Late Night Horrorshow: Zika Is Coming, Ready or Not

I’m probably gonna get dinged for chicken-littling, because hey, no Ebola outbreak happened in America, right? And yet… “White House Ebola response coordinator from 2014 to 2015” Klain’s Washington Post article:

The good news is that both the House and Senate have finally passed bills that would provide some funding to combat the Zika virus. The bad news is that this action comes more than three months after President Obama requested the aid. Moreover, the House bill provides only one-third of the response needed; pays for this limited, ineffective response by diverting money allocated to fight other infectious diseases; and necessitates a conference committee to resolve differences with the Senate bill, meaning we still do not know when any money will finally get through Congress to fund the response…

As befuddling as Congress’ refusal to approve funds for the Zika response is, perhaps even more of a mystery is why such approval is needed in the first place. If nature was threatening us with serious injury and evacuations via fire, flood or hurricane, the president could use his authority under the Stafford Disaster Relief and Emergency Assistance Act to provide immediate aid without waiting for Congress to act. The fact that epidemic “natural disasters” are the result of disease and not an earthquake or tornado should not constrain the federal government’s ability to provide a timely, comprehensive response…

Speaking of those damaged babies? Once the Zika virus gets established in “our” mosquitos, microcephaly is going to become yet another standard prenatal test for women in the afflicted areas. Or who’ve visited those areas. Or whose male partners were exposed to Zika, even months before the pregnancy. And by the time microcephaly can be diagnosed, it’s too late for a quiet ‘medical abortion‘ — women will need full surgical services, and most will have been visibly pregnant. It’s not going to be easy for ‘fundamentalist’ anti-choicers to find reasons to blame good married Christian white ladies in the Sunbelt for having been bitten by the wrong mosquito… but I’m sure they’re gonna try their damndest.
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Sports-Adjacent Open Thread: Has the Fourth Horseman Just Shown Up in Rio?

There will never be an Olympic Games that doesn’t involve some kind of unseemly political tradeoffs (like Russia’s anti-LGTB terrorism pre-Sochi) and unfortunate aftereffects (“Bombshell Report Details Elaborate State-Run Russian Doping Program During Sochi Olympics”). But the upcoming Summer Games in Rio have scored an especially depressing hat trick, as described in Foreign Policy:

Imagine trying to throw a giant party while going through an ugly divorce — and as disease-bearing mosquitoes swarm around your badly damaged house. That, essentially, is what Brazil is trying to do as it barrels toward this summer’s Olympic Games during an impeachment crisis and an as-yet uncontrolled Zika outbreak.

On Wednesday night, the Brazilian Senate voted to impeach President Dilma Rousseff. The political crisis that has rocked the country since Rousseff was first accused of manipulating government funds during her 2014 reelection campaign has only worsened the public health crisis caused by the explosive spread of a particularly dangerous strain of Zika virus…

And now, the Olympics could help a dangerous strain of Zika go global. [Amir] Attaran, who has served as an advisor to Brazil’s Ministry of Health, argued in the Harvard Public Health Review that Zika in Brazil is much more serious than previously acknowledged, and that allowing Rio to host the 2016 Olympics will speed up a global health crisis.

Rio has the highest number of probable Zika cases in the country, and the virus is more dangerous than previously thought — and not just for pregnant women, Attaran said.

“The effects on the adult nervous system are only beginning to be studied, but the preliminary findings are not good, and suggest that exposure to the virus is linked to Guillain-Barré disease, increasing the odds 60-fold,” he wrote.

In addition, new evidence seems to demonstrate both that Zika is clearly a cause of microcephaly, which shrinks babies’ brains, and that the virus can spread through sexual contact…
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Open Thread: Deadbeat Donnie’s Veepstakes

Of course they’ll fall into line eventually — it’s what Republicans do — but meanwhile we Democrats get to enjoy the klown show. Per the Wall Street Journal, “Tensions Rise Over Republican VP Options”:

While rank-and-file conservatives are searching for a signal that Mr. Trump shares their values, Ben Carson, a former GOP rival now helping the presumptive Republican presidential nominee pick a running mate, said Thursday Democrats may be among those considered…

Mr. Carson is the public face on the search process, while top campaign aide Paul Manafort is maintaining overall tight control, according to people familiar with the campaign. In the interview, the former surgeon took himself out of the mix. “I’m not interested in doing that for a number of reasons,” he said. “I don’t want to be a distraction.”…

Given that Republican National Convention delegates aren’t bound to abide by his choice, Mr. Trump could face an arena of delegates rebelling against his running mate choice if he sends the wrong signal. “He could get to Cleveland and designate someone as his vice president and have the convention lose its mind,” said Erick Erickson, an anti-Trump conservative activist.
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Thanks, Obama!

We’re so used to Republicans blaming President Obama for everything from Ebola to socks disappearing in the dryer that we have a sarcastic shorthand for it: Thanks, Obama! According to Republicans, even their own ignorant, racist, misogynist wrecking ball of a presidential candidate, Donald Trump, is somehow PBO’s fault.

Well! Last night, The Wall Street Journal published what may be the Platonic ideal of this plaintive wail:

Obama’s Greatest Triumph

He is six months away from destroying both the Republican Party and Reagan’s legacy.


Barack Obama will retire a happy man. He is now close to destroying his political enemies—the Republican Party, the American conservative movement and the public-policy legacy of Ronald Reagan.

As wonderful as it would be to credit PBO with skull-fucking Zombie Reagan, it didn’t exactly go down like that. In fact, PBO helpfully warned the Republicans that their oppositional defiant disorder would ultimately bite them on the ass, as Martin “Booman” Longman ably proves in this Washington Monthly column. An excerpt:

The Republicans should have listened to the president’s advice.

They thought they’d get more short-term bang for the buck by encouraging the Tea Party and the Birthers (including Trump). And they did.

And now their long-term reward is “Barack Obama will retire a happy man. He is now close to destroying his political enemies—the Republican Party, the American conservative movement and the public-policy legacy of Ronald Reagan.”

Yep. The whole piece is well worth a read (Longman’s piece, I mean, not Henninger’s).

Still, as gratifying as it is to see all those nasty chickens coming home to roost in the GOP henhouse, it would be foolish to count unhatched chickens in our own coop. I’ll believe the Republican Party is destroyed and Ronald Reagan’s legacy dismantled when I see a stake driven through its fat black heart and not a moment before.

Even so: Thanks, Obama!

Good news everybody

Just some more good news:

and the good news will probably continue for the first quarter of 2016:

So in 3 years, all of the data sources suggest that we’ve cut the uninsured rate in half and slowed the cost curve. There are another couple percentage points of easy gains once the rest of the Confederacy and the everyone between the Mississippi’s left bank and the Columbia’s south bank expand Medicaid.

Then we’ll actually need to take another whack to get the last 5% of the population covered AND get better coverage for 25% to 30% of the currently covered population.

Not observing games

PPACA has been attempting to bend the cost curve by penalizing stupid and avoidable errors.  One class of errors that has been amenable to reduction has been Medicare beneficiaries getting  re-admitted to hospitals  after their initial admission for a set of circumstances.  As soon as data started to be collected and before penalties started to be imposed, the readmission rate crashed.  Since penalties have been imposed, the rate is still going down but at a slower pace.  This does two things to the cost curve.  First, it reduces direct Medicare expenses as Medicare is not paying for another hospital day.  Secondly, changes in practices and procedures that result in lower Medicare readmission rates tend to diffuse throughout a hospital and all of its patients so people who are not covered by Medicare also benefit from the improvement in practice.

This sounds great.  We save money, save Grandma as hospitals are where old people die, and get better quality care.

However, wonks have worried that any quality measure that has real money attached to it can and will be gamed.

The easiest way to game a re-admission measure is to redefine admissions.  Hospitals have the ability to put people on “observation” status where to anyone but the billing and quality metrics department, the person looks like they are admitted.  They get the uncomfortably flimsy robe, they get the wrist band, they get poked and prodded and monitored just like an admitted patient.  They can stay in observation status for a time period including one midnight.  Yet these individuals are not part of the “admitted” or “re-admitted” population universes.

There was a possibility that a significant chunk of the seemingly great decline in readmission rates was really a bureaucratic shift of people getting moved from short term admissions to observation status.

That is not the case.

The New England Journal of Medicine  * has an interesting study on this matter:

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Good news everybody

The CDC  has released their initial 2015 uninsured population counts.  Good news, for all residents of the US in the US through September 2015.  Remember, this percentage will go down a bit more as Montana and Alaska are expanding Medicaid and the 2016 Open Enrollment period pulled in more people.


CDC 2015 uninsured rate

These numbers are a bit lower than Gallup and other sources because this data set includes kids and the elderly.  Both of those groups tend to have a higher insurance rate because there are more government programs aimed at those two populations.  Working age adults have a slightly higher than national average uninsured rate.