Death, Distinctively

The good folks at the Centers for Disease Control and Prevention have rounded up some nifty state-by-state statistics on “distinct” causes of death in each state, defined as “the cause of death in each state that stands out most relative to its national average.” So what do you imagine is Tennessee’s distinct cause of death? As shown in a map legend included in a Washington Post story on the CDC report, here are the choices:

Source: CDC via Washington Post

Source: CDC via Washington Post

…and the winner is…

Accidental discharge of firearms! Shocking. The map does suggest some handy travel tips: Stay away from hospitals in New Jersey, avoid unprotected sex in Louisiana, and don’t spend too much time with attorneys in Oregon.

Source: CDC via Washington Post

Source: CDC via Washington Post

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


Baldfaced Lies at the Legislature

I realize I’m becoming a bit of a broken record documenting the shameless lies and propaganda that dominate the Beacon Center of Tennessee’s messaging on “Insure Tennessee.” But since our state lawmakers insist on giving Beacon a platform to spread their nonsense, someone has to call bullshit. Consider it called.

At this morning’s Senate Health and Welfare Committee hearing on Insure Tennessee, committee members were shown this slide by the Beacon Center’s Justin Owen, who was appearing before the committee to describe the various forms of apocalypse that will ensue if the legislature approves Medicaid expansion.

BeaconSlideCrop

Owen wants to argue that Medicaid expansion puts stresses on the system that end up harming the most vulnerable individuals already covered, and the slide was an attempt to suggest there there is evidence for this alarming prediction in the experiences other states that have expanded Medicaid. There’s just one problem with the slide: Every claim it makes is factually incorrect.

You see five claims in that slide. Let’s take ’em one by one.

Arizona – dropped coverage for transplants? It is true that Arizona made some drastic cuts that included reducing Medicaid coverage for some transplants, but this occurred in 2010, before Obamacare took effect and a full three years before Arizona actually approved Medicaid expansion in 2013. And oh by the way, Beacon doesn’t want you to know that Arizona restored funding for those organ transplants for Medicaid patients in 2011.

Arkansas – denied drugs for cystic fibrosis patients? It is the case that Arkansas’ Medicaid program last year decided to deny access to the drug Kalydeco, which costs around $300,000 per year, triggering a patient lawsuit. What the Beacon Center conveniently omits adding, however, is that a few months later a state review board comprised of doctors and pharmarcists recommended that restrictions on the use of Kalydeco be eliminated, a recommendation that the Arkansas Department of Human Services has said it intends to adopt.

Oregon – stopped coverage for cancer treatments? This claim has its roots in a bogus chain email that made the rounds in 2013. PolitiFact Oregon has thoroughly vetted this and rates it a “pants-on-fire” lie: “Older patients diagnosed with cancer need not worry that treatment will be rationed or denied under the Affordable Care Act. The claim is based on an inaccurate reading of a bill that went nowhere.”

Maine – stopped treating brain injury patients? It is preposterous to attribute any change in coverage in Maine to Medicaid expansion given the basic reality that Maine is not participating in Medicaid expansion. It’s governor Paul LePage has been an unyielding advocate of shrinking Medicaid, not expanding it.

Rhode Island – implemented premium for disabled children? This refers to a proposal floated by Rhode Island’s governor early last year that would charge a $250/month premium to parents with kids in the state’s Katie Beckett program for severely disabled children. What the Beacon Center conveniently neglects to mention is that state lawmakers scoffed, the premium proposal was scrapped, and if you visit the Rhode Island Katie Beckett eligibility page you learn that “There is no cost to families.”

That Beacon slide on display for Tennessee lawmakers this morning had no title. It need one: “Things in other states that didn’t happen but if I can fool you into thinking they did maybe I can scare you into opposing health insurance for the working poor.”

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


Can Alarmist Propaganda Derail Insure Tennessee?

On the eve of the Tennessee legislature’s special session on Medicaid expansion, The Wall Street Journal over the weekend gave the Beacon Center of Tennessee an opportunity to expand its alarmist anti-Insure-Tennessee propaganda to a national audience. In a piece coauthored with Christie Herrera of the Foundation for Government Accountability (another libertarian think rant tank), Beacon CEO Justin Owen characterized Gov. Haslam’s plan as a “bad deal for the public” that will “hurt the neediest patients,” is financed with a “sketchy” funding scheme, and will bloat the national debt. Owen and Herrera summed up the coming week’s doings in melodramatic terms:

Tennessee lawmakers must decide if they are going to burden more state residents—and American taxpayers—with ObamaCare’s broken promises, failed schemes and unsustainable policies, or whether their state will lead the march toward more freedom, greater access, and better health outcomes.

Obamacare is, to be sure, complicated and a work in progress. But “broken promises, failed schemes and unsustainable policies” seems like a pretty harsh verdict (and by “harsh” I mean “delusional”) for a set of policies that can be demonstratably associated with…

…increased access to health insurance: In the one year period from Sept. 2013 to Sept. 2014, the uninsurance rate (percentage of adults lacking health insurance) dropped by 30% nationally. The drop is 36% in states doing the Medicaid expansion thing, 24% in those not. (Source: Urban Institute Health Policy Center.)

…a drop in growth of systemic health spending: Health inflation measured as a growth in national health expenditures in 2013 was at its lowest level since the statistic originated in the 1980s. (Source: Centers for Medicare and Medicaid Services.) Brookings sums it up this way: “Growth in health spending over the past four years has been the slowest rate on record in approximately 50 years.”

…the same or lower cost for most people in the individual market: For those with individual policies who had to change insurance because their old plans didn’t comply with minimum standards set by Obamacare or otherwise went away, 46% end up paying less, 39% more, and 15% the same. (Source: Kaiser Family Foundation.)

…some wins in quality of care: Obamacare changes to payment systems intended to stimulate cost savings were designed in part to improve outcomes as well, and there’s evidence that hospital-acquired infections and hospital readmission rates are significantly down. (Source: Dept. of Health and Human Services.)

…high levels of satisfaction: Survey data show that 78% of adults added to the ranks of those covered in 2014 are satisfied with their new health insurance. Also, 58% of those who have gained access to health care (either through exchanges or Medicaid expansion) say they are better off than before&#8212a number that rises to 70% for those who have actually used their coverage in some way. (Source: The Commonwealth Fund)

It is true, as Obamacare critics contend, that the expansion of coverage puts strains on the system. Many in the individual market may have narrower provider networks than before, and expanded Medicaid isn’t all that expanded if docs won’t take new Medicaid patients. These issues can add up to legitimate questions about whether increased access to insurance translates into increased access to care. A fair-minded person can also question whether some of the favorable trends and outcomes are merely coincident with Obamacare rather than caused by it. Odds are it’s some of both.

But to try to take down Insure Tennessee by tarring Obamacare as a package of “broken promises, failed schemes and unsustainable policies” is to live in a world of policy hallucination. If more people insured at lower cost with high satisfaction and some gains in quality translates into “failed schemes” then color me pro-failure.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


A Shopworn Lie

One of the louder voices opposing Gov. Haslam’s Medicaid expansion plan is the libertarian Beacon Center of Tennessee, which has just launched a new radio ad running in the Knoxville media market. The ad, framed as a conversation between a senior citizen and her daughter, resurrects one of the right’s most dubious (but nonetheless durable) canards on this issue:

DAUGHTER: “In fact, the Medicaid expansion will be paid in part by $716 billion in cuts to seniors’ Medicare benefits.”

MOM: “To give health insurance to able bodied adults?”

DAUGHTER: “You got it.”

It’s always good practice to begin a factually debunked assertion with the words “in fact.” This claim has been fact-checked so many times it should take up residence in the fact-checking hall of fame. But since Beacon thinks the way to build opposition to health insurance for the working poor is to recycle a lie, let’s go at it once more, with feeling.

The origin of that $716 billion number is an analysis by the Congressional Budget Office back in 2012 in response to a request from House Speaker John Boehner for an estimate of the cost of repealing Obamacare. On page 13 of its 22 page analysis, the CBO said that “Spending for Medicare would increase by an estimated $716 billion over the 2013-2022 period.”

Does that sentence mean, as the Beacon ad claims, that Medicaid expansion will be paid for by $716 billion in cuts to Medicare benefits? As the highly respected Annenberg Public Policy Center’s FactCheck.org has noted, the $716 billion is an estimate of the decline in future growth of Medicare spending owing to reductions in growth of payments to hospitals and providers, diminished subsidies for Medicare Advantage plans, and savings anticipated as a result of reimbursement system changes. The claim that projected declines in future spending growth represent cuts of Medicare benefits to seniors, they conclude, is “misleading and shameful.”

Don’t like the pinkos at Annenberg’s FactCheck.org? Fine. Let’s go to the roster of fact checkers:

Politifact.com: “Obamacare does not literally cut funding from the Medicare budget, but tries to bring down future health care costs in the program….There is reduction in spending to Medicare outlays, but it’s fueled by finding savings in the program, a move that Republicans actually supported in the Ryan budget. Medicare spending still increases in the coming years.”

Los Angeles Times Fact Check: “The president’s healthcare law does reduce future spending on Medicare, but those savings are obtained by reducing federal payments to insurance companies, hospitals and other providers, and do not affect benefits for people in the Medicare program.”

Washington Post Fact Check: “While it is correct that anticipated savings from Medicare were used to help offset some of the anticipated costs of expanding health care for all Americans, it does not affect the Medicare trust fund….Spending does not decrease in Medicare year after year; the reduction is from anticipated levels of spending in future years. Moreover, the “cuts” did not come at the expense of seniors.”

TIME Fact Check: “As for the cuts, they come from eliminating a massive subsidy to private insurers and gradually reducing the rate of growth in payments to some providers….The idea, however, that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue.”

Beacon describes itself (humbly) as an organization that “empowers Tennesseans to reclaim control of their lives, so that they can freely pursue their version of the American Dream.” Reclaim control of their lives? Or of their lies?

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


And I Mean the Left

NashvilleBroadcastingHistory.com

NashvilleBroadcastingHistory.com

This post appears at the Nashville Scene’s Pith in the Wind blog along with those of others who appeared on “The Round Table,” the long-time radio enterprise hosted by the great Teddy Bart, who passed away a few days ago.

Growing up in New York I fed an early nerdy talk-radio addiction using a bedside clock radio to catch the pompous erudition of the great Barry Farber, the offbeat weirdness of Long John Nebel, and even occasionally (yes I’ll admit it) the original semi-unhinged conservative radio mouthpiece Bob Grant. Whatever the politics and eccentricities of a particular host, the appeal was (mostly) civilized conversation about ideas with smart people for a loyal radio audience.

Each place I’ve lived after leaving the northeast for college always brought me in short order to cruising the radio dial for good local talk — surely I can find a version of this conversation almost anywhere. Landing on planet Nashville in the early 1990s I happened upon this Teddy Bart guy and his morning Round Table of … what, exactly? It felt like an odd mix: one minute serious journalists are kicking around city and state politics, the next minute Teddy is tickling the ivories of an electric piano in the studio and pivoting into sports and weather. So this is Nashville, I thought: You get a talk show only if you can play an instrument and sing.

Once I’d been spewing opinions in outlets like the Nashville Scene for a while, Teddy invited me to be on the Round Table from time to time as a panelist “on the left” (“and I mean the left,” he would always add with a smile). It was great fun, as it would be for any card-carrying political junkie, to chew the fat on issues of the day with other smart humans of diverse viewpoints. But it was serious fun: it was a great privilege to be part of conversations that were informed and constructive, that mattered (without taking themselves too seriously), and that were heard.

The show in its later years may have aired on obscure AM radio stations with obscure cable-access replay — hard to find unless you were looking for it, but it turns out a lot of people were looking for it. Almost nobody turned down an invitation to be on the show, and nine years after it ended I still run into people who recall my minor involvement and lament that Nashville has had no similar outlet for regular meaningful civic dialogue ever since.

He was plenty good with that keyboard, but thoughtful, civilized discourse turned out to be the instrument Teddy Bart played virtuoso.


Hero or Traitor? Or Something in Between?

snowdenThe sensational new documentary on Edward Snowden, CITIZENFOUR, opens here in Nashville at the Belcourt Theater next week. I reviewed the film for the Nashville Scene in this week’s issue. A snippet:

The film’s center, dramatically and chronologically, is the middle hour focusing on the fateful encounter of Snowden, the Guardian’s Glenn Greenwald, and documentarian Poitras (behind her camera, occasionally heard but never seen) in a Hong Kong hotel room for eight days in June 2013. Poitras’ camera was rolling from the start, giving us a front-row (bedside?) seat as history unfolds. Columbia Journalism School dean Steve Coll likens it to having footage of Bob Woodward’s first parking-garage meeting with Deep Throat.

From this seemingly mundane procedural footage, we learn that extended sequences of a few people talking in a hotel room, working on laptops, watching television, munching on room service and taking an occasional phone call can be downright spellbinding.

For anyone who cares about civil liberties in a free society, unmissable.


Can It Happen Here?

It — Ferguson — can theoretically happen anywhere, obviously. But there are some structural differences between metro St. Louis and metro Nashville in the way local and satellite governments are configured that are important to understand. An insightful New York Times op-ed today by political scientist Jeff Smith (previously a Missouri state senator from St. Louis) explains some of the history behind the geographic and demographic configuration of inner suburbs in St. Louis — history that is quite different from ours here in middle Tennessee:

Back in 1876, the city of St. Louis made a fateful decision. Tired of providing services to the outlying areas, the city cordoned itself off, separating from St. Louis County. It’s a decision the city came to regret. Most Rust Belt cities have bled population since the 1960s, but few have been as badly damaged as St. Louis City, which since 1970 has lost almost as much of its population as Detroit.

This exodus has left a ring of mostly middle-class suburbs around an urban core plagued by entrenched poverty. White flight from the city mostly ended in the 1980s; since then, blacks have left the inner city for suburbs such as Ferguson in the area of St. Louis County known as North County.

This governmental fragmentation, Smith notes, translates into large numbers of small towns with independent police forces and too much reliance on traffic stops for revenue:

St. Louis County contains 90 municipalities, most with their own city hall and police force. Many rely on revenue generated from traffic tickets and related fines….Ferguson receives nearly one-quarter of its revenue from court fees; for some surrounding towns it approaches 50 percent. Municipal reliance on revenue generated from traffic stops adds pressure to make more of them.

Ninety! And that’s in a county whose population outside of the city of St. Louis is roughly the same as Davidson County. As Smith explains, because the white-to-black shift in racial demographics in many of these suburbs has occurred only fairly recently, “fewer suburban black communities have deeply ingrained civic organizations,” which is part of how it comes to be that places like Ferguson have majority white power structures (city council, school board, police force) in majority black communities.

Smith sees a remedy, one that should sound vaguely familiar to Nashvillians: consolidation.

Consolidation would help strapped North County communities avoid using such a high percentage of their resources for expensive public safety overhead, such as fire trucks. It could also empower the black citizens of Ferguson. Blacks incrementally gained power in St. Louis City in part because its size facilitates broader coalitions and alliances. Another benefit of consolidation is the increased political talent pool. Many leaders just aren’t interested in running a tiny municipality….Consolidation could create economies of scale, increase borrowing capacity to expand economic opportunity, reduce economic pressures that inflame racial tension, and smash up the old boys’ network that has long ruled much of North County.

Obviously the kind of consolidation that might bring surburban communities together in 21st century St. Louis County doesn’t mimic the experience or the experiment Nashville and Davidson County launched 50 years ago. And certainly there are other factors that make St. Louis and Nashville very different places. But it is instructive during a period of searing civic tension in a metro area that in many ways qualifies as a peer city to think about structural similarities and differences when pondering the inevitable question: can it happen here?

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.


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