with other saps who have nothing to do but lie there nervously.2

My doctor appeared briefly, initially anonymous and unrecognizable in his surgical cap. I began by telling him that the rest of the stone might by now have passed, since I was no longer feeling any pain, or even discomfort. This didn’t daunt him: “Let’s go take a look,” he cheerfully suggested, as though he were a kid about to look through a telescope. By this point, I was increasingly convinced that this wasn’t a good idea, but the combination of my ambivalence and the weight of circumstance led me to agree (by saying nothing). I did manage to ask about the risks, to which he matter-of-factly replied with these two disconcerting possibilities. (1) “Sometimes the stone gets pushed back into the kidney, because we have to irrigate the ureter3 and the water can drive it back up there.” OK, I guess. (2) “Sometimes the ureter gets punctured, but that hasn’t happened in years.” Wait. How many years? What happens if it does get punctured? What are the chances? All questions I didn’t ask. Would you have?

So of course they found exactly no (zero, none, the null set) kidney stones after burrowing through my ureter all the way to the kidney. Couldn’t they have checked before going in? Because the procedure isn’t exactly inconsequential. Shortly after I woke up, I was seized by the same stabbing pain I’ve now grown to know and detest as kidney stone agony. It turns out that dilating the ureter often leads to violent spasms that call to mind, in a searing burst of unwanted nostalgia, the pain of the stone itself. And since the bladder is swollen to Hindenberg size, the pressure one feels brings its own deep discomfort.

As the nurse in the Recovery Room said to me:  “Well, they don’t tell you about this part. Oh, it’s just a procedure. A piece of cake.” Well, today is Tuesday — almost four full days after this l’il “procedure” and it’s the first that I’ve been coherent enough to do much of anything. Friday through Monday are lost to a narcotic haze that left me unable to do much of anything — even blog!

There were, and are, so many things wrong here. First, and most centrally, the surgery itself turned out to be completely unnecessary. Especially given the strong possibility that the stone had passed, wouldn’t a quick scan for it have made sense? Personally, I like to avoid needless surgery and the risks (not the least of which is general anesthesia).

Then there’s what they do, and don’t tell you — and when. It was only after I insisted three times that they summoned one of the surgical team’s doctors to my hospital bed to explain what was going on. Well, that’s not completely right, because apparently there was a doctor talking to me shortly after the surgery, but I was in such a state that I didn’t even remember the event. Is this what’s passing for bedside manner: a physician so clueless that he doesn’t bother noticing that the patient isn’t coherent enough to understand what is being said?

And about the pain: Yesterday, when none of the drugs I was taking would mitigate the latest bout of pain, my doctor suggested that I repair to the ER and ask to be admitted (at his direction). But once I got there, the resident urologist turned out to be the one who actually performed the surgery (that I thought my doctor was performing, by the way). Disagreeing with the other doc (likely without knowing it), he said that there was no need for me to enter the hospital, that the pain I was continuing to feel was normal, and that I could get even better pain-killing drugs, as needed.4 Oh, and the ER doc said that simple anti-inflammatory drugs, like ibuprofen, could really help. First time I’d heard that.

Lessons? First, although I won’t necessarily refuse surgery in the future, perhaps this sorry episode will get me to be more skeptical and to practice what I preach: Surgery is to be avoided, and there should be a presumption against it. Your MD’s livelihood may depend, in large part, on the number of surgeries he or she does, so  your interests may not coincide perfectly. I’m not suggesting that surgery in my case wasn’t indicated, just that it was only one of a few options. And not even necessary, as it turned out.

Second, one must insist, constantly, that one’s medical team lay out the whole picture — including pain to be expected, possible complications, risks and alternatives. As things stand, “informed  consent” is more a legal doctrine than a practical reality.

This post was originally published on September 8, 2009.

  1. This includes all jewelery, wedding rings not exempt. I wish I hadn’t asked why,  because the reason has to do with the problems metal presents when they’re trying to shock you back to life.
  2. There was a little TV in my tiny, curtained-in area, but it kept shorting out. When it did work, the guy in the next bed asked me to turn down what he thought was a violent show, with women screaming. I was in fact watching the US Open Tennis; the screaming came from Serena Williams every time she crushed the defenseless ball.
  3. Especially during the planting and growing seasons.
  4. Yes!
Categories: health care, Social Justice Tags:

The Cucinelli Follies, Redux

March 22nd, 2010 No comments

Virginia AG Ken Cuccinelli can’t help himself. Shortly after getting slapped down by his own governor, Bob McDonnell, for directing the state’s universities to rescind whatever anti-discrimination policies they had protecting their LGBT communities, his not-so-inner cultural warrior came out during an interview where he referred to gay and lesbian “acts” as detrimental to society. (Please don’t get me started.) So there was the basis for his letter to the schools; a letter that I opined was both unnecessary and legally flawed (a conclusion that was later backed up for by a former Virginia AG).

Now comes Cuccinelli revving up a lawsuit against the new health care reform bill (likely to be filed once the thing is finally enacted). The basis of the suit is that Congress has no authority to mandate that individuals buy health insurance. Here, though, he has less choice because the Virginia legislature passed one of these vogue laws that purports to defend its citizens against any federal mandate. So it’s his job to argue for that law in court. But he’ll lose, for the reasons my colleague Andy Fichter made clear in his op-ed article yesterday. (It’s a good, clear read for non-lawyers.) This is just one more hare-brained effort to short-circuit the legitimate legislative process. Throw some bricks through a Democratic congresswoman’s window, shout “baby killer” on the floor of the House, argue that the bill can’t go through Senate reconciliation because it involves money (and so does Social Security! and you can’t do that through reconciliation), storm into Congress on the eve of the vote to bully and insult legislators — it’s all fair game, now. Good losers, they’re not, but whatever has happened to the respect we owe each other in civil society?

Categories: health care, Virginia Tags:

Health Care Reform Bill Passes House

March 21st, 2010 No comments

In a vote the outcome of which became evident earlier in the day, the House just passed the Health Care Reform bill. The rest will be all Sturm und Drang — in other words, endless fodder for pundits, but with no real surprises or deviation from the outcome.

I made the tragic error of listening to much of the debate tonight. Oy! A few good points raised on either side (arguing about the effect on Medicare; whether the CBO estimate can be trusted; the wisdom and enforceability of mandates), but most of it was the worst kind of bloviating. Our freedoms will be sacrified, our nation will slide into a Euro-socialist swamp, and on and on. These Representatives are living counterarguments to their own assertions about “American exceptionalism”, unless that exceptionalism is that we’re a completely negative, uncharitable people.

This is a huge victory, let us not forget amid all of the distraction.

His Holiness [sic] and the “Pro-life” Canard

March 20th, 2010 1 comment

I was Catholic, but only by circumstance, and that was a very long time ago. I didn’t so much leave the Catholic Church as I lost interest in all churches and in organized religion, generally. But it should be said that my experience growing up in the stultifying, boring Church didn’t exactly awaken whatever religious feeling I might otherwise have had. And my family was very low-key about it: No Catholic school, limited instruction in doctrine, little evidence of it at home. We went to Church most Sundays, unless there were swim meets in the way. But that’s about it.

For me, then, leaving the Church was easy and not even so much the product of a conscious decision. It’s more like I would have needed to decide to be a Catholic, rather than not to.

Yet growing up around all of that ritual and history had some effect on me, notably that I follow and in some way care about what the Church is doing more than I otherwise would. Most of the time, I’m either amazed or appalled (or both), but then there are the occasions when the socially progressive, charitably inclined part of what the Church is supposed to champion reminds me that it’s not all one-way traffic to Hell (to use one of their favorite scare words, among many).

Lately, the Church has been in the news and mostly for terrible reasons. The unfolding horror of the sex scandals in Ireland and Germany,1 which have — let’s face it — implicated His Holiness [sic] in the cover-up is just the most dramatic of the stuff coming through the wire. There’s also the benighted response by the Diocese in D.C. in response to marriage equality (ending health benefits to employees’ spouses, discontinuing their foster care program), and the expulsion of pre-schoolers from the Sacred Heart of Jesus (remember him?) because their parents were lesbians. Add to that the bishops’ opposition to the Senate health care reform bill on the ground that it doesn’t do enough to make abortion even more difficult to obtain, and I’m left to say: Enough already.

Just in time, other voices in the Church have come forward to call the bishops on their slick, “pro-life” (read: anti-life) rhetoric. The Catholic Health Association (CHA), which describes itself as “the nation’s largest group of not-for-profit health care sponsors, systems, and facilities,” has taken on the bishops’ abstract, disembodied, and disconnected opposition to the health care reform effort. Here’s why:

The insurance reforms will make the lives of millions more secure, and their coverage more affordable. The reforms will eventually make affordable health insurance available to 31 million of the 47 million Americans currently without coverage.

CHA has a major concern on life issues. We said there could not be any federal funding for abortions and there had to be strong funding for maternity care, especially for vulnerable women. The bill now being considered allows people buying insurance through an exchange to use federal dollars in the form of tax credits and their own dollars to buy a policy that covers their health care. If they choose a policy with abortion coverage, then they must write a separate personal check for the cost of that coverage.

There is a requirement that the insurance companies be audited annually to assure that the payment for abortion coverage fully covers the administrative and clinical costs, that the payment is held in a separate account from other premiums, and that there are no federal dollars used.

In addition, there is a wonderful provision in the bill that provides $250 million over 10 years to pay for counseling, education, job training and housing for vulnerable women who are pregnant or parenting. Another provision provides a substantial increase in the adoption tax credit and funding for adoption assistance programs.

An association of nuns, representing 59,00o sisters, agrees and amplifies, from the point of view of those actually providing health services to the poor (compare the bishops):

We have witnessed firsthand the impact of our national health care crisis, particularly its impact on women, children and people who are poor. We see the toll on families who have delayed seeking care due to a lack of health insurance coverage or lack of funds with which to pay high deductibles and co-pays. We have counseled and prayed with men, women and children who have been denied health care coverage by insurance companies. We have witnessed early and avoidable deaths because of delayed medical treatment.

The health care bill that has been passed by the Senate and that will be voted on by the House will expand coverage to over 30 million uninsured Americans. While it is an imperfect measure, it is a crucial next step in realizing health care for all. It will invest in preventative care. It will bar insurers from denying coverage based on pre-existing conditions. It will make crucial investments in community health centers that largely serve poor women and children.

[T]his is the REAL pro-life stance, and we as Catholics are all for it….

Did this get Bark Stupak to rethink his position? What do you think? Perhaps because of unpleasant experiences with Catholic nuns in school (write your own joke), he blathered about getting his “pro-life” guidance not from them but from the bishops and organizations like Focus on the Family — the same group that has this advice for parents who find that spanking isn’t working: “The spanking may be too gentle. If it doesn’t hurt, it doesn’t motivate a child to avoid the consequence next time. A slap with the hand on the bottom of a multidiapered thirty-month-old is not a deterrent to anything. Be sure the child gets the message….”

If health care reform doesn’t pass tomorrow, it will be because Stupak has been able to hold on to enough fellow slavish devotees of the simplistic pro-life legislators. They should listen to the people who actually deliver health care services. If they did, they might take a position that is actually pro-life; instead of “pro-life,” complete with ironic quotations.

  1. There’s been great coverage of the issue over at the Daily Dish.