Friday, December 13, 2013

Promises To Fix Mental Health System Still Unfulfilled

More From Shots - Health News HealthFDA Warns Against Test Touted As Mammogram AlternativeHealthIf You Drank Like James Bond, You'd Be Shaken, TooHealthA Nasty Fever Called Chikungunya Hits Close To HomeHealthPromises To Fix Mental Health System Still Unfulfilled

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, December 11, 2013

Despite Big Market In Florida, Obamacare Is A Hard Sell

More From Shots - Health News HealthSome Young Athletes May Be More Vulnerable To Hits To The HeadHealthGlobal Malaria Deaths Hit A New LowHealthStaph Germs Hide Out In The Hidden Recesses Of Your NoseHealthHealth Exchange Enrollment By State, In 2 Charts

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Despite Big Market In Florida, Obamacare Is A Hard Sell

More From Shots - Health News HealthPopular Antacids Increase The Risk Of B-12 DeficiencyHealthTo Fight Meningitis Outbreak, Princeton Tries European VaccineHealthDespite Big Market In Florida, Obamacare Is A Hard SellHealthDon't Count On Insurance To Pay For Genetic Tests

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Despite Big Market In Florida, Obamacare Is A Hard Sell

More From Shots - Health News HealthPopular Antacids Increase The Risk Of B-12 DeficiencyHealthTo Fight Meningitis Outbreak, Princeton Tries European VaccineHealthDespite Big Market In Florida, Obamacare Is A Hard SellHealthDon't Count On Insurance To Pay For Genetic Tests

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, December 6, 2013

How to Revive the Fight for Single-Payer

Rep. Jim McDermott of Washington is optimistic that it will come�if we give states the tools to adopt it at their own pace.

When the media frenzy subsides and Republicans run out of scare stories, the country will be faced with the most important question about Obamacare: Can it deliver what it promised? Thanks to the Affordable Care Act, a new business model is rapidly emerging in the medical-industrial complex that, in theory, can dramatically reduce the inflated costs of healthcare while serving everyone�rich and poor, healthy and sick. But the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies. A lot of liberal Democrats, though they voted for Obama�s bill, remain skeptical.

�In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system,� said Washington Representative Jim McDermott. �We�re not making refrigerators. We�re dealing with human beings, who are way more complicated than refrigerators on an assembly line.� I turned to the Seattle congressman for a candid assessment because he�s the third-ranking Democrat on the House Ways and Means Committee and has been an advocate of single-payer healthcare for decades. Plus, he�s a doctor.

The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding �integrated delivery systems��nonprofit and profit-seeking�that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they�re hiring younger doctors as salaried employees. An American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.

�The medical-industrial complex is putting itself together so that the docs will be the least of our problem,� McDermott said. �They will simply be serfs working for the system.� The AMA�s market research reports that �hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.� Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.

�It�s possible hospital groups can reduce costs,� the congressman said, �but I look at the consolidations going on and ask myself, �Are we going to wind up with hospitals that are too big to fail? Are we going to have hospitals so powerful that we cannot not give them what they want?� It�s going to be the government against the medical-industrial complex, which is developing very rapidly. If the Little Sisters of Providence [his fanciful example] become a conglomerate and the government says you should close some of your hospitals, they will say, Who says?�

Despite these doubts�not to mention the Republican-promoted hysterical attacks on the ACA on other grounds�McDermott is actually optimistic. He expects stronger healthcare systems roughly resembling single-payer �to spring up like dandelions� around the country�led by progressive states that really want to make it work. �That�s probably going to happen in Vermont, Washington and Oregon,� he said. �California has tried twice to have a single-payer system and was defeated by the forces of money. Jerry Brown in California, maybe Cuomo in New York, maybe Kentucky. The governor in Oregon, John Kitzhaber, and our governor in Washington, Jay Inslee, all want it to happen.�

Having introduced a single-payer bill in Congress every year since 1993, McDermott is developing a different approach this time: a strategy designed to get around the hard-core resistance in so many states. �I now have a bill I�m going to drop in soon as a patch to the ACA,� he said. �What I�m trying to do is let the states that want it to go ahead, whether it�s Tennessee or Illinois. �Medicare for All� sounds wonderful, but the country is so diverse, you have to allow the delivery system to evolve where it can. You have to do it state by state.�

McDermott tried to sell this concept to the Obama administration and to Senator Max Baucus of Montana, chair of the Senate Finance Committee and one of the key Capitol Hill brokers in 2009�10 for what would become the ACA. No sale in either case. Instead, the president rejected the �public option� and made �bad deals� with hospitals, drug companies, the insurance industry and other players, McDermott said. Those interests agreed not to fight new rules on their behavior toward consumers, and in return Obama provided them with millions of new paying customers, subsidized by the government.

Under the ACA, hospital groups must sign a non-discrimination agreement, but as a practical matter they can still find ways to pick and choose which patients they will treat. The rules for Medicaid are set by each state, and enforcement varies widely among them. Typically, many private practices severely limit impoverished patients on Medicaid or refuse to serve any at all because that threatens their rate of return. Less obviously, some of the leading health conglomerates celebrated for their high quality and cost controls do the same. �When you dig down in all these great places like Mayo and the Cleveland Clinic, you see the same sort of thing,� McDermott said. �The Mayo doesn�t go out looking for Medicaid patients, and they don�t take just anyone who walks in the door.�

McDermott�s new legislation would break from the longstanding liberal assumption that the government must enact universal social programs that apply rules and benefits uniformly to all states at once. He figures that would allow the resistance to block single-payer for many years. So he wants to create a special deal for the limited number of states willing to uphold higher standards. State legislatures and governors can win approval to design and operate their own single-payer system, deciding how and where to spend the healthcare money the federal government already pumps into their state. (The Vermont Legislature has already approved, with the governor�s support, a move toward single-payer but can�t implement it until 2017, when it will need a federal waiver to do so.)

The congressman offered his hometown example, known as WWAMI�a five-state cooperative arrangement that includes Washington, Wyoming, Alaska, Montana and Idaho. The University of Washington has the only medical school in the Northwest border region, so the other states send their med students to Seattle and finance their education, in return for the students� commitment to come home to serve rural communities. This mutual support has functioned for forty years, despite red-blue differences. McDermott believes those five states could do a better job than distant DC of deploying and operating a first-class healthcare system.

To liberals who cry heresy, McDermott invokes Robert La Follette�s famous dictum that the states should be our �laboratory for democracy,� the best place to experiment and develop new solutions to public problems. Conservatives ought to like McDermott�s proposal because it disperses power closer to local decision-making. Liberals can embrace his approach as a practical way to break the stalemate on healthcare and open the way for basic solutions.

The congressman from Seattle thinks it may take a few more years of chaotic conflict before people understand the opportunity. But state governments�even in the neo-Confederate Republican Party�may start clamoring for this new approach once they begin to see the results.

�There are places where this could work,� McDermott said, �and once people see it work in Oregon or Washington, or maybe Kentucky, the people in Tennessee are going to say, �Why the hell don�t we have that? Are we not as good as the people in Oregon?� Then you�re going to get the governor of Tennessee to do an about-face.�

How to Revive the Fight for Single-Payer

Rep. Jim McDermott of Washington is optimistic that it will come�if we give states the tools to adopt it at their own pace.

When the media frenzy subsides and Republicans run out of scare stories, the country will be faced with the most important question about Obamacare: Can it deliver what it promised? Thanks to the Affordable Care Act, a new business model is rapidly emerging in the medical-industrial complex that, in theory, can dramatically reduce the inflated costs of healthcare while serving everyone�rich and poor, healthy and sick. But the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies. A lot of liberal Democrats, though they voted for Obama�s bill, remain skeptical.

�In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system,� said Washington Representative Jim McDermott. �We�re not making refrigerators. We�re dealing with human beings, who are way more complicated than refrigerators on an assembly line.� I turned to the Seattle congressman for a candid assessment because he�s the third-ranking Democrat on the House Ways and Means Committee and has been an advocate of single-payer healthcare for decades. Plus, he�s a doctor.

The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding �integrated delivery systems��nonprofit and profit-seeking�that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they�re hiring younger doctors as salaried employees. An American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.

�The medical-industrial complex is putting itself together so that the docs will be the least of our problem,� McDermott said. �They will simply be serfs working for the system.� The AMA�s market research reports that �hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.� Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.

�It�s possible hospital groups can reduce costs,� the congressman said, �but I look at the consolidations going on and ask myself, �Are we going to wind up with hospitals that are too big to fail? Are we going to have hospitals so powerful that we cannot not give them what they want?� It�s going to be the government against the medical-industrial complex, which is developing very rapidly. If the Little Sisters of Providence [his fanciful example] become a conglomerate and the government says you should close some of your hospitals, they will say, Who says?�

Despite these doubts�not to mention the Republican-promoted hysterical attacks on the ACA on other grounds�McDermott is actually optimistic. He expects stronger healthcare systems roughly resembling single-payer �to spring up like dandelions� around the country�led by progressive states that really want to make it work. �That�s probably going to happen in Vermont, Washington and Oregon,� he said. �California has tried twice to have a single-payer system and was defeated by the forces of money. Jerry Brown in California, maybe Cuomo in New York, maybe Kentucky. The governor in Oregon, John Kitzhaber, and our governor in Washington, Jay Inslee, all want it to happen.�

Having introduced a single-payer bill in Congress every year since 1993, McDermott is developing a different approach this time: a strategy designed to get around the hard-core resistance in so many states. �I now have a bill I�m going to drop in soon as a patch to the ACA,� he said. �What I�m trying to do is let the states that want it to go ahead, whether it�s Tennessee or Illinois. �Medicare for All� sounds wonderful, but the country is so diverse, you have to allow the delivery system to evolve where it can. You have to do it state by state.�

McDermott tried to sell this concept to the Obama administration and to Senator Max Baucus of Montana, chair of the Senate Finance Committee and one of the key Capitol Hill brokers in 2009�10 for what would become the ACA. No sale in either case. Instead, the president rejected the �public option� and made �bad deals� with hospitals, drug companies, the insurance industry and other players, McDermott said. Those interests agreed not to fight new rules on their behavior toward consumers, and in return Obama provided them with millions of new paying customers, subsidized by the government.

Under the ACA, hospital groups must sign a non-discrimination agreement, but as a practical matter they can still find ways to pick and choose which patients they will treat. The rules for Medicaid are set by each state, and enforcement varies widely among them. Typically, many private practices severely limit impoverished patients on Medicaid or refuse to serve any at all because that threatens their rate of return. Less obviously, some of the leading health conglomerates celebrated for their high quality and cost controls do the same. �When you dig down in all these great places like Mayo and the Cleveland Clinic, you see the same sort of thing,� McDermott said. �The Mayo doesn�t go out looking for Medicaid patients, and they don�t take just anyone who walks in the door.�

McDermott�s new legislation would break from the longstanding liberal assumption that the government must enact universal social programs that apply rules and benefits uniformly to all states at once. He figures that would allow the resistance to block single-payer for many years. So he wants to create a special deal for the limited number of states willing to uphold higher standards. State legislatures and governors can win approval to design and operate their own single-payer system, deciding how and where to spend the healthcare money the federal government already pumps into their state. (The Vermont Legislature has already approved, with the governor�s support, a move toward single-payer but can�t implement it until 2017, when it will need a federal waiver to do so.)

The congressman offered his hometown example, known as WWAMI�a five-state cooperative arrangement that includes Washington, Wyoming, Alaska, Montana and Idaho. The University of Washington has the only medical school in the Northwest border region, so the other states send their med students to Seattle and finance their education, in return for the students� commitment to come home to serve rural communities. This mutual support has functioned for forty years, despite red-blue differences. McDermott believes those five states could do a better job than distant DC of deploying and operating a first-class healthcare system.

To liberals who cry heresy, McDermott invokes Robert La Follette�s famous dictum that the states should be our �laboratory for democracy,� the best place to experiment and develop new solutions to public problems. Conservatives ought to like McDermott�s proposal because it disperses power closer to local decision-making. Liberals can embrace his approach as a practical way to break the stalemate on healthcare and open the way for basic solutions.

The congressman from Seattle thinks it may take a few more years of chaotic conflict before people understand the opportunity. But state governments�even in the neo-Confederate Republican Party�may start clamoring for this new approach once they begin to see the results.

�There are places where this could work,� McDermott said, �and once people see it work in Oregon or Washington, or maybe Kentucky, the people in Tennessee are going to say, �Why the hell don�t we have that? Are we not as good as the people in Oregon?� Then you�re going to get the governor of Tennessee to do an about-face.�

Wednesday, December 4, 2013

An Outsider on the Inside

Though battling terminal illness, Tim Carpenter is still busy moving Congress left.

Tim Carpenter is the national director of Progressive Democrats of America (PDA). Founded in 2004 in the aftermath of Rep. Dennis Kucinich�s (D-Ohio) presidential run, the group works what it calls an �inside-outside� strategy�aimed at translating the activism of outside social movements into progressive legislation in Congress. PDA works closely with progressive advocacy groups and about a dozen activist members of the Congressional Progressive Caucus, aiming to push the 72-member voting block to take more aggressive stances on issues as diverse as the welfare state, healthcare, trade and foreign policy. This year, PDA has lobbied Congress and helped organize rallies against reductions in Social Security and pushed for a so-called Robin Hood tax on financial transactions.

A native of Southern California, Carpenter is a longtime activist with history in the grassroots campaigns against anti-nuclear power, the Catholic Worker movement and Democratic Socialists of America. When he is not on the road organizing, he lives with his family in western Massachusetts.

Do progressives in Congress have anything to learn from the Tea Party?

Progressives can learn a lot from the Tea Party in regards to the inside-outside strategy of holding elected officials accountable. The Congressional Progressive Caucus took a number of missteps and miscues leading up to the Affordable Care Act. We should never have abandoned the fight on single payer. We should have never opted for a public option. We divided our forces much too early. What we can learn from the Tea Baggers is to hold elected officials accountable and not give up�certainly not before we�re deep into a fight.

You have been working with the Progressive Caucus since the founding of PDA in 2004. How effective is the caucus?

The Progressive Caucus has been a landing point for progressive activists who are working inside the Democratic Party. If you�re working an inside-outside strategy, you have to have a base to come home to, and the Progressive Caucus has offered us that. In reality, of those 72 members, only about 10 are what we would call leaders within the Progressive Caucus. Our work as Progressive Democrats of America is to strengthen those who are leading. To have a place where we as progressives can come together and work is important. Over the course of the last year or two under the leadership of Rep. Keith Ellison (D-Minn.) and Rau�l Grijalva (D-Ariz.), we�ve seen the more progressive wing of the caucus hold the line, particularly in regard to making sure that no missiles were tossed into Damascus.

Some critics of the Progressive Caucus suggest that it would be more effective to have a smaller, more aggressive caucus. What do you think?

I agree. I would rather be in a meeting with 10 people who want to make a difference, get out and lead than be in a room with 60 people who call themselves progressives. I would rather surround myself with those who are willing to roll up their sleeves and go out and risk defeat. An aggressive, focused, principled caucus that held the line on single payer would have served our movement much better through this fight over the Affordable Care Act.

Steve Cobble, a co-founder of PDA, makes this analogy of the horseshoe, saying there are issues in Congress where you can link the left of the Progressive Caucus with some Tea Party, libertarian-minded Republicans. Is that an effective strategy?

We have political opportunities in this Congress, whether it�s the horseshoe analogy or in bed with strange bedfellows�whatever you want to term it. There are libertarians and Tea Baggers out there who agree with us that it�s unconscionable to spend the resources we do on the military budget. And we find agreement on not going into Syria. So if you can find the votes and if you can put together a majority to prevent our president from taking us into an unnecessary, illegal war, you�re going to take those votes wherever you can get them.

What kind of small victories are achievable in this political landscape?

I�m a glass-half-full person, so it�s not that difficult for me to find those little victories, beginning with the food stamp program. We began that fight when the Democratic Party leadership was absolutely silent. We had a phone call with Rep. Jim McGovern (D-Mass.) when PDA activists were delivering letters every month to their members of Congress in defense of food stamps. McGovern told us the Democratic Party leadership was silent on this question and that it was important that we simply have a vote of conscience to save the food stamp program. By the time it went on to the floor, we thought we had 133 votes but ended up with 188 votes [out of a possible 218 needed to win]. That was a victory. A vote of conscience in which 188 folks stood up to save food stamps. At the same time as we were garnering those votes, we were doing street actions in front of the offices of the Democratic leadership, Chief Deputy Minority Whip Debbie Wasserman Schultz (Fla.), Minority Whip Rep. Ste- ny Hoyer (Md.) and Minority Leader Nancy Pelosi (Calif.). By the time the Farm Bill came back around again then for a vote, all of those members in the leadership were on the floor voting to kill that bill.

An example of a major victory would be Syria. Again, our Democratic leadership was silent. Our president was willing to risk another war. And again activists around the country, led by Rep. Barbara Lee (D-Calif.), pushed Congress not to use military force but to begin a course of diplomacy.

What do you say to the critics on the Left who would claim that the PDA mission is ultimately hopeless, that the Democratic Party is not going to be reformed, and that if you really want to build progressive political power, it necessarily has to take place outside of that framework?

We live in a two-party system. Until we change the political realities of our two-party system, whether it be until we can get real public financing or until we can get real proportional representation, the playing field will be skewed. Before we have a third party, we need a strong second party. We�re the insurgency inside the Democratic Party fighting to return it to its progressive roots. We are hopeful that, through the work we do, we can begin to engage on the inside with those who are now on the outside and encourage them to do what they can to level the playing field.

A lot of PDA folks were part of Dennis Kucinich�s 2004 campaign for president. How important do you think it is in 2016 to have a progressive presidential candidate?

That�s a big debate. We need to be realistic. We are not going to elect a progressive president in 2016, just as we weren�t going to elect a progressive president in 2004, though Kucinich certainly didn�t want to hear it at the time. But if we�re going to transform the Democratic Party it�s important that we put in place a vision of what the Democratic Party can look like under a progressive presidency. So for that reason alone we need to have a horse in the race in 2016 who will challenge Hillary Clinton, the presumptive nominee. We need to re- mind folks that Hillary was wrong on the war in Iraq and she was wrong on trade. There are a lot of issues that as progressive Democrats we would want to challenge her on.

The Democratic Party, at its roots, is a progressive party. So my hope is that we would have a candidate who will be the standard-bearer for the progressive Democrats. I see the tide turning. It�s imperative that the progressive movement run a strong, articulate progressive candidate and campaign in 2016.

Given that you are waging an uphill battle against cancer, have you been preparing for what�s going to happen with PDA?

You�re definitely putting the elephant in the room in talking about the fact that I�ve got a terminal illness. It�s a question we�re wrestling with. The short answer is we honestly don�t know. We�re not a card-carrying organization; we�re a community of people. We�re going to meet in February as a community and we�ll talk about it. The work�s going to continue and I hope to be as productive, or even more productive, as we move on to the 2014 election season.

Tuesday, December 3, 2013

Nonprofits Challenge Missouri Licensing Law For Insurance Guides

More From Shots - Health News HealthMammograms In 3-D May Be Better, But Hard Proof Is MissingHealthNonprofits Challenge Missouri Licensing Law For Insurance GuidesHealthOverweight And Healthy: A Combo That Looks Too Good To Be TrueHealthObama Launches HIV Cure Initiative, Ups Pledge For Global Health

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Monday, December 2, 2013

Obama Launches HIV Cure Initiative, Ups Pledge For Global Health

More From Shots - Health News HealthObama Launches HIV Cure Initiative, Ups Pledge For Global HealthHealthAlleged Perils Of Left-Handedness Don't Always Hold UpHealthAs Polio Spreads In Syria, Politics Thwarts Vaccination EffortsHealth CareACLU Sues, Claiming Catholic Hospitals Put Women At Risk

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Saturday, November 30, 2013

How Will We Know If HealthCare.gov Is Fixed?

Listen to the Story 3 min 24 sec Playlist Download Transcript   Enlarge image i

Health care specialist Stacy Chagolla helps William Bishop compare plans at an Affordable Care Act enrollment fair in Pasadena, Calif., this month.

David McNew/Getty Images

Health care specialist Stacy Chagolla helps William Bishop compare plans at an Affordable Care Act enrollment fair in Pasadena, Calif., this month.

David McNew/Getty Images

Saturday is the day the Obama administration set as its deadline for making HealthCare.gov a "smooth experience" for most users.

A tech-savvy team of engineers, database architects and contractors has been working through the holiday to ensure the White House makes good on that promise, but judging the success of their efforts may take some time.

How will we know whether the website is fixed? NPR's health policy correspondent Julie Rovner says that partly depends on how you define "fixed." She joins Weekend Edition Saturday host Scott Simon to explain what that means.

Interview Highlights

What "fixing" HealthCare.gov means

Remember the promise is to have it working for what they call the "vast majority of users," by which the administration means 80 percent of visitors to the site.

That means 1 of every 5 people will still need to use a call center, an in-person counselor, or a paper application due to a technical problem or because his or her individual situation is too complex to be handled online. So Amazon or Orbitz this is not.

But then again, this is not buying a TV or a plane ticket, either. Many people have pointed out that spending a couple of hours buying health insurance online is still a lot faster than the old way, when you might have had a 50-page paper application and a process that literally took weeks.

How the administration has been fixing the website

There was a little show and tell earlier this week, where the White House actually showed reporters some of the 300 or so people who have been working pretty much around the clock from various centers located in the Washington, D.C., suburbs.

They've got a separate hardware team doing upgrades to increase the website's capacity, for example � they're saying it should be able to handle 800,000 separate visits per day going forward.

Then another team is working on software. They're fixing bugs and trying to make the website more user-friendly for consumers.

Will anyone be able to tell if the site is really fixed?

That's the really frustrating part. I'm not sure we will, at least not at first. We do already know it's working better than it was in October � which, frankly, was a pretty low bar to get over. The administration has all kinds of fancy metrics to show how well the website is working, but we don't have our own independent access to them.

We do know a big test is likely to come on Monday, when people who have been talking to relatives over the long holiday weekend � or who wake up and suddenly realize it's December and they want coverage in January � all try to sign on at once.

More Stories About HealthCare.gov Shots - Health News Breaking Up With HealthCare.gov Is Hard To Do All Tech Considered HealthCare.gov Team Working Through Holiday To Meet Deadline Health Care A New Worry Looms Online For The Affordable Care Act NPR Double Take Double Take 'Toons: Healthcare Webslight?

Key parts of the site that must wait

Insurance companies are getting increasingly worried. It seems that while so much effort has been going into what they call the "front end" of the site � where consumers go to compare insurance plans and sign up for coverage � some parts of the "back end" of the site � where insurance companies actually get paid � haven't even been built yet.

The administration says it will get that done before money has to begin to change hands sometime in January, but given that nothing up until this point has happened on schedule, that doesn't make insurance companies feel a whole lot better about things.

One piece of the site that will wait an entire year

Small businesses were supposed to be able to sign up online to enroll their employees through the federal website starting this month. That was already delayed from Oct. 1. Now that won't happen online until next November.

They can still compare plans online, but they'll have to use paper applications and go through an insurance broker or agent or an insurance company directly, unless they're in one of a handful of states that's got its small-business exchange up and running.

The administration has been pretty candid about this � they've said their top priority is to make the website work for consumers first, and pretty much everything else is taking a back seat.

Share Facebook Twitter Google+ Email Comment More From Health Care Health CareWhite House Optimistic At Deadline To Fix ObamacareHealth Care3 Stories From HealthCare.gov UsersHealth CareHow Will We Know If HealthCare.gov Is Fixed?Health CareA New Worry Looms Online For The Affordable Care Act

More From Health Care

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, November 27, 2013

Small-Business Access To Online Health Exchanges Delayed Again

More From Shots - Health News HealthSmall-Business Access To Online Health Exchanges Delayed AgainHealthBooming Demand For Donated Breast Milk Raises Safety IssuesHealthIn Rural Iowa, Distance Makes Health Care Sign-Ups A ChallengeHealthEstrogen May Not Help Prevent Fuzzy Thinking After Menopause

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Monday, November 25, 2013

21 Ways the Canadian Health Care System is Better than Obamacare

Dear America:

Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.

In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!

Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.

Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.

Love, Canada

Number 21:
In Canada, everyone is covered automatically at birth � everybody in, nobody out.

In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.

Number 20:
In Canada, the health system is designed to put people, not profits, first.

In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.

Number 19:
In Canada, coverage is not tied to a job or dependent on your income � rich and poor are in the same system, the best guaranty of quality.

In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.

Number 18:
In Canada, health care coverage stays with you for your entire life.

In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.

Number 17:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of �in-network� vendors and no extra hidden charges for going �out of network.�

In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking � thus restricting freedom of choice � and if you want to go out of network, you pay for it.

Number 16:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.

In the United States, under Obamacare, for thousands of Americans, it�s pay or die � if you can�t pay, you die. That�s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.

Number 15:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don�t even see a bill.

In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.

Number 14:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn�t cover tens of millions of people.

Number 13:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.

Number 12:
In Canada, simplicity leads to major savings in administrative costs and overhead.

In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.

Number 11:
In Canada, when you go to a doctor or hospital the first thing they ask you is: �What�s wrong?�

In the United States, the first thing they ask you is: �What kind of insurance do you have?�

Number 10:
In Canada, the government negotiates drug prices so they are more affordable.

In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.

Number 9:
In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.

Number 8:
In Canada, there are no necessary co-pays or deductibles.

In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.

Number 7:
In Canada, the health care system contributes to social solidarity and national pride.

In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.

Number 6:
In Canada, delays in health care are not due to the cost of insurance.

In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.

Number 5:
In Canada, nobody dies due to lack of health insurance.

In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.

Number 4:
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, a majority � many for different reasons � oppose Obamacare.

Number 3:
In Canada, the tax payments to fund the health care system are progressive � the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.

In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.

Number 2:
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.

In the United States, Obamacare�s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage �we have to pass the bill so that you can find out what is in it.�

Number 1:
In Canada, the majority of citizens love their health care system.

In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system � single-payer, free choice of doctor and hospital , everybody in, nobody out.

Sunday, November 24, 2013

Colorado Ads Use Sex And Alcohol To Sell Health Insurance

More From Shots - Health News HealthColorado Ads Use Sex And Alcohol To Sell Health InsuranceHealthMore Children Are Being Medicated For ADHD Than BeforeHealthWhite House Pushes Next Year's Health Plan Sign-Ups LaterHealthEye Makeup Used To Protect Children Can Poison Them Instead

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Thursday, November 21, 2013

The U.S. Lags in Life Expectancy Gains

From Bloomberg Businessweek –

Life expectancy in the U.S. has been growing more slowly than in other developed countries and is now more than a year below the developed-country average, according to a new report (PDF) from the Organisation for Economic Co-operation and Development.

Even though Americans, on average, live to be almost 80, this is not good news. Life expectancy at birth is affected by trends in everything from infant mortality, accident rates, and violence to chronic diseases and care for the elderly, which makes it a highly sensitive indicator of a nation�s economic development.

U.S. life expectancy in 2011 was 78.7 years. That was an increase of a little less than eight years since 1970. Impressive, but not as big as the 10-year gain for the OECD as a whole. �Life expectancy [in the U.S.] is now more than a year below the OECD average of 80.1,� the OECD said in a press statement, �compared to one year above the average in 1970.�

Why has the U.S. fallen off pace? The OECD report sums up some American studies by the National Research Council and the Institute of Medicine that suggest some causes. None of the theories reflect well on the U.S.:

1. The highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care, and a large share of the population uninsured;

2. Health-related behaviors, including higher calorie consumption per capita and obesity rates, higher consumption of prescription and illegal drugs, higher deaths from road traffic accidents and higher homicide rates;

3. Adverse socioeconomic conditions affecting a large segment of the U.S. population, with higher rates of poverty and income inequality than in most other OECD countries.

Ouch.

Wednesday, November 13, 2013

More Than 106,000 Chose Health Plans Under Affordable Care Act

More From The Two-Way U.S.Air Force Officer Acquitted Of Groping Woman At BarU.S.Four Marines Killed In Camp Pendleton Training AccidentPolitics'Holy Cow' And 'Kangaroo Court': Panel Grills HealthCare.gov OfficialsU.S.Intelligence Officials Aim To Pre-Empt More Surveillance Leaks

More From The Two-Way

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

'Holy Cow' And 'Kangaroo Court': Panel Grills HealthCare.gov Officials

More From The Two-Way U.S.Air Force Officer Acquitted Of Groping Woman At BarU.S.Four Marines Killed In Camp Pendleton Training AccidentPolitics'Holy Cow' And 'Kangaroo Court': Panel Grills HealthCare.gov OfficialsU.S.Intelligence Officials Aim To Pre-Empt More Surveillance Leaks

More From The Two-Way

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Tuesday, November 12, 2013

Despite Health Law, Uninsured Rely On Prevention Care Patchwork

More From Shots - Health News HealthShift In Cholesterol Advice Could Double Statin Use HealthClinton To Obama: Honor Promise That People Can Keep CoverageHealthSo, You Have Gonorrhea. Who Tells Your Ex?HealthMedicaid Questions Slow Insurance Purchases On Colorado Exchange

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Self-Employed And With Lots Of Questions About Health Care

More From Shots - Health News HealthThe Case Against Brain Scans As Evidence In CourtHealthWHO Rates Typhoon's Medical Challenges "Monumental"Health CareThe First Estimate On Insurance Signups Is Pretty Darned SmallHealth$4.2 Billion Deal Highlights Drug Profits From Rare Diseases

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Saturday, November 9, 2013

When Caregivers Are Abusers: Calif. Complaints Go Unanswered

Listen to the Story 6 min 2 sec Playlist Download Transcript   Enlarge image i

Jim Fossum holds a photograph of his aunt, Elsie Fossum, who died from injuries her caregiver said were the result of a fall.

Mina Kim/KQED

Jim Fossum holds a photograph of his aunt, Elsie Fossum, who died from injuries her caregiver said were the result of a fall.

Mina Kim/KQED

Nurse assistants and home health aides provide intimate care, bathing, feeding and dressing the elderly, disabled or ill. So what happens when an abusive caregiver hurts a patient?

Public health regulators in California have been letting many complaints sit for years � even when they involve severe injuries or deaths.

'Beaten To A Pulp'

Elsie Fossum's nieces and nephews say she was the aunt you wanted to have.

"She gave us our first car," Janet Flynn remembers. Her brother, Jim Fossum, chimes in: "A '59 Ford Galaxie 500, with massive fins on it."

Flynn says their aunt, a librarian and teacher who never married or had kids, always looked chic.

Enlarge image i

Elsie Fossum's niece, Janet Flynn, and nephews Jim Fossum, left, and John Fossum, say they never heard from California's Department of Public Health following their aunt's death.

Mina Kim/KQED

Elsie Fossum's niece, Janet Flynn, and nephews Jim Fossum, left, and John Fossum, say they never heard from California's Department of Public Health following their aunt's death.

Mina Kim/KQED

"She would come for the summer with this tiny Samsonite suitcase," Flynn says. "And she would be impeccably dressed, mixing and matching, and her hair was always done. Always looked wonderful."

But on the morning of July 3, 2006, Elsie Fossum lay in a pool of blood on the floor of her bedroom at Claremont Place, a Los Angeles-area assisted living facility. The 95-year-old Fossum had lived there for two years.

Her eyes were bruising black, her lip was badly cut, and her right arm was broken. But she was alive.

The lone caregiver on Fossum's floor that night said Fossum fell, but Beverlee McPherson, a registered nurse who supervised nurse assistants at Claremont Place, suspected abuse.

"She looked like she went four or five rounds with Muhammad Ali," McPherson says.

Unable to take much food or water through her swollen mouth, Fossum died of dehydration less than three weeks later. A Los Angeles County coroner could not rule out assault and called the manner of death undetermined.

McPherson is resolute.

"Oh, I'm 100-percent convinced she didn't fall out of bed, 100 percent," she says. "If you saw this woman's face, I mean, her entire face was beaten to a pulp."

'Staying On Top Of Complaints'

Emergency room nurses who treated Fossum at a nearby hospital also suspected abuse. The hospital quickly notified the California Department of Public Health, the agency responsible for decertifying nurse assistants who violate standards of care.

Cases Closed With No Action Taken

The number and rate of license revocations against nursing assistants and in-home health aides suspected of abuse have plunged, while cases closed without action have increased.

Enlarge image i Center For Investigative Reporting/KQED Center For Investigative Reporting/KQED

But internal documents obtained by the Center for Investigative Reporting show department investigators shelved Fossum's case for six and a half years.

CDPH Director Ron Chapman blames the delays in handling complaints on a backlog of more than 900 cases that piled up between 2004 and 2008.

"There were a number of reasons for that backlog, including poor management decisions during that time," Chapman says.

The department implemented a plan in 2009 to address the backlog, says Chapman, who was sworn in to his position in 2011.

"In the two years that I've been in the job, there's now new management from top to bottom, and we're staying on top of all the complaints as they come in," he says.

Yet the number of nurse assistants facing disciplinary action following complaints has dropped, from 27 percent a few years ago to 9 percent last year.

Chapman says he sees no evidence that addressing the backlog has undermined the quality of the department's current work, but Marc Parker, who headed the investigations section for nine years, says he was forced to cut corners.

"Hundreds of cases were closed, hundreds, with nothing but a phone call," he says.

'A Failure To Protect'

Parker says without visits to facilities, investigators are unable to see the layout of a room, conduct impromptu interviews, or assess a person's body language. Parker retired in December of 2011, earlier than planned.

"I could not protect the public any longer," he says. "There was just a failure to protect the most vulnerable people in our state from abuse and neglect."

A Sudden Drop



The California Department of Public Health is required to notify the attorney general's office when its investigators find evidence of crimes, especially violent acts, at health care facilities. After 2009, the department all but stopped sending patient abuse deaths to state prosecutors.

Enlarge image i Center For Investigative Reporting/KQED Center For Investigative Reporting/KQED

Public health regulators are required to report all suspected crimes to the state attorney general. In the seven years before addressing the backlog, the department referred an average of 37 deaths a year. Last year, they referred three. The year before that, two.

"We don't understand that decline in numbers," Chapman says. "It's very concerning to me and we are looking into it." He says his staff is drafting agreements with the attorney general's office to improve communication.

As for Elsie Fossum's suspicious death, department investigators closed her case this year, and decided no action was warranted against her caregiver.

Also this year, however, the Los Angeles County Sheriff's Department opened a homicide investigation into Elsie Fossum's death. Her caregiver is the sole person of interest. Chapman now says he's willing to review the case.

Elsie Fossum's nephews and niece say they never heard from the Department of Public Health. Flynn says their calls and emails to state agencies and local police have turned up little information.

"I would think that this would be very chilling to anyone who has loved ones in a facility, especially if you think safeguards are in place and you think that staff are qualified and that this is being regulated, and this I find chilling," Flynn says.

This story was co-reported by Ryan Gabrielson at the Center for Investigative Reporting.

Share Facebook Twitter Google+ Email Comment More From Health Care Health CareDemocrats Try To Tweak Health Care LawHealth CareWhen Caregivers Are Abusers: Calif. Complaints Go UnansweredHealth CareWhite House Releases Long-Awaited Rules On Mental HealthHealthIn Massachusetts, Health Care Prices Remain Hard To Get

More From Health Care

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, November 8, 2013

White House Releases Long-Awaited Rules On Mental Health

More From Shots - Health News Health CareWhite House Releases Long-Awaited Rules On Mental HealthHealthIn Massachusetts, Health Care Prices Remain Hard To GetHealthPolio In The Middle East And Africa Could Threaten EuropeHealthPersistence Pays Off For Uninsured Alaskan

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

White House Releases Long-Awaited Rules On Mental Health

More From Shots - Health News Health CareWhite House Releases Long-Awaited Rules On Mental HealthHealthIn Massachusetts, Health Care Prices Remain Hard To GetHealthPolio In The Middle East And Africa Could Threaten EuropeHealthPersistence Pays Off For Uninsured Alaskan

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Thursday, November 7, 2013

How The Affordable Care Act Pays For Insurance Subsidies

More From Shots - Health News HealthDoctors Slow To Embrace Recommended HPV TestingHealthSurgeons Discover Quirky Knee Ligament All Over AgainHealthWhy Doctors Are Testing An Epilepsy Drug For AlcoholismHealth CareHow The Affordable Care Act Pays For Insurance Subsidies

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, November 6, 2013

The President Wants You to Get Rich on Obamacare

From the New York Times –

Tom Scully bolted through the doors and up the stairs to a private dining room on the third floor of the �21� Club. Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. He typically projects a combination of confidence and bemusement, but on this rainy September afternoon, he was frenzied. Scully was scheduled to deliver the keynote address at an event hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy (tag line: �Washington to Wall Street�). Today�s discussion centered on the most significant change in decades to the nation�s health care policy, the Patient Protection and Affordable Care Act, a.k.a. Obamacare. As Scully walked to the front of the room, some 50 managers from hedge funds, mutual funds and private equity firms tucked into the round tables. Others gathered in the hallway. A hush of anticipation hung in the air.

During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy. While large health care businesses � insurance companies, for instance, and hospital chains � have poured significant resources into preparing for millions of new customers, countless investors have appeared spooked by the perpetual threats to repeal, or at least revise, the law. According to Thomson Reuters, private equity investment, usually the lifeblood for entrepreneurialism, has dropped by an astonishing 65 percent in the health care sector this year.

Scully has been trying to assuage these worries, but the nervous questions keep coming at him. Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. �No way,� Scully said. �Way more � way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work.� Another asked if Scully was worried about Congressional repeal. �It�s just not going to happen,� he said. �Don�t pay attention to Rush Limbaugh.� When Scully finally began his speech, he noted that the prevailing narrative among Republicans � assuming that many in the room were, like him, Republican � was incorrect. �It�s not a government takeover of medicine,� he told the crowd. �It�s the privatization of health care.� In fact, Obamacare, he said, was largely based on past Republican initiatives. �If you took George H. W. Bush�s health plan and removed the label, you�d think it was Obamacare.�

Scully then segued to his main point, one he has been making in similarly handsome dining rooms across the country: No matter what investors thought about Obamacare politically � and surely many there did not think much of it � the law was going to make some people very rich. The Affordable Care Act, he said, wasn�t simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed.

Scully, who has spent the last 30-some years oscillating between government and the private sector, is hoping to be his own best proof of the Obamacare gold mine. As a principal health policy adviser under President George H. W. Bush, he helped formulate many of those past Republican initiatives � like the shift to private-insurance programs � that Obamacare has put into law. Under George W. Bush, he ran the Centers for Medicare and Medicaid Services and oversaw a host of proto-Obamacare reforms, like Medicare Part D, which introduced competition into the government-supported health care market. After leaving C.M.S. in 2004, Scully began working simultaneously at Welsh, Carson, Anderson & Stowe, a leading health care private equity firm, and Alston & Bird, a law firm and health care lobbying organization. When the Affordable Care Act became law in 2010, he found himself in the rare position of being a lobbyist, private equity executive and former government health care official with access to a serious amount of capital. During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it.

Continue reading…

The President Wants You to Get Rich on Obamacare

From the New York Times –

Tom Scully bolted through the doors and up the stairs to a private dining room on the third floor of the �21� Club. Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. He typically projects a combination of confidence and bemusement, but on this rainy September afternoon, he was frenzied. Scully was scheduled to deliver the keynote address at an event hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy (tag line: �Washington to Wall Street�). Today�s discussion centered on the most significant change in decades to the nation�s health care policy, the Patient Protection and Affordable Care Act, a.k.a. Obamacare. As Scully walked to the front of the room, some 50 managers from hedge funds, mutual funds and private equity firms tucked into the round tables. Others gathered in the hallway. A hush of anticipation hung in the air.

During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy. While large health care businesses � insurance companies, for instance, and hospital chains � have poured significant resources into preparing for millions of new customers, countless investors have appeared spooked by the perpetual threats to repeal, or at least revise, the law. According to Thomson Reuters, private equity investment, usually the lifeblood for entrepreneurialism, has dropped by an astonishing 65 percent in the health care sector this year.

Scully has been trying to assuage these worries, but the nervous questions keep coming at him. Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. �No way,� Scully said. �Way more � way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work.� Another asked if Scully was worried about Congressional repeal. �It�s just not going to happen,� he said. �Don�t pay attention to Rush Limbaugh.� When Scully finally began his speech, he noted that the prevailing narrative among Republicans � assuming that many in the room were, like him, Republican � was incorrect. �It�s not a government takeover of medicine,� he told the crowd. �It�s the privatization of health care.� In fact, Obamacare, he said, was largely based on past Republican initiatives. �If you took George H. W. Bush�s health plan and removed the label, you�d think it was Obamacare.�

Scully then segued to his main point, one he has been making in similarly handsome dining rooms across the country: No matter what investors thought about Obamacare politically � and surely many there did not think much of it � the law was going to make some people very rich. The Affordable Care Act, he said, wasn�t simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed.

Scully, who has spent the last 30-some years oscillating between government and the private sector, is hoping to be his own best proof of the Obamacare gold mine. As a principal health policy adviser under President George H. W. Bush, he helped formulate many of those past Republican initiatives � like the shift to private-insurance programs � that Obamacare has put into law. Under George W. Bush, he ran the Centers for Medicare and Medicaid Services and oversaw a host of proto-Obamacare reforms, like Medicare Part D, which introduced competition into the government-supported health care market. After leaving C.M.S. in 2004, Scully began working simultaneously at Welsh, Carson, Anderson & Stowe, a leading health care private equity firm, and Alston & Bird, a law firm and health care lobbying organization. When the Affordable Care Act became law in 2010, he found himself in the rare position of being a lobbyist, private equity executive and former government health care official with access to a serious amount of capital. During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it.

Continue reading…

Monday, November 4, 2013

Bariatric Surgery Can Keep Pounds Off For Years

More From Shots - Health News HealthBariatric Surgery Can Keep Pounds Off For YearsHealthChildhood Maltreatment Can Leave Scars In The BrainHealth CareOregon's State Exchange May Be Worse Than HealthCare.govHealthJohnson & Johnson To Pay $2.2 Billion In Marketing Settlement

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, November 1, 2013

Which Plans Cover Abortion? No Answers On HealthCare.gov

More From Shots - Health News HealthFeds To Ease Restrictions On Flexible Spending AccountsHealthSorry, Red Sox, Heavy Stubble Beats Beards For AttractivenessHealthSeeing In The Pitch-Dark Is All In Your HeadHealth CareWhich Plans Cover Abortion? No Answers On HealthCare.gov

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, October 30, 2013

Victims Of Tainted Steroid Injections Still Struggling

More From Shots - Health News HealthOnline Advice Can Hurt Teens At Risk For Suicide, Self-HarmHealthNotices Canceling Health Insurance Leave Many On EdgeHealthThe Long List Of Health Apps Features Few Clear WinnersHealthWhy Insurers Cancel Policies, And What You Can Do About It

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Saturday, October 26, 2013

'Loyal Soldier' Sebelius Vows To Stay Put, Fix HealthCare.gov

Listen to the Story 3 min 57 sec Playlist Download Transcript   Enlarge image i

Health and Human Services Secretary Kathleen Sebelius speaks Thursday in Phoenix.

Laura Segall/Getty Images

Health and Human Services Secretary Kathleen Sebelius speaks Thursday in Phoenix.

Laura Segall/Getty Images

This has not been an easy month for Health and Human Services Secretary Kathleen Sebelius.

Republican Sen. Pat Roberts of Kansas � who learned the political ropes working for Sebelius' father-in-law, then a Kansas congressman � called for her to step down over the debut of HealthCare.gov, the problem-plagued website where people are supposed to apply for coverage under the Affordable Care Act.

Invited on the usually friendly-to-Democrats The Daily Show, Sebelius was lampooned by host Jon Stewart, who challenged her to a race of sorts: "I'm going to try and download every movie ever made, and you're going to try to sign up for Obamacare, and we'll see which happens first."

And while she was able to laugh off Stewart's opening gag, Sebelius had trouble clearly explaining why, if businesses have been given an extra year to implement Obamacare, individuals shouldn't have the same delay.

Sebelius served six years as the Democratic governor of largely Republican Kansas. She is the daughter of the late Ohio Gov. John Gilligan. University of Kansas political science professor Burdett Loomis says she remains popular at home, despite the hits she's been taking in Washington:

"This hasn't been an easy time for her. The Obamacare rollout has clearly been problematic; she pretty much got roasted on Jon Stewart; but she's been a loyal soldier to Barack Obama and I think she truly believes that Obamacare is in the best interest of the country."

Seven years ago the Bush administration unveiled Medicare Part D, which provides seniors with prescription drug benefits. The website for that program had a similarly rocky debut. The HHS secretary then was former Utah Gov. Mike Leavitt, who notes Sebelius did not make many of the key decisions regarding the rollout of Obamacare. Leavitt says he empathizes with Sebelius:

"It's much like being the pilot of an airplane full of passengers sitting on the tarmac with a series of complications you don't entirely control. It's better to say to the passengers, 'This is where we are. This is how much time we expect it'll take. ... Here's what we're doing to remedy it and here's how it's going to affect you. We're doing our best.' "

Before being elected governor, Sebelius was Kansas insurance commissioner. The Republican occupant of the job now, Sandy Praeger, says the glitches in the rollout of Obamacare are not Sebelius' fault.

"The complexity of what she's having to deal with is massive and in an environment that's been pretty politically charged, to say the least. So I have a great deal of sympathy for what she's having to work through," says Praeger. "I know she's probably very frustrated."

Praeger says calls for Sebelius to resign are totally inappropriate. And in an appearance in Phoenix, Sebelius rejected Republican demands she step down.

'The majority of people calling for me to resign I would say are people who I don't work for and who do not want this program to work in the first place," Sebelius said Thursday. "I have had frequent conversations with the president and I have committed to him that my role is to get the program up and running, and we will do just that."

Sebelius is expected to testify before a House committee investigating the Affordable Care Act's implementation as soon as Wednesday.

Share Facebook Twitter Google+ Email Comment More From Health Care Health CarePR Experts: Obamacare Message (Not Just The Site) Needs FixPoliticsBipartisan Anger, Competing Interests Over HealthCare.govHealth Care'Loyal Soldier' Sebelius Vows To Stay Put, Fix HealthCare.govBusinessFor Obamacare To Work, It's Not Just About The Numbers

More From Health Care

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, October 25, 2013

Administration: A Month Needed To Fix Obamacare Enrollment Site

More From The Two-Way NewsIn Calif., Hundreds March To Protest Fatal Police Shooting Of BoyNewsJPMorgan Chase Settles With Housing Regulator For $5.1 BillionNewsUnited Slapped With $1.1 Million Fine Over Tarmac Delays NewsCase Of 'Little Maria' Is Solved, Bulgarian Romas Are Her Parents

More From The Two-Way

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Monday, October 21, 2013

If A Tech Company Had Built The Federal Health Care Website

More From All Tech Considered Digital LifeOnline Dating Is On The Rise (But There Are Still Haters)TechnologyThe HealthCare.gov 'Tech Surge' Is Racing Against The ClockScienceWhat's Creepy, Crawly And A Champion Of Neuroscience?BusinessCredit Cards Under Pressure To Police Online Expression

More From All Tech Considered

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Enrollments For Health Care Exchanges Trickle In, Slowly

More From Shots - Health News Health CareHow Long Do They Really Have To Fix That Obamacare Website?HealthScientists Grow New Hair In A Lab, But Don't Rush To Buy A CombHealthFirst Polio Cases Since 1999 Suspected In SyriaHealthBreast Milk Bought Online Has High Levels Of Bacteria

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

5 Questions Kathleen Sebelius Must Answer

More From It's All Politics PoliticsChristie's Gay Marriage Decision Has Primary Consequences Politics5 Questions Kathleen Sebelius Must AnswerPoliticsMonday Morning Political MixRemembrancesTom Foley, A House Speaker Who Embraced Compromise And Comity

More From It's All Politics

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

The HealthCare.gov 'Tech Surge' Is Racing Against The Clock

More From All Tech Considered Digital LifeOnline Dating Is On The Rise (But There Are Still Haters)TechnologyThe HealthCare.gov 'Tech Surge' Is Racing Against The ClockScienceWhat's Creepy, Crawly And A Champion Of Neuroscience?BusinessCredit Cards Under Pressure To Police Online Expression

More From All Tech Considered

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Obama: Health Care Site Is Troubled; Affordable Care Act Is Not

More From The Two-Way BusinessIt's Back To The Future For E-Cigarette Ads, At Least For NowThe Two-WayCold Crime: Jell-O Stolen From Work Fridge Sparks Police CallNewsBoy Scouts Eject Leaders Who Toppled Ancient RockSpaceGovernment Shutdown Delays Rocket Launch

More From The Two-Way

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, October 18, 2013

Obamacare Fight Leads Sen. Roberts To Turn Against Old Friend Sebelius

More From It's All Politics RemembrancesTom Foley, A House Speaker Who Embraced Compromise And ComityPoliticsConservative Group Backs Challenge To 'Liberal' McConnellPoliticsAfter Budget Fight, No Sign Of Cease-FirePoliticsObama's Immigration Pivot Hits A Bruised GOP's Weak Spot

More From It's All Politics

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Obamacare Fight Leads Sen. Roberts To Turn Against Old Friend Sebelius

More From It's All Politics RemembrancesTom Foley, A House Speaker Who Embraced Compromise And ComityPoliticsConservative Group Backs Challenge To 'Liberal' McConnellPoliticsAfter Budget Fight, No Sign Of Cease-FirePoliticsObama's Immigration Pivot Hits A Bruised GOP's Weak Spot

More From It's All Politics

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, October 16, 2013

Hitches On Health Exchanges Hinder Launch Of Insurance Co-op

More From Shots - Health News HealthFamily Caregiving Can Be Stressful, Rewarding And Life-AffirmingHealth CareTo Reduce Patient Falls, Hospitals Try Alarms, More NursesHealthHitches On Health Exchanges Hinder Launch Of Insurance Co-opHealthBioethicists Give Hollywood's Films A Reality Check

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Tuesday, October 15, 2013

Medicare Begins Open Enrollment, With An Online Caveat

More From The Two-Way SportsFeel Old Yet? Roddick And Blake Will Play On Senior CircuitNewsFitch Places U.S. Under Review For A Credit DowngradeThe Two-WaySupreme Court To Weigh EPA Permits For Power Plant EmissionsNewsFISA Court: We Approve 99 Percent Of Wiretap Applications

More From The Two-Way

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, October 11, 2013

FAQ: Understanding The Health Insurance Mandate And Penalties For Going Uninsured

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

So I have to carry health insurance?

Yes, just about everyone is required to have insurance as of Jan. 1, 2014, or else they'll be liable for a tax penalty. That coverage can be supplied through your job (including COBRA or a retirement plan), public programs such as Medicare, Medicaid or the VA, or an individual policy that you purchase.

What is the penalty for not having health insurance?

The penalty for not having health insurance, at least for 2014, is up to $95 per adult and $47.50 per child or 1 percent of your taxable income � whichever is greater. It does go up substantially in a couple of years, eventually to a maximum of 2.5 percent of taxable income. The amount you owe will be pro-rated to reflect the number of months you were without coverage.

If you owe the penalty, it is assessed on your 2014 income tax form that's due April 15, 2015. And that's how the government finds you � it asks on your income tax form if you had health insurance. People who have it will get some sort of certificate of coverage from their health insurers. If your income is so low that you do not file a tax return, you are exempt from paying the penalty.

Can I go to jail if I don't have health insurance?

No, you can't go to jail for not paying the penalty; the government can't even garnish your wages. The most the IRS can do is withhold your tax refund.

What if I don't have health insurance and I get sick or have to go to the emergency room?

If you don't have insurance, you'll get a bill, just as it's always been. If you can't pay, the hospital or other health care provider will still try to collect from you, although there are some provisions of the law aimed at discouraging some of the most aggressive collection tactics that have been used in the past. If they don't collect, the health care provider would have to eat the cost. That's why hospitals were so anxious to have most people covered by insurance, so they could stop having to provide so much free care to people who couldn't pay.

Can I wait until I get sick to sign up for insurance?

No. You can't just sign up when you're sick and facing big medical bills. Otherwise that's what everyone would do. The exchanges under the Affordable Care Act have been designed pretty much the same way most employer insurance plans are: There's an open season every year when you can buy or change plans, and that's generally the only time you can buy or change plans. This year's open season is a lengthy one � it runs from Oct. 1 to March 31, 2014. In future years it will begin in October and end in December of each year.

Is there anybody who doesn't have to have insurance?

Yes, the government has identified exemptions. Individuals who cannot afford coverage because the cost of premiums exceed 8 percent of their household income or those whose household incomes are below the minimum threshold for filing a tax return are exempt. People experiencing certain hardships, including those who would have been eligible for Medicaid under the health law's new rules but whose states chose not to expand their programs, also are exempt.

Other exempt groups include prisoners, Native Americans eligible for care through the Indian Health Service, immigrants who are in the country illegally, people whose religion objects to having insurance coverage, members of a health care sharing ministry and individuals who experience a short coverage gap of less than three consecutive months.

If you are seeking an exemption for incarceration, membership in an Indian tribe or health care sharing ministry, you can apply through the health insurance exchanges or make a claim when you file taxes. If you are claiming economic hardship or a religious exemption, you must get an exemption certificate from the online insurance exchange. If you are claiming that coverage is unaffordable, that you are in the United States without proper documentation or that you have a coverage gap of less than three months, you can make the claim when you file your 2014 taxes in 2015.

See other Frequently Asked Questions on the Affordable Care Act:

All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act How Obamacare Affects Employers And How They're Responding Where Medicaid's Reach Has Expanded � And Where It Hasn't

Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Share Facebook Twitter Google+ Email Comment More From The Affordable Care Act, Explained HealthFAQ: Where Medicaid's Reach Has Expanded � And Where It Hasn'tHealthFAQ: How Obamacare Affects Employers And How They're RespondingHealthFAQ: What Retirees And Seniors Need To Know About The Affordable Care ActHealthFAQ: A Young Adult's Guide To New Health Insurance Choices

More From The Affordable Care Act, Explained

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Tuesday, October 8, 2013

Would A Federal Shutdown Delay Health Care Exchanges?

More From Shots - Health News HealthMany Teens Admit To Coercing Others Into SexHealthVeterinarians Say Health Law's Device Tax Is Unfair To PetsResearch NewsFirst Malaria Vaccine Moves A Step Closer To Approval HealthDelaying Aging May Have A Bigger Payoff Than Fighting Disease

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.