Pay Or Die

It turns out that some of the Sackler family were pressing hard to get more people addicted to the opioids Purdue Pharma was selling, even as they were trying to avoid media coverage for their drug connections and donating to museums, which should now be removing the Sackler name from their halls.

But that’s only secondarily what this post is about. It turns out that manufacturers of insulin, which many people need to stay alive, have been gaming the system to make things more profitable for them and much more inconvenient for patients and doctors. But what’s human suffering compared to profit, hey Ray Sackler?

The exorbitant prices confound patients and doctors alike since insulin is nearly a century old now. The pricing is all the more infuriating when one considers that the discoverers of insulin sold the patent for $1 each to ensure that the medication would be affordable. Today the three main manufacturers of insulin are facing a lawsuit accusing them of deceptive pricing schemes, but it could be years before this yields any changes.

There are several reasons that insulin is so expensive. It is a biologic drug, meaning that it’s produced in living cells, which is a difficult manufacturing process. The bigger issue, however, is that companies tweak their formulations so they can get new patents, instead of working to create cheaper generic versions. This keeps insulin firmly in brand-name territory, with prices to match.

This is why we need a different healthcare system. I’m not well enough informed to know whether it’s single payer or Medicare for All, or something else. But this profiting off human suffering has to end.

Open thread.






187 replies
  1. 1

    When I saw the headline, I thought this would be about the proposal Trump will make this afternoon.

  2. 2
    The Midnight Lurker says:

    I’m still betting ‘National Emergency’. Yeah, yeah… I heard some Trump staffer saying that wasn’t going to be it too, but since when can you trust anything coming out of this White House?

  3. 3
    The Midnight Lurker says:

    And I know this isn’t going to win me any friends here, but after reviewing the back and forth on this Special Council v Buzzfeed report this a.m., I’m under the distinct impression that Mueller’s office cocked this whole thing up and owe us an explanation or at least some further clarification.

  4. 4
    Betty Cracker says:

    Agreed, Cheryl. Also, some people named Sackler need to go to jail.

    @Dorothy A. Winsor: I’ve been blissfully avoiding the news. The shitgibbon is proposing something? Thanks for the heads-up — I’ll redouble my news avoidance.

  5. 5
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    Also need a lot of redos on the insane level of intellectual property gangsterism we encourage here.

  6. 6
    Suzanne says:

    @Betty Cracker: I am also avoiding. I’m missing the Women’s March, too….sitting in the ENT awaiting room trying to get my goddamn snotbox fixed. I needed an emergency appointment—-first available was two weeks later.

    I miss breathing.

    Best healthcare system in the world! No waits!

  7. 7
    JPL says:

    @Dorothy A. Winsor: DACA extension for the wall. It doesn’t even sound like a permanent fix to DACA

  8. 8
    Betty Cracker says:

    @Suzanne: Damn, hope they can fix the snot-locker and get you outta there soon! Breathing is important!

  9. 9
  10. 10
    Ohio Mom says:

    Insulin prices are criminal but then there are all the other items diabetics also need: blood sugar meters and testing strips — and the cost of the strips really adds up — lancets, needles, alcohol wipes, insulin pens, and I know I am leaving things out.

    Ohio Dad has the kind of Type 2 diabetes that has progressed to where he needs insulin, and our old Insurance did not cover all those extras. You can’t know how much insulin you need to give yourself without testing your current bloody sugar level. Now we could afford to pay out of pocket but obviously a lot of people can’t.

    And there have been fabulous advances in insulin pump technology, including wearable blood sugar monitors that communicate with the wearable pump, but this equipment is horribly expensive and insurance companies often balk at approving them.

    We have a deeply corrupt and sadistic health care system. The ACA was an important improvement but hardly enough.

  11. 11
    OzarkHillbilly says:

    We must have the worst possible health care delivery system except for those places that don’t have one at all. Medicare is the most kluged up mess imaginable, with add ons on top of the add ons on top of the add ons. Trying to figure out what does what and the differences between the various options while trying to read the tea leaves of one’s health future leads to a “pin the tail on the donkey” decision process.

    You just hope you don’t get needlessly fucked too terribly bad.

  12. 12
    Ruckus says:

    Money is the cure for everything. Just ask a greedy fuck.

    The only way for this to change is to have a working government. With 40-50% of this country thinking that government is the problem and if it would just get out of the way, everyone important could be rich and another what 20% have their heads up their own asses and could care less about good government, how do you get there? The current incarnation of idiots supposedly in charge will either bumble their way into a lot less control-profit, or will at least be destructive enough that just rebuilding will take years, meanwhile the stupid marches on.
    Awww to be young and pissed. Almost as good as old and pissed.

  13. 13
    SFAW says:

    I’m trying to determine if “Shkreli” is some weird palindrome of “Sackler.” Or vice versa.

  14. 14
    Doug R says:

    Even here in Canuckistan, my wife has been complaining about the increased cost on her diabetes. Ironic since its discovers Banting and Best were Canadian.

  15. 15
    CarolDuhart2 says:

    Retirement means I also get Medicaid, so I have some coverage along with my Fed Coverage. I went to refill my short-acting insulin, and a month’s worth with no insurance-$949.00. Thankful for coverage, but I feel all Robin Hoody. I bet if we threatened these guys with the guillotine, we could have insulin at $1 a day even with the new testing and delivery systems. Or at least threaten them with the 70% tax rate.

  16. 16
    Suzanne says:

    @Ohio Mom: I just attended a presentation about the new insulin pumps a couple of months ago. Just incredible. I’d love if there was a grassroots effort to buy and distribute these en masse for people who need them. NPR did a story on people who are rationing insulin, but I don’t think most people really understand the extent of the issue. I did not until relatively recently.

  17. 17
    Ohio Mom says:

    @OzarkHillbilly: Yes, on one hand, I am happy to see that my Medicare eligibility is just a few years off. It feels like a finishing line, I’ll have made it.

    On the other hand, I am dreading wading through the options and experiencing first hand that it isn’t everything young ones think it is.

    At least I already know it’s expensive; I had to break the news to a friend who is thinking of retiring soon that No, Medicare isn’t free, the premiums are taken out of your Social Security. I know I did the right thing by busting her bubble but I felt bad anyway.

  18. 18
    Amir Khalid says:

    Salah puts away a fumbled save from the Palace keeper. Liverpool 3-2 Palace!

  19. 19
    MattF says:

    Oxycontin blues.

    A Sackler Museum on the Mall doesn’t make up for the evil.

    ETA, OT: I wouldn’t get real excited over the ‘major announcement’ this afternoon. Experience is that Trump reading from a Teleprompter is ignorable.

  20. 20
    Brachiator says:

    This is why we need a different healthcare system.

    I agree, but I don’t know what changes would solve this insulin pricing problem. This goes deeper than the government negotiating drug prices.

    @Ohio Mom:

    Insulin prices are criminal but then there are all the other items diabetics also need: blood sugar meters and testing strips — and the cost of the strips really adds up — lancets, needles, alcohol wipes, insulin pens, and I know I am leaving things out.

    Ohio Dad has the kind of Type 2 diabetes that has progressed to where he needs insulin, and our old Insurance did not cover all those extras.

    This is crazy. These are not extras, they are essential to part of the process for treating diabetes. And some of these products have been around for decades. They should be becoming cheaper, in part simply because manufacturing and distribution processes have improved.

    Alcohol wipes to clean my computer or phone screen are cheap. Even allowing for increased requirements for keeping swipes sterile for human use, costs should be reasonable.

    And this is before you get to the issue of insurance reimbursements.

  21. 21
    Luthe says:

    I know there would be screams of “Big Guv’mint!” and “Socialism!” but we really need a federal agency to produce medications on both an ongoing and emergency basis. Ongoing for drugs where the price-gouging is obvious and emergency for drugs where the supply is running short and no generic manufacturer is willing to step in and produce it. To avoid any charges of distorting the market, whether the drug is in production could be based on a) the retail price of the drug (production stops when the retail price is less than X, with X being adjusted for inflation every year) or b) current available supply (if supply drops below a certain threshold, production resumes). This would also provide leverage for the government in negotiations with drug companies, since any demands for unreasonable prices could be met with a threat to start making it in-house instead of being overcharged.

    Of course, this will never happen.

  22. 22

    This is why we need a different healthcare system. I’m not well enough informed to know whether it’s single payer or Medicare for All, or something else. But this profiting off human suffering has to end.

    Insurance reform won’t address the root causes, which are broken IP laws and exclusively-private pharmaceutical manufacturing.

  23. 23
    OzarkHillbilly says:

    @Ohio Mom: Part A is free. You gotta pay for everything else.

  24. 24
    Ruckus says:

    @CarolDuhart2:

    Or at least threaten them with the 70% tax rate.

    We had a 90% rate at the end of WWII and the rich still got richer. I’m for doing the same again, 90% for the very top. Most of their money seems to be made moving money from one hand to the other and not actually doing much else so let them make a bit less. I recall the Warren Buffet story where he stated that his secretary pays a higher percentage in tax than he does. At least he thought this was wrong and should be changed. Alas, a dream that will never come to pass, at least in my lifetime. The senate is filled with people with more money than sense of country or duty, and greed, so expecting this is ridiculous.

  25. 25
    John Carter1966 says:

    Just wait til EVERYONE dies and no one spends money on any medication…that’ll fix the greedy bastards!

  26. 26

    @Suzanne: I saw the news items about people having to pay for insulin or their rent, but didn’t realize what was going on until I read the article in the (yes!) Times.

  27. 27
    Frankensteinbeck says:

    This is not evidence we need a new health care system. I mean, we totally do need one, but THIS is evidence we need a duck load more regulations on big business than we have.

    @The Midnight Lurker:
    Like I just said down below, Mueller did this once before. Bloviating he gives no shits about. When both sides start accepting a story about leaks from his organization, then he cares.

  28. 28

    @OzarkHillbilly: Yeah, Part A is the hospital, Part B is the doctor, and D is the drugs. You pay for the last two. I believe the payment for B is income based. When Medicare was designed, sick people went to the hospital and stayed there a while. Now drugs are a much bigger part of treatment. Also Parts A and B are designed to pay about 80% of the cost, so most people buy supplements. I get mine through AARP.

  29. 29

    @Major Major Major Major: That’s why I said “healthcare system.” We need to hang the greedy bastards at the pharmaceutical companies. And the greedy bastards who lobby for garbage IP laws.

  30. 30
    Ohio Mom says:

    @Suzanne: The other thing to keep in mind is that people don’t take insulin for the sake of the moment (though when you are in the same room with someone whose blood sugar level is too high or too low, it’s no fun).

    Diabetic complications can be horrific: kidney disease, stroke, heart disease, heart attacks, amputations. Nerve damage, hearing damage, sight impairment and blindness. And a bunch more.

    Over the long run, helping diabetics keep their blood sugar at its best level saves gobs of money.

    But with our merry-go-round of health coverage, with an individual’s insurer frequently changing over time, an insurance company that buys you an expensive pump and monitoring system might not be covering you long enough to save money when you don’t have a heart attack.

  31. 31
    debbie says:

    @OzarkHillbilly:

    Part A is just for hospitals. I’ve been afraid to ask my doctor whether her medical group accepts Medicaid. I won’t be able to afford Medicare.

  32. 32
    Suzanne says:

    @Ohio Mom:

    But with our merry-go-round of health coverage, with an individual’s insurer frequently changing over time, an insurance company that buys you an expensive pump and monitoring system might not be covering you long enough to save money when you don’t have a heart attack.

    For sure. My employer changed carriers this year. Even when you keep the same job, you don’t always keep the same coverage.

  33. 33
    Amir Khalid says:

    Sadio Mane scores in injury time: Liverpool 4-2 Palace. And then Max Meyer pulls one back for Palace: 4-3. And that’s it. Whew.

  34. 34
    HinTN says:

    @The Midnight Lurker: I think someone in Mueller’s shop leaked the uncorroborated detail and they’re putting the lid on. Occam’s Razor

  35. 35
    Ohio Mom says:

    @debbie: Yes, a lot of medical practices have a quota on how many Medicaid patients they will accept.

    It’s a problem for people with disabilities who have no other insurance, which is probably most of the adults. Ohio Son has four and a half years on Ohio Dad’s Insurance as a primary, then…

  36. 36
    opiejeanne says:

    @JPL: On Twitter I saw a comment that an offer to extend DACA isn’t something that we need from Trump, because of this: lie Mystal

    @ElieNYC
    16m16 minutes ago
    More
    Lawyer alert: The Supreme Court, yesterday, decided to not take the DACA case, leaving DACA in place for at least another year

    Trump offering to extend DACA for a year is like me offering to not lasso the moon. He’s offering to allow something he can’t stop anyway
    #TrumpShutdown

  37. 37
    OzarkHillbilly says:

    @Dorothy A. Winsor: Don’t forget Medi-Gap, which pays for all the parts everything else scrimps on. Types A thru K IIRC and that doesn’t even get into the different policies within each group. Oh and Type F** is getting phased out in 2020 so if you want it better get it now because you won’t be able to after that!

    **(probably because it works too well)

  38. 38
    scav says:

    Big Pharma is definitely part of the system, along with Big Insurance and Big Hospital. It’s am interacting, intersupporting complex (I’m sure there are a few more technological limbs), and the unhealthier we are, the more they make. Add in the short-term profit maximization ideology of the current business elite and there’s not a lot of incentive to keep the sick sheep healthy enough for future sheering.

  39. 39
    Ohio Mom says:

    Re: Mueller. I will be beyond happy to be wrong, but I am a little too reminded of Fitzmas.

    Everyone knew the Fitzmas story was true, it didn’t matter. Everyone knows Trump did not win fair and square, and enough people think that is fine and dandy because it’s MAGA.

    I’m going to eat lunch now, maybe that will brighten my mood.

  40. 40

    For those of you trying to figure out what Trump will say, Daniel Dale’s advice is good. I’m going to wait to hear what Pelosi has to say. And Trump’s speech has been moved to 4 pm Eastern.

  41. 41
    Ruckus says:

    @Luthe:
    Having the systems sitting there waiting for a short fall isn’t a valid answer. Insulin for example is a biologic and making something with a biologic process is relatively slow and has steps that take time and most any step can fail. It’s a matter of size of process, speed of process, success of process, and it takes ongoing large enough production to smooth over the bumps. But is also a known process and as Cheryl pointed out the problem is not a process problem but a greed problem. Large drug companies run through a lot of money and think they deserve a lot more money for doing that. Not all of them are profitable but many are very profitable and they do that by manipulation of the drugs themselves, not for improvement of the drug but for improvement in their return on investment. They want a far higher profit rate, not just a decent profit.
    But the world is changing. We have a lot of humans on this rock and a lot of them need drugs to live. Do we pay companies by buying the products at any price to build plants to create the drugs – that are expensive and therefore affordable by fewer in our current system because of pricing and greed or do we socialize the production so that for the same price we can have a larger production or do we remove some of the patient restrictions so that others can enter the market? It’s not an easily answerable question and it’s one that’s been asked for a long time with no resolution.

  42. 42
    Steeplejack says:

    @Dorothy A. Winsor:

    Heh, well played.

  43. 43
    WaterGirl says:

    @HinTN: Lawfare dissected the wording of the Buzz Feed article yesterday, even before Mueller’s statement came out.

    IIRC, they thought the wording clearly indicated the leak was not from Mueller’s office and was more likely to be SDNY or another entity.

  44. 44
  45. 45
    Ruckus says:

    @debbie:
    If I retired right now and had to have Medicare, I could not live other than the most meager existence. The fact that I have the VA means that I don’t have to pay Medicare costs. I do pay copays with the VA but on average it’s less than the deduction for Medicare and when I retire that will go away. I will always have to pay for my drugs with the VA. And what will I have to pay when the genius who is currently screwing up the VA gets his way and privatizes large parts of the VA? I’m getting to the point that working will not be possible, so if all of this comes to pass, what do I do? Do we have to be productive every minute of our adult lives – or just die?

  46. 46
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    OT- The tribal elder that the pathetic MAGA choads of Covington Catholic harassed yesterday was none other than Nathan Phillips, a Vietnam vet and Omaha elder who does annual ceremonies for buried Native American vets at Arlington every year.

    Kentucky is deranged, but none are so deranged as the suburban Cincinnati folks in northern Kentucky. They’re evil. For a time, my counterculture youngest daughter at UC dated a young man from there. He was desperate to keep her away from his parents, and I warned her that it would never work out, and explained that Northern Kentucky Catholics were extremely different from Louisville Catholics. The ones here are mostly into social justice and contraception and everybody having a good time. The Catholics there are into McMansions, pretenses of wealth, casual racism, anti abortion extremism, contraception bans and right wing politics.

  47. 47
    MomSense says:

    Stimate is currently running about $750 for a 2.5 milliliter spray bottle. The generic desmopressin costs $495 for the same amount.

    Medicare4all is not going to solve the prescription drug problem.

  48. 48
    Baud says:

    @opiejeanne:

    I would like the DACA people to make that call. They’re the ones who have to live with this.

  49. 49
    Brachiator says:

    @Ruckus:

    We had a 90% rate at the end of WWII and the rich still got richer. I’m for doing the same again, 90% for the very top.

    There has never, never, ever been a top effective tax rate of 70% or 90%. And the Trump tax cuts reformed the entire system to benefit corporations and the very highest top earners, with a bone tossed to other income groups, and gristle shavings for lower income people.

    But it is easy to rally around the idea of a boost to the top marginal rate. But I would really like to see what the Democrats have to offer to reverse Trump’s tax cuts and to offer something better.

    Also, yep, the rich got richer in the years after WW2, and there is no evidence that this era was a paradise of social spending. I think that, thanks to unions, this era saw an increase in wages and national incomes, but a lot of the more accessible economics articles focus on GDP growth rather than broader measures of social and economic well being.

  50. 50
    Ella in New Mexico says:

    This is why we need a different healthcare system. I’m not well enough informed to know whether it’s single payer or Medicare for All, or something else. But this profiting off human suffering has to end.

    This article makes me so very, very angry.

    If all of you knew how many beautiful, once promising young adult Type I Diabetics I’ve watched be admitted multiple times a year in Diabetic Ketoacidosis who now, entering their late 20’s and early 30’s with severe peripheral and retinal neuropathy, kidney failure, and heart disease you’d cry. I’ve watched kids go from having a 4 year golf scholarship to being blind and having a foot amputated, dependent on opioids and medical marijuana to just get through their day. I’ve seen 28 year olds getting dialysis 3 times a week which gives them a life expectancy of about 5 years without a transplant. I’ve seen these kids become young adults stuck in a world of depression, drug addiction, lost hopes and dreams. Because the damage done is done, it’s not irreversible. We can only hope to prevent it getting worse.

    And I work in one hospital, out of two in a smaller city. Extrapolate this common story to hundreds of similar places in America and you can see the damage people like the Sacklers and other big wigs in the pharmaceutical companies have done to what may be millions of people.

    Back before Obamacare, a lot of young people got dropped off their parent’s insurance at 22 or Medicaid when they turned 19. They’d go without insulin or use far less than they needed because of the high costs. Now they can get their insulin sometimes for free, but it’s too late. They’ll die early deaths because of our obsession with free market capitalism as the solution to every fucking thing. We’re seeing the old days return as the incremental tearing down of the safety net Obama care was giving us is making way under Republicans and now Trump, transferring costs back on the backs of people who are too sick to even be able to walk to the grocery store, much less get a job to pay their co-pays.

    Other countries with successful solutions to healthcare outlaw this kind of immorality. No matter what healthcare system we end up giving ourselves it has to severely limit profits and motivation to squeeze to the top of the food chain all revenue. Lets hope we can survive until we can change it.

  51. 51
    Leto says:

    This is why we need a different healthcare system.

    After being a part of this system, couldn’t agree more. I’m currently on Eliquis (blood thinner) due to them finding a blood clot in my left calf after my accident, and that drug alone makes up half my medication bill because I can’t get a generic. I know England is having issues with the NHS, but ffs, they’re still light years ahead of where we are. The German system is, potentially, a better model for the blood suckers because everyone is covered via universal insurance, but you can still purchase private coverage if you want “fancier” care (aka don’t want to deal with the pleebs).

    I was a pretty big proponent of healthcare reform before, but it’s moved up several rungs now. Funny how life rearranges priorities.

  52. 52
    Ksmiami says:

    @Ohio Mom: chef here – the problem is bigger than healthcare and literally caused by the food supply. If anyone is able literally go 90 percent plant based whole food and cut sugar as much as possible- it could save a lot of money and your life not to mention the planet.

  53. 53
    The Moar You Know says:

    Fucking Jason Leopold is a liar who has done this before and just did it again; served up a dish of bullshit because he knows it’s what his audience has been praying for. Fitzmas redux. He needs to suffer real consequences this time, because he keeps MAKING SHIT UP and people keep hiring him. Fuck him and his bullshit stories.

  54. 54
    Repatriated says:

    @The Midnight Lurker: Possibility (but IMHO not likely): It was a disinfo op, to provoke the committee to ask, “Did the President ask you to lie to Congress?” If he chose to do so on his own initiative (with assent but not a direct request), or if there was a request that came through an intermediary, he could truthfully answer “no” and thereby create a valuable sound bite.

    Follow-up questions could clear up the mendacious response, but the damage would have been done.

  55. 55
    The Moar You Know says:

    Also. Regarding the Sacklers. Friend of mine finally died last year from her ongoing and unstoppable opiate addiction. I always knew it would end like this. Smart girl. Math and chemistry prodigy. Her gateway: OxyContin.

    I want the Sacklers jailed for murder and I am being very charitable in wishing only that.

  56. 56
    Burnspbesq says:

    @Ohio Mom:

    I burned through my entire 2019 deductible on a 90-day supply of sensors for my CGM system.

    And a lot of insurers won’t cover CGM for Type 2.

    It’s easy to understand why Tim Cook (himself a diabetic) is pushing his minions so hard to find a way to get the Apple Watch to do CGM. it’s both a massive, profitable market and a good thing to do.

  57. 57
    opiejeanne says:

    @Baud: Yes, but Trump offering to extend something that has already been extended by the court not wanting to address it should be a non-starter, shouldn’t it?

    What am I missing here? I’m sure I’ve missed something.

  58. 58
    Aleta says:

    @Ohio Mom: with an individual’s insurer frequently changing over time, an insurance company that buys you an expensive pump and monitoring system might not be covering you long enough to save money when you don’t have a heart attack.

    This.

  59. 59
    Ohio Mom says:

    @Ksmiami: I am rolling my eyes at this prime example of victim-blaming. It’s not possible to compensate for a defunct pancreas with diet.

    You could eke out a little extra time by starving yourself but I wouldn’t call that a good quality of life.

    ETA: and while we are on the subject of eating, I see that my fish and slaw sandwich did not improve my mood.

  60. 60
    debbie says:

    @Cheryl Rofer:

    Dems should hold out for more than three lousy years. How about permanent?

  61. 61
    Amir Khalid says:

    @Cheryl Rofer:
    IOW, no one knows what Trump is going to say on any occasion — not even Trump’s own people — until he says it. I guess there’s never a dull moment when you work for this President.

  62. 62
    debbie says:

    @Ohio Mom:

    Thanks. I did not know that.

  63. 63
    Miss Bianca says:

    @Ella in New Mexico: oh, my God. : (

  64. 64
    Ruckus says:

    @Brachiator:
    Yes.
    I was glossing over the actual paid rate but it was higher for a while and did help pay down the debt from WWII in a more reasonable timeframe. Of course as you know most very wealthy or even rather wealthy pay a lower rate than a lot of actual productive working people because of the tax code. Maybe it’s do less, pay less, make more. Nice if you can get it I guess.
    Your entire last graph is spot on. The majority of people got relatively wealthier, even if the country only got a bit better. Of course the minorities got shit.
    Life became a bit less of a crap shoot and more of a reasonable proposition. For some. RWMOU want that to be reversed so that only they have a good life. If they can’t have actual slavery they will settle for economic slavery.

  65. 65
    Brachiator says:

    @Ksmiami:

    chef here – the problem is bigger than healthcare and literally caused by the food supply. If anyone is able literally go 90 percent plant based whole food and cut sugar as much as possible- it could save a lot of money and your life not to mention the planet.

    This is sheer nonsense.

  66. 66
    Jim, Foolish Literalist says:

    @Repatriated: (Hennessey is responding to the Conway’s tweet of “fake news picking on my large adult president argle-bargle”)

    Susan Hennessey @ Susan_Hennessey
    Thanks Kellyanne. That’s a good point. Can you clarify one thing that’s been puzzling me? Did the president know that the testimony Michael Cohen submitted to Congress, which Cohen made public prior to submitting, was false? And if so, is there a reason he didn’t say anything?

    also, too, after the testimony was submitted, didn’t the chief magistrate of the United States have knowledge of a crime committed against the American people and their elected representatives?

  67. 67
    debbie says:

    @Ruckus:

    I hear you. I try to formulate a plan, but I’m really just running around in circles.

  68. 68
    Immanentize says:

    @Ella in New Mexico:
    This is why some drugs -+ like the polio vaccine -+ need to be nationalized. It’s a form of wartime profiteering. I just hate how these fuckers add serious costs to being poor.

  69. 69
    Kelly says:

    @Major Major Major Major:

    Insurance reform won’t address the root causes, which are broken IP laws and exclusively-pirate pharmaceutical manufacturing.

    fixed that for you

  70. 70
    Bill Arnold says:

    @The Moar You Know:

    I want the Sacklers jailed for murder and I am being very charitable in wishing only that.

    Mass murder. They will probably escape official justice because they bought a lot of deniability (e.g. bad science and lots of disingenuous PR and …) and can afford expensive legal talent. But they killed at least 10s of thousands, perhaps hundreds of thousands of people.

  71. 71
    Baud says:

    @opiejeanne: Three years gets us past the next election. The courts might not last that long.

    I’m not saying this hypothetical deal is a good one. I’m saying it’s easy for me to be cavalier about it, and I don’t want to do that.

  72. 72
    Mr Stagger Lee says:

    @MattF: Pablo Escobar bankrolled ghetto neighborhoods into places poor people can live in decency and bankrolled playgrounds and soccer fields,(and is still revered in some poor barrios in Medellin) but in the end he lost his empire and his life because of his destructive war against Colombia he wanted to be the ruler. (wondering how he could accomplish that in a country like Colombia if you know what I mean)

  73. 73
    Immanentize says:

    @Ruckus:
    I really need to find the right Congress critter to pitch my medical coverage plan. USAA clued me into this idea (I am a member be ause my wife worked for USAA in San Antonio)

    First, extend VA benefits to all veteran families and dependants (including aged parents, etc.) Then, extend the same coverage to Federal employees. Then there will be such a large system and so many people covered that the private insurance system will not be profitable and one stop medical for all. Not perfect, but it would, in one generation, get us to national health.

  74. 74
    Jim, Foolish Literalist says:

    @Le Comte de Monte Cristo, fka Edmund Dantes: are you familiar with Park Hills, where the school is located? Covington Catholic, whose wiki page has already been edited

    Covington Catholic White Male Entitlement High School

    they have taken their phones off the hook, took their twitter private and I imagine people are desperately calling around Cincinnati desperately trying to find a lawyer willing to talk to the national media, and the parents of the boy featured in the video are planning a sudden vacation to their condo in FL or CO
    looks like the lead story at the Cincinnati Enquirer website

  75. 75
    Timurid says:

    @Ella in New Mexico:

    Bin Laden got shot in the face for less than this…

  76. 76
    Immanentize says:

    @The Moar You Know: @Bill Arnold:
    Yes but, they gave $$ to the arts!
    /s/

  77. 77
    germy says:

    Gillibrand got a Q about Al Franken tonight in Sioux City; here's how she answered. pic.twitter.com/Ou7pfoTmZj— Dave Weigel (@daveweigel) January 19, 2019

  78. 78
    Kelly says:

    @Dorothy A. Winsor:

    Also Parts A and B are designed to pay about 80% of the cost, so most people buy supplements.

    Another candidate for an Obamacare tweek. Put the same subsidies per income % and out of pocket limits on Medicare that Obamacare plans have.

  79. 79
    Immanentize says:

    @Mr Stagger Lee:
    This used to be the PLO plan too. Education and food for the people. It was Jim Jones’ original plan in California. But, everybody wants to rule (their incredibly small part of) the world.

  80. 80
    germy says:

    https://en.wikipedia.org/wiki/Raymond_Sackler

    The wikipedia entry for the Sacklers reads like a publicist’s press release (it was probably copied and pasted from one)

    At the v e r y bottom, there’s a tiny paragraph about an unfortunate… controversy. Very easy to miss.

  81. 81
    Immanentize says:

    @Burnspbesq:
    I may have mentioned this previously, but I know a bunch of people in research labs (including Draper!) Are working on a 24/7 health monitoring device(s). One guy wanted to call it a “sick bit.”

    One researcher put it this way: in any new car, you can get instant readouts about every system. A light goes out and you get an alert. But humans? One time a year to the Doc — I’m feeling OK! Maybe some cursory blood work. See you next year!

    ETA. Draper because the military really wants this for troop readiness. So $$$

  82. 82
    The Midnight Lurker says:

    I’m sorry guys… lots of interesting theories, but the sad facts of the case are this:
    Buzzfeed writes a story that says Trump ordered Cohen to lie to Congress. They run the story past Mueller’s office, who presumably read it or are told the gist. They decline to comment (per usual). Buzzfeed publishes the story. All hell breaks loose on the hill and in the media.
    Twenty-two hours later, the Special Council’s office issues what amounts to a rebuttal, but which is, at best, confusing and cryptic. I read over the statement several times and I still can’t determine if Muller’s office is saying the entire story is inaccurate, or just that BF got the sourcing wrong.
    Buzzflash is standing by the story. Hard. One of the reporters has gone on to say he has even seen the source material. Now I know BF has a rocky reputation, but they seem to be pretty certain on this one.
    If the Special Council’s office was trying to stop leaks, get Congress to tap the brakes on impeachment talks, or whatever the hell they thought they were accomplishing with this public denouncement, it has failed if not completely backfired. As best I can tell reading the papers this morning, it looks like all Mueller’s office did was put fresh ammo in Trump’s “Fake News! It’s all a hoax!” guns.
    Barr’s testimony to Congress last week was less than encouraging. Couple that with the fact he is best friends with Mueller and they have worked closely in the past, and now I’ve got a sick feeling. After yesterday’s ‘announcement’, I’m downright worried.
    Guys, what if Mueller ain’t all that? Have we put all our proverbial eggs into one basket?

  83. 83
    Baud says:

    @The Midnight Lurker: No, which is why we elected Dems in a wave election.

  84. 84
    Ruckus says:

    @Leto:
    Being born in the late 40s I’ve had similar medical issues of most of my age cohorts. IOW a normal usage of the system. But now, as I hit the last phase of life, that of knowing a lot of docs and seeing a lot of procedures up close and personal, I’m extremely lucky that I’m in the VA. It is similar to a complete healthcare system. Sure there are hiccups and waits, and waiting is part of any interaction with it, even the ER. Supply and demand is always and obvious. There is a payment system and how much one earns effects how much one copays so it isn’t free to everyone it covers. But I used to purchase HC insurance for my employees. Every year I’d spend way too much time going over the plans, the limits, the costs and this was 30 yrs ago. Now it’s far worse. The entire system, from insurance to actual care to drugs, it’s not healthcare, it’s a profit center.
    Medicine today can fix far more things, but actually help a higher percentage of people? I’m not actually sure of that. Can anyone say oxytocin?

  85. 85
    jimmiraybob says:

    @Brachiator:

    There has never, never, ever been a top effective tax rate of 70% or 90%.

    Do you mean that there has never been an effective top marginal tax rate of 70% or 90%? Because there has certainly been a top marginal tax rate of 70% or 90%.

  86. 86
    Immanentize says:

    @Baud:
    But different DACA people feel differently on this issue. Some want all or nothing, others want to live (here) to fight another day. I’m not sure there is ready consensus on extension.

  87. 87
  88. 88
    Jim, Foolish Literalist says:

    @The Midnight Lurker: Neither Bob Mueller, nor William Barr, nor Donald trump can stop Adam Schiff, Elijah Cummings or Jerry Nadler from subpoenaing every witness Mueller has interviewed, and broadening their scope beyond Mueller’s mandate. And a lot of that testimony will be public, on TeeVee.

    Yesterday was not a good day, but it gave trump a talking point on twitter and Foxnews for people who already believe him.

  89. 89
    Baud says:

    @Immanentize: Ok, fair enough. I just don’t want to throw anyone under the bus simply because I like seeing Pelosi make Trump sweat.

  90. 90
    Elizabelle says:

    @The Midnight Lurker:

    Go demoralize someone else.

    And, as baud pointed out, we worked our asses off to elect a more representative House of Reps. With Democratic control. And it’s not a one-time thing.

  91. 91
    Mr Stagger Lee says:

    @Jim, Foolish Literalist: Living in Ohio in the 70’s and 80’s I seem to recall that most of Catholic schools in the Cincinnati area were same sex, like Moeller(the kings of Ohio High School football) Elder and St. Xavier, I think John Boehner went to one of them.

  92. 92
    Immanentize says:

    @Baud: I completely agree. I think this one is a hard call (depending on the offer) — for everyone. Of course, Pelosi can then write a bill with permanent DACA relief and dare Trump to veto.

  93. 93
    debbie says:

    @Quinerly:

    Can you tell what the kids in the background are chanting? Is it white power stuff?

  94. 94
    Immanentize says:

    @Jim, Foolish Literalist: That is true, but a subpoena from Congress is only as good as the willingness of the DOJ to back it up. Ooopsie.

  95. 95
    Elizabelle says:

    @The Midnight Lurker:

    I read over the statement several times and I still can’t determine if Muller’s office is saying the entire story is inaccurate, or just that BF got the sourcing wrong.

    Might the problem be with you? I got a surprise last night: was watching Anderson Cooper’s show last night, and Maggie Haberman was behaving quite well. She seemed to believe the Buzzfeed story — I think a LOT of journalists do, because it’s out there and it’s true. No one on Anderson’s panel was throwing the whole story out.

    The problem seems to be an issue with some part of a claim. Perhaps of having documentary evidence involving Trump.

    Haberman really stuck her neck out defending Buzzfeed as a credible journalism outlet. I was very pleasantly surprised to see that side of Maggie. It does not show up in her writing, somehow.

  96. 96
    RAVEN says:

    Quinerly

    Oh just fucking great, keep the ball rolling on this horseshit.

    in a previous interview with Phillips, he told Indian Country Today that returning from Vietnam was not easy as a veteran. “People called me a baby killer and a hippie girl spit on me.”

  97. 97
    Elizabelle says:

    The CNN panel all thought it was a very lawyerly response, and actually quite limited.

    If inscrutable to us nonlegal types.

  98. 98
    Suzanne says:

    @The Midnight Lurker:

    Guys, what if Mueller ain’t all that? Have we put all our proverbial eggs into one basket?

    The only way out is through. We have to defeat him electorally. I wet dream about perp walks, too, but that is exactly that. If you were counting on Mueller to fix it, then, yes, you did put your eggs in one basket.

    So it’s time to get over ourselves and elect Democrats in 2020, and to make cultural change, such as discouraging Trumpy people from ever voting again.

  99. 99
    Immanentize says:

    @RAVEN: I hate that spit shit. More spit was directed at Hippies than was ever launched at Veterans. Why say it? Is it just part of the handbook regarding veteran victimization? Why not talk about the VFW instead?

  100. 100
    Baud says:

    @Immanentize: No the house can go to court on its own. They only need DOJ for criminal contempt.

  101. 101
    Mr Stagger Lee says:

    @Suzanne: Hear Hear! The republicans today are not the ones in the 1970’s who put country first, willing to take an ass beating in the midterms and told Nixon he was done, there will be no removal of Trump Don IL, hell the these scumbag Repuglicans would rather enrich an oligarch than pay a Coast Guardsman, Border Patrol or Hell’s Bell’s an Secret srevice Agent. Ley’s get to work on 2020.

  102. 102
    Ruckus says:

    @Immanentize:
    It’s an interesting concept. From my perspective as a user of the VA system I’d have to ask, how long do you think it would take to implement such a scheme, money aside? Ten yrs, twenty or even thirty? In a number of ways the VA system is hurting and needs attention to just maintain it’s current goals. President Obama was doing that, president dipshit is not just not doing that but is actively trying to fuck the system into the ground. Of course the VA is no where near the limit of his destructive stupidity, vindictiveness and assholyness.

  103. 103
    Ohio Mom says:

    @Suzanne: I agreed with this last night and I agree even more today.

    @Mr Stagger Lee: Boehner went to Moeller. You have to take an entrance exam to get into St. X, it’s the elite school. Not saying Boehner took the test, just saying he didn’t go there.

    When I see Boehner with his drink and cigarette, I think, You can take the boy out of the Reading bar, but you can’t take the Reading bar out of the boy. (Reading bring the working class neighborhood where his dad’s bar was). Getting into the pot business is a natural for him.

  104. 104
    bk says:

    @jimmiraybob: “Effective rate” is not the same as “marginal rate”.

  105. 105

    @Immanentize: Whatever deal they do needs to be in writing so Trump can’t reject it once he gets what he wants.

  106. 106
    opiejeanne says:

    @Baud: Ok, it’s the 3-year vs. the uncertainty of how long the court will refuse to hear it.

    I mean, I knew I was missing something if I was arguing with Baud.

    (Personally, I think the Democrats should demand it be made permanent)

  107. 107
    Brachiator says:

    @jimmiraybob:

    Do you mean that there has never been an effective top marginal tax rate of 70% or 90%? Because there has certainly been a top marginal tax rate of 70% or 90%.

    the top marginal tax rate and effective tax rate are two different things.

    So, let’s keep it simple and look at actual data, from the Tax Foundation.

    The data shows that, between 1950 and 1959, the top 1 percent of taxpayers paid an average of 42.0 percent of their income in federal, state, and local taxes. Since then, the average effective tax rate of the top 1 percent has declined slightly overall. In 2014, the top 1 percent of taxpayers paid an average tax rate of 36.4 percent.

    The Alternative Minimum Tax for Individuals, came about (in 1967, I think) because it was discovered that a number of extremely rich individuals paid zero in federal income tax, even though the top marginal rate had been as high as 91%.

    One problem that we currently have, thanks to some of the tax law changes, is that individuals have ways to set up plans that allow them to accrue large gains in income that are never taxed. Roth IRAs are one example of this. Roth IRAs may be a good thing, but the impact on the system is what it is.

  108. 108
    sukabi says:

    @Ohio Mom: I’ve been seeing “Cash for sealed, unexpired testing strips” signs stuck along side the road around here the last week or so. Very weird, they’re styled the same as the “Cash for Houses, any condition” signs ….

    Thought it was strange…I guess it makes sense if there’s going to be a manufactured shortage in the coming months.

  109. 109
    jimmiraybob says:

    @Ohio Mom:

    (Reading bring the working class neighborhood where his dad’s bar was)

    Oh. I had an entirely different picture – me, a book, a glass of bourbon, maybe a pub burger……

  110. 110
    Karen says:

    I have Medicare and I take Latuda for bipolar depression. It’s about $1.5K every 30 days. It also has happened to be a psych med that had me from existing and planning to kill myself when my parents passed to feeling hope. Real hope. I take another med and you can see I end up in the donut hole pretty quickly. I’m lucky that my insurance has a subsidy where I don’t have pay, but I’m scared that I’ll have to go off of Latuda if I can’t get that subsidy again.

  111. 111
    Mai Naem mobile says:

    I was at a store waiting for some work to get done and started talking to the receptionist. Her adult son is a Type 1 diabetic. Doesn’t qualify for O Care subusdies because he makes too much money. Makes too little to afford insulin so hes relying on his endocrinologist to give him freebie samples. He was in the hospital a couple of years ago in a coma and almost died because he didn’t have insulin. The long acting and short acting insulins are around 300 bucks a vial each and some people go through more than one vial a month. But we live in the richest country in the world and it will kill Sheldon Adelson to pay a couple hundred million in taxes that won’t go into GOP coffers.

  112. 112
    WhatsMyNym says:

    @OzarkHillbilly:

    Don’t forget Medi-Gap, which pays for all the parts everything else scrimps on… Oh and Type F** is getting phased out in 2020 so if you want it better get it now because you won’t be able to after that!
    **(probably because it works too well)

    When I had to switch my mother over to outside insurance (old employer went to an HRA), I found the reviews warned that Plan F was not the best deal. The extras it includes are just rolled into your monthly payment.
    For our region, Plan G comes out ahead in price even when you include the missing Part B Deductible cost. Plan N is best if you’re not seeing Doctors very often, because it includes co-pays.

  113. 113
    Suzanne says:

    @Mr Stagger Lee:

    Ley’s get to work on 2020.

    I intend to be exceedingly pragmatic and results-oriented and ruthless for 2020. I am interested in winning. I am not here for intra-party bullshit or purity tests.

    I am here for the electoral annhiliation of Trump, the GOP, and the humiliation and cultural marginalization of their voters. Nothing less will do.

  114. 114
    WaterGirl says:

    @germy: I call bullshit on her saying that there were 8 CREDIBLE accusations. I do not feel better in the slightest after reading her reply. It seemed pretty self-righteous to me.

    Thanks for posting that, though. It was enlightening.

  115. 115
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    @Jim, Foolish Literalist:

    Yep. Those deranged people are why I’m stuck with MAGA asshole Thomas Massie in Congress – his district is a ridiculous sprawl from Ashland to Cincinnati’s suburbs to the outer suburbs of Louisville. The Cincinnati lump is so large that it swamps our votes.

    Thankfully, since I work in Louisville and know John Yarmuth (and claim his daughter-in-law as a friend), if I actually need something I can approach him.

  116. 116
    opiejeanne says:

    @WaterGirl: I’m with you. The first one that rolled in was ridiculous and shouldn’t have gotten any press at all.

  117. 117
    sukabi says:

    @jimmiraybob: I’m not a tax person, but here’s what’s always pissed me off about discussions about tax rates… It doesn’t matter what the top tax rate is because there are all the loop holes that allow the wealthy to ‘set aside, deduct, and hide’ a huge amount of their income from being taxed. So the top tax rate is meaningless because NO ONE pays it in the current system, but that’s the rate they like to bring out when there’s a discussion of tax rates and how the poor rich people are taxed too much.

    What they should be talking about is the effective tax rate, and how much of their income they’re able to protect from taxation.

  118. 118
    Ladyraxterinok says:

    @OzarkHillbilly: I believe part A is taken out of SS payment

  119. 119
    Ksmiami says:

    @Ohio Mom: I’m so not victim blaming, I’m saying that the ungainly health care system feeds off of the victims of our corporate food system like joint parasites, please don’t misunderstand.

  120. 120
    Ohio Mom says:

    @sukabi: I don’t know what those signs are about, I also see them periodically. Some scam.

    The @jimmiraybob: I misremembered. Boehner lived in Reading, the bar is in Carthage, a very similar neighborhood. It’s a dive. Andy’s Cafe on Vine.

  121. 121
    jimmiraybob says:

    @Brachiator:

    I thought that you were countering an argument that I hadn’t heard anyone making RE: that there had been an effective tax rate of 70% or 90%. So when I said that there has never been an effective top marginal tax rate of 70% or 90% I was referring to the fact that there were always ways, if you were lucky enough to hit the bracket, to mitigate the 70% or 90% rate to get to a much lower number. I may not be using proper econospeak but I think that we’re both saying…or thinking…the same thing.

  122. 122
    Jim, Foolish Literalist says:

    Nate Silver @ NateSilver538
    Maybe Pelosi should offer to fully fund the border wall in exchange for passage of HR 1, the Democrats’ giant voting rights/campaign finance/anti-corruption bill. It’s her top priority and the border wall is Trump’s, so everyone gets what they want.

    ETA: to clarify: 5bn isn’t even a down payment on Wall in trump’s noggin, and the eminent domain challenges will be like Jarndyce v Jarndyce, so I’m okay a trade-off on this level. The Dems’ get has to be enough to scare trump off from trying to use the govenermnet as a hostage again.

  123. 123

    @Jim, Foolish Literalist: The problem with trying to strike that kind of bargain with Trump or McConnell is that they can’t be trusted. Maybe pass and sign HR 1, then pass the funding for the wall. Or package them together, if that’s possible.

  124. 124
    Jim, Foolish Literalist says:

    @Cheryl Rofer: Maybe pass and sign HR 1, then pass the funding for the wall.

    absolutely– anything the Dems offer has to be signed, sealed and delivered before he gets Wall

  125. 125
    raven says:

    @Immanentize: It’s constant and never going away. Even PHONY Nam vets use it all the time.

  126. 126
    Ksmiami says:

    @Brachiator: I Dont find the studies of Dr Weill and Dr Greger nonsense but you do you- and if you want further data, the recent blue zone studies are pretty compelling

  127. 127
    rikyrah says:

    @Ohio Mom:
    I read the story about insulin and cried for the young man who died cause he couldn’t afford insulin.😢😢😢

  128. 128
    Immanentize says:

    @Ruckus: 15 or 20 years. The first part would be easy — family and dependents. Take the money from the HUGE defense budget.
    The rest would take time.

  129. 129
    J R in WV says:

    @Brachiator:

    @Ksmiami:

    chef here – the problem is bigger than healthcare and literally caused by the food supply. If anyone is able literally go 90 percent plant based whole food and cut sugar as much as possible- it could save a lot of money and your life not to mention the planet.

    This is sheer nonsense.

    Perhaps you could expand on your extremely brief and bitter rejection of this chef’s opinion about plant-based whole food diets with cites and facts. I ask this because I have seen peer reviewed articles about the environmental costs of huge herds of cattle, CAFO sites filled with hogs, and poultry farms as well as the health cares costs related to diets high in meat based proteins.

    While some species (cats for one example we are all familiar with) are obligate carnivores, Humans are not, though a modest portion of meats, eggs and dairy are good, more legumes and pulses with whole grains are also a good thing.

    So “This is sheer nonsense.” just stated like that with no supporting information is pretty much self-defined as nonsense to me. Not saying how sheer it is, tho.

    Note: I am not now, nor have I ever been, a vegan. Slave bees and dairy cows, laying hens, all OK by me, if well kept and cared for, which is a big if in agribusiness. Driving past cattle CAFO locations, even on the other side of a large hill, can be an oxygen free, terrible smelling, exposed to poison fumes, kind of experience… not recommended! Should be illegal, is illegal actually but not properly enforced.

  130. 130
    Baud says:

    @Cheryl Rofer:

    Don’t think so. HR 1 will have to be implemented, and that means Trump would implement it.

  131. 131
    jimmiraybob says:

    @jimmiraybob:

    RE: that there had been an effective tax rate of 70% or 90%.

    Duh. I hang my head in shame that I didn’t take into account all of those that are trying to conflate the two (marginal v. effective) to muddy the waters.

  132. 132
    germy says:

    @debbie:

    Can you tell what the kids in the background are chanting? Is it white power stuff?

    Knowing those idiots, they were probably yelling at him to go back to his own country.

  133. 133
  134. 134
    Jim, Foolish Literalist says:

    @debbie: @germy: I tried to make it out and couldn’t. Didn’t see anyone in the thread get it either

  135. 135
    Immanentize says:

    @WaterGirl: There are at least three ways to look at what Gillibrand did:
    1) She was sincerely outraged, felt there was a moral duty to speak up, and did so
    2) She saw an opportunity to lead and get before the press on a trending issue and ran with it
    3) She saw an opportunity to kneecap a potential opponent in 2020 and took it.
    I am sure there may be others. But the problem with her excuse — #1 — is that it will forever invite investigations and cries of hypocrisy or worse if any case is revealed ever in which she let some guy slide who did what Franken did or worse. It’s too pure and self-righteous. As I used to say to juries (usually about prosecutors), “everyone loves the righteous, but few like the self-righteous.” And Gillibrand does not portray as righteous.

  136. 136
  137. 137
    rikyrah says:

    @WaterGirl:
    I can honestly say that I have other choices besides her and will choose accordingly. But, no, the Franken thing hangs on her like an albatross for me. I thought that it was a scam from the get go.

  138. 138
    J R in WV says:

    @Immanentize:

    Why not talk about the VFW instead?

    My very limited experience with the VFW is that it provides private clubs where people can drink AND smoke in bars, exposing employees of the clubs to toxic substances while at work. Some gambling also, too. And motorcycle riding for those healthy enough to ride a big bike.

  139. 139

    @Jim, Foolish Literalist: Seems to have been “Build that wall”

  140. 140
    Brachiator says:

    @J R in WV:

    Perhaps you could expand on your extremely brief and bitter rejection of this chef’s opinion about plant-based whole food diets with cites and facts. I ask this because I have seen peer reviewed articles about the environmental costs of huge herds of cattle, CAFO sites filled with hogs, and poultry farms as well as the health cares costs related to diets high in meat based proteins.

    A chef is neither a nutritionist nor an environmental scientist.

    This person made an extraordinary claim:

    If anyone is able literally go 90 percent plant based whole food and cut sugar as much as possible-

    and made vague, non-quantified promises

    it could save a lot of money and your life not to mention the planet.

    There is nothing to respond to here.

    But here’s something fun. Want to live to be a hundred? Be born an Okinawan and eat a high carb diet:

    Of particular note is the number of people who reach 100 years of life. For every 100,000 inhabitants, Okinawa has 68 centenarians – more than three times the numbers found in US populations of the same size. Even by the standards of Japan, Okinawans are remarkable, with a 40% greater chance of living to 100 than other Japanese people….

    Rather than suffering a prolonged demise, the Okinawan centenarians appeared to have delayed many of the usual effects of ageing, with almost two thirds living independently until the age of 97. This remarkable “healthspan” was evident across many age-related diseases. The typical Okinawan centenarian appeared to be free of the typical signs of cardiovascular disease, without the build-up of the hard “calcified” plaques around the arteries that can lead to heart failure. Okinawa’s oldest residents also have far lower rates of cancer, diabetes and dementia than other ageing populations.

    Genetic jackpot

    Given these results, there is little doubt that Okinawa has an exceptional population. But what can explain that extraordinary longevity?

    Genetic good fortune could be one important factor. Thanks to the geography of the islands, Okinawa’s populations have spent large chunks of their history in relative isolation, which may has given them a unique genetic profile. Preliminary studies suggest this may include a reduced prevalence of a gene variant – APOE4 – that appears to increase the risk of heart disease and Alzheimer’s. They may also be more likely to carry a protective variant of the FOXO3 gene involved in regulating metabolism and cell growth. This results in a shorter stature but also appears to reduce the risk of various age-related diseases, including cancer.

    They also eat a diet based on sweet potato rather than rice.

    In short, we still have a lot to learn.

  141. 141
    indycat32 says:

    @Ladyraxterinok: There’s no cost for Part A. Part B is about $130/month. I have Medicare Advantage through IU Health. The $130 premium also includes part D (which I have yet to use).

  142. 142
    rikyrah says:

    @Cheryl Rofer: l
    They totally can’t be trusted.
    No $$$$ for the wall, which is not a wall, but a slush fund😡😡

  143. 143
    Jim, Foolish Literalist says:

    @Dorothy A. Winsor: /confessional whisper/ it’s the only Dickens novel I’ve read that I didn’t like, but the BBC version of a couple of years ago was great. Charles Dance was far scarier as Mr Tulkinghorn than he ever was as Tywin Lannister

  144. 144
    debbie says:

    @Ladyraxterinok:

    No. It is free, zero dollars. It’s automatic when you turn 65, regardless of whether you want it or not.

  145. 145
    Immanentize says:

    @raven: That’s a riot — Phony Nam Vets probably use the phony story more to prove they aren’t phonies.

  146. 146
    J R in WV says:

    @bk:

    @jimmiraybob: “Effective rate” is not the same as “marginal rate”.

    Wait, wait… didn’t I see someone talking about “effective marginal rate” in the conversation about taxes??????

  147. 147
    germy says:

    @debbie: I thought they raised it to 67.

    Does it depend on one’s birthdate? I’m unclear.

  148. 148
    Immanentize says:

    @Dorothy A. Winsor: @Jim, Foolish Literalist:
    I often say that today’s habeas corpus procedures in state and federal death penalty cases make Bleak House litigation look like the most well oiled justice machine.
    But I agree with J, F.L., too many dei ex machina in that book.

  149. 149
    Ohio Mom says:

    @J R in WV: I can’t speak for Brachiator but of course our agricultural policies and what our culture propels us to eat are not, um, optimal.

    And of course what any single person consumes can influence to some degree their health: better to drink water than diet pop, and so on.

    But an insulin-dependent diabetic isn’t going to be cured through diet, nor are many, many other serious conditions. Which is what chef appeared to be saying: “It could save a lot of money and your life.”

  150. 150
    TomatoQueen says:

    Unfortunately from NPR, and from 2016, but no change in the past two years to this: https://www.npr.org/2016/12/22/506497044/the-murky-world-of-secondhand-diabetic-test-strips which was a point of much conversation when I worked in the American Diabetes Association national call center. Which reminds me that in my rejoinder to the question about whether I test regularly (not no more, A1c is at 5.0 3 times running) that I should mention the cost of strips, loudly. Thoughts from my best friend, a Type 1 for 60 years: Humalog doesn’t work the way it should ymmv, an insulin pump killed her sister, all monitors marketed today are ridiculous, insurance companies are worse, and Eli Lilly, the major US insulin manufacturer, has business practices which merit only the worst fodiaf. In fact, we were both agreeing the other night that the circles in Dante’s Inferno could use some editing for modern times. Headfirst in a pile of barn leavings is a bit mild.

  151. 151
    Mnemosyne says:

    @Ksmiami:

    Dr. Weil doesn’t say what you’re claiming he says. I have a feeling that you’re conflating Type 1 (insulin-dependent) and Type 2 diabetes. Here’s what Weil says about Type 1:

    https://www.drweil.com/health-wellness/body-mind-spirit/diabetes/diabetes-type-1/

    For Type 1 diabetics, a good diet can NEVER replace insulin. Ever. And Dr. Weil specifically says that.

  152. 152
    Immanentize says:

    @J R in WV: The VFW (mostly WWII Vets) was kinda famous for rejecting returning Vietnam Vets because they didn’t fight in a real war, had long hair, drugs, etc. In my home town, the VV’s just took their custom over to the Polish Club and other such neighborhood venues.

  153. 153
    Ohio Mom says:

    @Ladyraxterinok: The thing you absolutely need to know about Medicare is that you MUST sign up within the window of three months before/three months after your 65th birthday. Else there are life-long penalties in the form of higher payments for the parts you do pay for.

  154. 154
    Ksmiami says:

    @J R in WV: I am not an extremist on this at all, but I became very interested in the concept of sustainability while watching people cook and consume tons of animal proteins and dairy without thought and as I reviewed more studies, I recognized weaknesses in the Standard American Diet and that many of our chronic and killer diseases have a pretty direct line to diet and lifestyle that other countries do not suffer. I just wanted to pass on the idea that our end game medical system feeds off our crappy food system.

  155. 155
    Kelly says:

    @germy: Medicare is still 65, Social Security full retirement has increased a few months per year for folks born after 1955 up to 67 for folks born in 1960.

  156. 156
    debbie says:

    @germy:

    It’s 65 and it’s automatic. I didn’t think much of it (“couldn’t hurt”) until my insurance company froze my HSA. They told me I would have to submit all bills to Medicare before they would consider reimbursement. I don’t know how many calls it took for me to convince them that none of the bills were hospital-related and that they could not do what they were doing. They could not freeze money that was not theirs.

    The day I actually connected to someone who actually understood what was going on and that my account had been miscoded was the day I sat and cried for hours. Others have far huger healthcare problems than I, but shit, it was like fighting a monster.

    It took five months to get this resolved, and I’m not confident it won’t happen again at some point.

  157. 157
    Ruckus says:

    @Immanentize:
    In my mind the money is the easy part. The infrastructure and the staff don’t exist for that. And if the staff existed there is no place to put them.

  158. 158
    Litlebritdifrnt says:

    @Leto: England has the same thing where you can buy private coverage if you want it. Other than that everyone is covered by the NHS, free care for everyone and maximum 8 pounds per prescription. Anyone over 60 pays nothing for prescriptions. My mother has private add on coverage for when she needs it. Several years ago the NHS scheduled knee surgery for her when she was booked on a cruise. Rather than cancel the cruise she went private and had the surgery prior to the cruise. Before we moved over here with co-pays (State Employees insurance) my husband’s prescriptions cost us upward of $350.00 a month. The first time he went to fill his prescriptions the pharmacists said it was “nothing” my husband was perplexed “you’re over 60, over 60s don’t pay”. Gobsmacked.

  159. 159
    Ksmiami says:

    @Mnemosyne: I understand the difference between type 1 and 2 but if we had fewer type 2 cases there would be more resources allocated to research and solutions for type 1. And that’s the whole problem with the American Healthcare system – the medical profession is incentivized to put profits over people. An endocrinologist makes more money with 10 type 2 diabetes patients than the 1 or 2 type 1 patients even though the meds and his advice will never eliminate the type 2 disease.

  160. 160
    Immanentize says:

    @Ruckus: It could just by expanding/co-opting current HMO structures to be part of the VA delivery net. My Family Practice would do that in a heartbeat.

    ETA: it would be much easier to implement than Medicare for All because of the stable system already in place. If public health is the goal, the VA is way further down the road than any other provider system

  161. 161
    Mnemosyne says:

    @Ksmiami:

    Oh, sweet Jesus. You actually think that endocrinologists are trying to keep their Type 2 patients sick.

    Into the pie filter you go, conspiracy theorist.

  162. 162
    Ruckus says:

    @germy:
    Yes, the age for full participation in SS has been raised and is being phased in based upon birth year. SSA has the info.

  163. 163
    WaterGirl says:

    @Immanentize: So well put! thank you

  164. 164
    WaterGirl says:

    @rikyrah: Yep. Anyone who can’t see the dirty tricks at work and acknowledge that they at least played a large part in the supposed offenses that came forward is either not very bright or is willfully ignoring that aspect. If KG had said “I know there were dirty tricks at play and some of those reports simply didn’t hold water, but for me there was one credible report that I simply couldn’t ignore”, I wouldn’t dislike her with the heat of a thousand suns.

  165. 165
    WaterGirl says:

    @debbie: Part B is taken out of your SS payment.

  166. 166
    Ksmiami says:

    @Brachiator: Look, there is a lot of compelling medical and scientific nutrition research that’s been done and you can compare where we are on it to the early “tobacco is good for you” days – as someone who has Read a lot of the data and the conflicting information often funded by BigAg, I’d rather get in front of a solution for my customers and my family than wait for the day when we are posting huge food warning labels on a package of bacon. And as a matter of course, more Americans will die from Heart Disease and cancer than other chronic diseases so healthy diet and lifestyle play a huge role in combating both.

  167. 167
    debbie says:

    @WaterGirl:

    Ladyraxterinok asked about Part A though.

  168. 168
    Ksmiami says:

    @Mnemosyne: no they aren’t trying to keep their type 2 patients sick, but the drugs and the short patient visits won’t be enough to overcome the disease without radical lifestyle changes. That’s all.

  169. 169
    J R in WV says:

    @Brachiator:

    All very interesting data.

    But I think the evidence regarding global warming gases emitted by meat-based agriculture is pretty clear. Our love for red meat causes huge amounts of methane and CO2 to be added to the atmosphere. Which could crash not just civilization, but also the biosphere itself!

  170. 170
    Ksmiami says:

    @J R in WV: starchy potatoes are a plant based food last I checked. When I talked about sugars, I meant the refined stuff processed food companies put in everything from bread to juices etc.

  171. 171
    Ruckus says:

    @Immanentize:
    I’m not disagreeing with the concept at all. The US would be a better place if the entire system included everyone and was The VA – called maybe US Healthcare? I’m saying that to get the VA to that point is not nearly as easy. The VA is a rigidly controlled system, is big enough to control the prices it pays for drugs for example. However it’s rare to get the latest drugs unless there is nothing generic to replace it. I get an on patient migraine relief med because the only other workable solution is a particular opiate. My copay is more for it but far less than I used to pay and I used to get it from Canada, which was about 35% cheaper than US pharmacies. The VA currently has a system in place to pay outside vendors for treatment if there is too long a wait or the closest clinic is over a set milage – I believe it’s 50 miles. The LA VA hospital is over 100 miles from the fringes of it’s coverage area. and can’t take reasonable care of just all the vets that live in it, let alone the literally millions of non vets. Now if you are saying that nothing has to change except who pays the current docs, how many docs are going to want to work for what the VA pays? Here is the USAJOBS site, you can look up and see what a VA doc gets paid. I doubt that a lot of docs would work for that amount and that’s about what the VA would have to pay to cover everyone. Also we wouldn’t need the healthcare insurance companies and that’s a lot of unemployment. My last private Drs. office had 2 docs 2 RNs, 1 LP and 1 receptionist and 4 insurance clerks. Cash price 11 yrs ago was $100 per visit. How many of those 4 insurance clerks would still be there?

  172. 172
    opiejeanne says:

    @Jim, Foolish Literalist: He was pretty damned scary as The Patrician in Going Postal.

  173. 173
    opiejeanne says:

    @debbie: We’re fighting with our doctor’s office because they keyed in a checkup as a physical and Medicare doesn’t cover that (they say). We’ve tried to get them to re-code it and re-submit it but they don’t seem to understand the problem. Ugh.

  174. 174
    WaterGirl says:

    @debbie: I obviously was not clear. Someone else had already said that A was free; what I was trying to convey is that indeed something does come out of your SS payment, but it is Part B not Part A.

    Communication, how does it work?

  175. 175
    Brachiator says:

    @Ksmiami:

    Look, there is a lot of compelling medical and scientific nutrition research that’s been done and you can compare where we are on it to the early “tobacco is good for you” days – as someone who has Read a lot of the data and the conflicting information often funded by BigAg,

    To be as kind as possible, you and I read the data and come to different conclusions.

    And as a matter of course, more Americans will die from Heart Disease and cancer than other chronic diseases so healthy diet and lifestyle play a huge role in combating both.

    This is at best a tremendous oversimplification of the issue. And cancer deaths are actually declining. Your belief in the power of healthy diet and lifestyle is just flat out wrong.

  176. 176
    Ruckus says:

    @Brachiator:
    Isn’t the main reason that cancer deaths are decreasing is better treatments?
    My cancer for example. Ten yrs ago the best choice was surgery, which was performed as an open procedure and had about 99% complications. Now if the surgery is performed it is done robotically and the complications are down to 95%. But better still is that there are now non invasive procedures (a fancy radiation machine) which have a dramatically better complication rate, on the order of maybe 20-25%. And better long term prognosis. Chemo procedures show a similar path for the most part, new drugs work better and are more directed.
    Personally I believe that a lot of current medical problems are because our life expectancy has gotten higher and often that is from medical procedures that extend our lives enough to put people at higher risk. And yes a lot of our extension is from child age issues that have decreased young deaths an amazing amount. Still older people in both my immediate and extended families have benefited from this, pacemakers, my cancer, other’s cancers. It’s a small list but not an unusual one. Open heart surgery, organ transplants are two more.

  177. 177
    Brachiator says:

    @J R in WV:

    But I think the evidence regarding global warming gases emitted by meat-based agriculture is pretty clear. Our love for red meat causes huge amounts of methane and CO2 to be added to the atmosphere. Which could crash not just civilization, but also the biosphere itself!

    So one question, I guess, is whether we can mitigate the problems.

  178. 178
    Brachiator says:

    @Ruckus:

    Isn’t the main reason that cancer deaths are decreasing is better treatments?

    Not sure. But let’s say, the answer is yes. What’s wrong with that?

    My cancer for example. Ten yrs ago the best choice was surgery, which was performed as an open procedure and had about 99% complications. Now if the surgery is performed it is done robotically and the complications are down to 95%.

    Great example. And I hope you are doing well.

    Personally I believe that a lot of current medical problems are because our life expectancy has gotten higher and often that is from medical procedures that extend our lives enough to put people at higher risk. And yes a lot of our extension is from child age issues that have decreased young deaths an amazing amount. Still older people in both my immediate and extended families have benefited from this, pacemakers, my cancer, other’s cancers. It’s a small list but not an unusual one. Open heart surgery, organ transplants are two more.

    There are more older people alive, and not just because of a decrease in birth rates. And that’s how it should be in advanced societies. Basic improvements in health, sanitation, clean water, elimination of childhood diseases through immunization, less stressful work lets more people live longer, healthier lives. And then we throw in medicine and surgery.

    My doctor told me once that when they were first introduced, patients didn’t get a pacemaker until they had survived their second heart attack. Now, I read about people getting pacemakers for their pets.

  179. 179
    Ohio Mom says:

    @Ksmiami: In the very, very early stages of Type 2 diabetes, when insulin resistance is first observed, for some patients, radical and heroic changes to diet and very frequent, rigorous exercise can increase insulin sensitivity and seemingly stop the disease’s onset.

    I am also aware of morbidly obese people who have had gastric bypass surgery and as a result, reversed their Type 2 diabetes.

    Do these changes last, I don’t know. I would be interested in what the research says. I would expect that for a fair number, the reprieve is short-lived. For whatever reasons, the person has a propensity for diabetes and that probably isn’t going away.

    It should also be noted that once Type 2 has progressed (and it *does* progress), there are no DIY treatments or cures.

    If your argument is against systematic forces — for example, the farm products we subsidize (corn) vs. the ones we don’t (produce), our culture’s infatuation wth fast food, that sort of thing, fine. No argument here.

    But no blaming the individual, please. It’s a fantasy that we are solely responsible for, and deserve, our health and disease. It’s a cruel and clueless stance.

  180. 180
    MoxieM says:

    I just searched the comments for keywords, not read all. (Honest representation).
    And the Sackler’s business practices sound odious from what I’ve read. But, as a person with a chronic, progressive spine condition (not responsive beyond a certain point to exercise, which I do) and other stuff, blah blah. I’ve been in constant pain, and it’s getting worse, for at least the past 6 years. for two months of those 6 years I’ve had a very low dose Oxy Rx, and they are the only times my pain has been remotely relieved.

    I want to draw you attention to the emotional and psychological consequences of living with constant pain–it’s horrendous. Moreover, I’m what’s known as an “Elder Orphan” (between 22-35% of the population are). Meaning, I have no partner or children or other kin nearby to help me with life, and I’m basically very isolated. I do all my own household stuff, in dire pain. How many of you come out of the grocery store with tears streaming down your face from the pain of a normal shopping trip?

    It’s not as if I don’t know about the issues associated with opioids and long term pain control. Once upon a time I did public health research on injection drug use, even, sponsored by SAMHSA and NIDA. I read the literature. And I’ve tried yoga, acupuncture, chiropractic, NSAIDS, water exercise, Pilates, and probably 5 more things…

    That’s all. I just find that the voices of those of us who could be responsible users of pain control are nearly silent, or silenced, in this conversation. We exist, and our needs are no longer met, if they ever were.

  181. 181
    Leto says:

    @Litlebritdifrnt: This is a very late comment but this is part N of why Avalune are looking to get back overseas. Quality of life is FAR superior.

  182. 182
    Ohio Mom says:

    @Brachiator: When pacemakers were first introduced, no one could know if they were safe and effective in the long run. Someone who already had two heart attacks had less to lose since the established protocol wasn’t working on them. They had few options so why not take a risk.

    Ohio Dad needed a new heart valve last year. He wanted the trans catheter one, where they snake a collapsed artificial valve through a vein in your goin, and once the valve reaches its destination, it’s popped open in place.

    But only high-risk patients can get them because they have less to lose. Ohio Dad was low risk so he had to do the established protocol, which is open heart surgery.

    Doctors are in the midst of studying the trans catheter in low-risk patients. So we can assume that the pattern will be followed and one day pets will get trans catheter heart valves too.

    On a related note, I think this thread is dead. On to the next one!

  183. 183
    Ohio Mom says:

    @MoxieM: So sorry to read this about you.

    I frequent a breast cancer discussion board and the women with very advanced cancer have the same complaint, that their ability to control their pain and remain as functional as they can is very much hampered by the backlash against opioids.

    They are not always able to get the relief they need because of laws preventing abuse — I should say supposedly preventing abuse. There’s still plenty of abuse, obviously.

  184. 184
    The Lodger says:

    @Ruckus: I just checked the site and signed up for mySS. Good news: my actual retirement age is 66, not 67 as I thought. I’ll also be signing up for Medicare in three months, regardless of whether I can stay on my employer’s plan or not. So thanks for that comment. It helped me sort some important stuff out.

  185. 185
    Ohio Mom says:

    @The Lodger: As I noted above, you must apply for Medicare in the window between three months before/three months after your 65th birthday, or be forever penalized.

    The other thing to know is that the amount of your monthly SS benefit will be different according to when you elect to start collecting. Collect at the earliest date possible, and you will get less each month than your full benefit; wait to start and you will eventually get a larger amount than your full benefit.

    The parts of the Social Security website I’ve looked at so far have been pretty easy to follow.

  186. 186
    Procopius says:

    @Ruckus: Dean Baker points out at least every week that the problem is government granted/enforced monopolies, i.e. patents. There are better ways to finance medical research, and most renewed pharmaceutical patents in recent years aren’t new inventions anyway — they’re tiny tweaks in the manufacturing process that cost practically nothing and allow another twenty years of monopoly. A lot of the current pharma research is government funded now, too.

  187. 187
    EthylEster says:

    @The Moar You Know wrote :

    because he keeps MAKING SHIT UP

    and people keep believing him.
    There must be a simple remedy for this…..thinking, thinking.

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