Medical Bleg

Asking for a friend: Anybody got advice on picking a competent hernia surgeon?

And/or tips on good elective surgical programs in the Boston area, or the Northeast generally?



Open Thread: Post-Racial America, Y’All!

Speaking of ol’ George ‘never let myself be out-n*****ed again’ Wallace…
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LBJ famously said that signing the Civil Rights Act would endanger Democratic politicians ‘for the next fifty years.’ But in the long run, the GOP’s ‘Southern Strategy’ turns out to be even more dangerous. Not just to the country (Repubs wouldn’t care about that) but to a GOP that finds itself outnumbered as well as outgrown.



GOP Congress: We Luv Babies, But Not As Much As We Love Our Treason Flag

Not The Onion/Andy Borowitz:

House Republican lawmakers sought to reverse previously passed legislation restricting the display of the Confederate flag in federal cemeteries by slipping a provision stripping the legislation into a larger appropriations bill that included Zika funding. The House bill passed last week on largely partisan lines, but was blocked in the Senate Tuesday by a Democratic filibuster.

The Confederate flag language was just one of a number controversial provisions included in the bill, which also included an amendment cutting Planned Parenthood funding and other swipes at the Obama administration’s public health initiatives.

Republican lawmakers are warning that the American public will now blame Democrats if Zika becomes a full-blown health crisis. But Democratic leaders suggested that filibustering Tuesday’s bill was an easy call — pointing to provisions like the Confederate flag reversal…

Mr. Pierce, “Did Republicans Really Just Bring the Confederate Flag into the Zika Debate?”:

The Democratic opposition to the bill in the Senate primarily dealt with the whack the bill took at Planned Parenthood, and the president was likely to veto this bill anyway, not least because it contains half of what he asked for to fight the disease, and because it does so by draining money from other urgent priorities. But, honestly now, babies are being born with severe birth defects, and this is seen as an opportunity to get back a fight you’ve already lost?

That’s not governing. That’s a talk show.

As of mid-June, per the Centers for Disease Control & Prevention, at least “Three women in the U.S. mainland infected with the Zika virus have delivered infants with birth defects and three others have lost or terminated pregnancies because their fetuses suffered brain damage from the virus”.

States have been scrambling to find funds for Zika prevention efforts, resorting to stealing it from other programs. At least one Republican, Rep. Ted Poe (Texas) complained that his district wasn’t getting enough Zika funding from the CDC — even as he personally voted to cut the agency’s funding.

And the women most likely to be affected are, of course, those least likely to be able to protect themselves.

Not for the first time, I find myself wishing that the GOP Talibangelicals and their enablers would actually be judged under the religious standards they profess, because it wouldn’t be the biblical Heaven to which the Jesus described in their holy book sent them.



Tuesday Morning Open Thread: Yes, It’s That Important

When SCOTUS struck down Texas’ HB2 regulations yesterday, Richard Mayhew predicted “A lot more from lawyers later.” Here’s a couple of respected legal analysts. Linda Greenhouse, in the NYTimes, “The Facts Win Out on Abortion“:

… There is no poetry in the 40-page opinion, which strikes down a Texas law that would have closed most abortion clinics in the state in the name of protecting women’s health. The dry, almost clinical tone could scarcely be more different from the meditative mood the Supreme Court struck the last time it stood up for abortion rights, in Planned Parenthood v. Casey, 24 years ago this week. “Liberty finds no refuge in a jurisprudence of doubt” was Justice Anthony M. Kennedy’s mysterious opening line in that opinion…

Although nearly one-third of American women will have an abortion in their lifetime, a goal of abortion opponents has been to carve out abortion practice from ordinary health care, to ghettoize and delegitimize it. Those days are now over, too. Singling out abortion for regulation that can’t be justified on medical grounds is unacceptable, as Justice Ruth Bader Ginsburg emphasized in a concurring opinion.

When I first read Justice Breyer’s opinion, my sense of relief struggled against a feeling that something nonetheless was missing: not necessarily the aspirational rhetoric of the Casey decision but some explicit acknowledgment of what it means to women’s equality and dignity not to be trapped in an unwanted pregnancy.

Then I realized that while the court in Casey called upon “the contending sides of a national controversy to end their national division by accepting a common mandate rooted in the Constitution,” it didn’t really work out. Maybe, after all, this is not a moment for poetry, but for facts. There’s not much in Justice Breyer’s opinion that’s quotable. But there’s not much that’s debatable either, and that’s what matters.

Linda Hirshman, in the Washington Post, “How Ruth Bader Ginsburg just won the next abortion fight”:

She has written into law the factual finding that abortion is safe.
… The strategy of purporting to help women, which has, until today, been stunningly successful, started with the attack on so-called “partial birth abortion” in 1995. It reached its high water mark with Justice Anthony Kennedy’s hotly contested 5-to-4 decision upholding the restrictions on such procedures in Gonzales v. Carhart in 2007. Kennedy found medical disagreement about the safety advantages of the procedure. Importantly, he then deferred to the findings of the legislature that women would be safer and better off without partial birth abortion…

… When the news broke that RBG was concurring, the initial reaction was puzzlement. Why would Ginsburg need to write separately from a pro-choice opinion by her liberal colleague Breyer? Looking at her concurrence, however, the explanation is clear.
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The Politicization of Policy

Earlier today the Supreme Court, in a 4-4 deadlocked ruling pertaining to President Obama’s Executive Order pertaining to the status of the parents of American citizens or legal residents who are in the country illegally, issued the following ruling: “The judgement is affirmed by an equally divided Court.” In the short term this means that the original District Court ruling, affirmed by the 5th Circuit Court of Appeals, stands. It is unclear whether this means that the President will seek to enforce his executive order to not deport the parents of American citizens or legal residents outside of the 5th Circuit or not. The ruling is partially the result of Texas and 25 other states shopping for a sympathetic District Court Judge, which is why they filed it in Brownsville, not Austin the state capitol. It demonstrates both the challenges of a divided Supreme Court and the politicization of policy.

While Speaker Ryan has issued a statement lauding the decision and claiming it as a victory for the Constitution and Congress, specifically under Article 1, this is simply part of the politicization of this particular policy. And that comes at a price. Both in lives affected and in dollars spent. The reality that no one wants to mention when discussing the President’s DAPA and expanded DACA order to defer deportations for specific, low risk classes of undocumented people in the US, and which demonstrates why Speaker Ryan’s claiming victory for Article 1 and the Congress’s power to write the Law, not the Executive Branch, misses the point is that Congress did write the Law. Congress made it a misdemeanor to improperly enter the US; specifically entering in an undocumented capacity without papers while avoiding immigration control. Unlawful presence, overstaying one’s visa or not leaving the US and returning to one’s home country when one is supposed to is not actually a crime at all. The Executive Branch, however, has to administer (execute) this law. But here’s where the rubber of making Law hits the road of enforcing it: Congress also has to provide the ways and means.

Currently Congress only appropriates enough money for the Department of Homeland Security to deport approximately 450,000 undocumented immigrants that have illegally entered or overstayed their visas. This is not something new. Congress never appropriates enough money to deport everyone who has entered illegally or overstayed their visas. The cost for trying to identify, round up, and deport all of the estimated 11 million undocumented people – both improper entry and unlawful presence – in the US right now is estimated at no less than a $100 billion and up to $600 billion. As a result every Presidential Administration has had to prioritize who to focus on. The focus is always on those who have been arrested and/or previously convicted of engaging in violent crimes or who are tied to human or drug trafficking or terrorist/extremist organizations. And this makes sense from a domestic, public policy standpoint: focus on those who present the greatest potential threat to the US, American citizens, legal residents, and those visiting the US. What Speaker Ryan, Governor Abbot of Texas and his 25 colleagues from when he was the Texas Attorney General, Federal District Court Judge Hanen, the 5th Circuit Court of Appeals, and the four Supreme Court Justices that voted to uphold the lower court rulings against the Administration’s Executive Orders have chosen to ignore is that tomorrow the Obama Administration still only has enough Congressionally appropriated funding to deport 450,000 people in the US illegally. And tomorrow the Department of Homeland Security is still going to have to prioritize who they focus on – the parents of an American citizen who other than the Federal misdemeanor of improper entry or the not an actual crime at all of unlawful presence are otherwise law abiding or the guy trafficking women for the sex trade.

We’ve reached this moment of policy and juridicial stupidity because both the President and those opposing his policy of prioritization politicized the issue. The President publicly announced the policy of placing the parents of US citizens and legal residents on the low priority list for deportation, which provided them with an effective exemption. President Obama did this as part of a strategic communication strategy to signal to an important constituency that he, and the Democratic Party, were not going to forget them even if Congress was unable or unwilling to act. The House GOP majority, as well as twenty-six Republican controlled states, responded by also strategically communicating to their constituencies that they would sue the President to overturn his Executive Order to ensure that the Law was administered and that only Congress, as Article 1 states, can write Law. The issue, which was already politicized, was dialed up to 11.

There is no way of knowing if, had the President not publicly announced what he was doing, the GOP House Majority or one or more of these 26 Republican governed states would have still objected as vehemently or opposed the President’s actions through a lawsuit. Moreover, there isn’t equal guilt for politicization on both sides. Until or unless Congress appropriates more funds for deportations, which they do not seem to be inclined to do, the Obama Administration, and any subsequent administrations, will only have the funding – the means – to identify, arrest, detain, and deport 450,000 undocumented people per year. No matter what Judge Hanen, the 5th Circuit Court of Appeals, or the Supreme Court rules, tomorrow the Department of Homeland Security, part of the Obama Administration’s Executive Branch, will still have to prioritize who to deport. I fully expect that they will continue to prioritize their efforts on those accused of and/or convicted of violent crimes, as well as those suspected to be trafficking drugs and people or of being affiliated with extremist or terrorist organizations. Focusing on less dangerous cohorts among the undocumented would create an actual threat to the safety and security of the US, its citizenry, its legal residents, and those visiting for work, school, or enjoyment.



Open Thread: John Oliver Is AWESOME

As explained at Slate:

On Sunday night John Oliver staged what he described as “the largest one-time giveaway in television show history,” giving $14,922,261.76 to nearly 9,000 lucky Texans. Or maybe not-so-lucky Texans, at least until Sunday: The money came in the form of forgiveness for out-of-statute medical debts, debts so old they could no longer be recovered in court. It was part of a lengthy investigation into the shady ethics and questionable practices of debt buyers, companies that buy up debts for pennies on the dollar and go to great, sometimes illegal lengths to collect them…

The broader case Oliver is making is that the entire debt buying industry is corrupt and underregulated, not just the most laughably incompetent collectors. It’s difficult to argue after seeing his footage of the Debt Buyers Association’s annual conference, in which trade group members scoff at the idea of their debtor’s legal rights. But the strongest argument Oliver makes that the industry needs work is that they let him become a part of it. Without too much hassle, he was able to set up his own debt collection company and purchased a portfolio of nearly $15 million in Texas medical debts. (Total cost: less than $60,000.) Then, with the press of a giant red button, he forgave all $15 million. As best as the staff of Last Week Tonight could figure, this gives Oliver the record for largest giveaway (previously held by Oprah Winfrey for giving her audience cars). Given the misery debt buyers and collection agencies cause, it’s hard to imagine any late-night host doing more concrete good for such a small cash outlay—but here’s hoping they make a competition of it.

Oliver’s deft at turning jokes about what’s actually a horrific situation: America’s self-proclaimed Masters of the Universe have birthed an entire industry based on screwing every last penny out of the victims of medical catastrophes. I cannot believe this is the best and highest purpose for the richest, most advanced society on the planet.



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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