Good news on health care

 It’s not obvious from the title, but the recently passed Inflation Reduction Act (IRA) is the biggest federal health care legislation in a dozen years, one that will directly benefit over one in four West Virginians.

For starters, the law permanently extends the Black Lung Excise Tax, which provides benefits for over 4,400 West Virginia families impacted by that terrible disease caused by breathing coal dust. Nationwide nearly 26,000 families will benefit, including over 18,000 primary beneficiaries and around 7,000 dependents. According to the Brookings Institution, Black Lung is most prevalent in central Appalachia, with 20.6 percent of miners affected. 

In the late 1960s, a historic grassroots movement spearheaded by West Virginia coal miners and supporters brought the issue to national attention and won federal legislation to establish the benefit, although its funding was in jeopardy in recent years until the bill was passed.

The IRA also extends Affordable Care Act (ACA) marketplace subsidies for three years for people who purchase insurance plans on the exchange, which will help around 23,000 West Virginians and over 14 million people nationwide.  

People who buy care through the ACA marketplace have traditionally been the hardest group to find health care since they aren’t covered by employer-based insurance and don’t qualify for public programs such as Medicare, Medicaid, Tri-Care, or VA benefits. Thanks largely to ACA subsidies and Medicaid expansion, the number of uninsured Americans reached an all time low of eight percent this summer: still too high but a big improvement.

The biggest impact of the bill will be on people receiving Medicare, which covers over 440,000 West Virginians and around 64 million Americans, although these changes will be rolled out over time. 

According to the Kaiser Family Foundation, in 2023 insulin will be capped at $35 a month on the Medicare Part D prescription drug program; drug companies have to offer rebates if prices increase above inflation; and cost sharing for adult vaccines under Part D and Medicaid will be eliminated.

The Medicare diabetes cap is a big deal, although a ruling by the senate parliamentarian blocked its application to private insurance. According to the American Academy of Family Physicians, which supported several IRA medical provisions, “More than 37 million Americans have diabetes, and an estimated one-quarter of people with diabetes in the United States ration their insulin due to costs. In 2021, U.S. diabetes deaths exceeded 100,000 for the second consecutive year.” The WV Department of Health and Human Resources estimates that 240,626 West Virginians have that disease with undiagnosed cases 65,210.

In 2024, the IRA caps Medicare premium increases to six percent a year through 2030; eliminates a part D co-pay for catastrophic coverage; and expands eligibility for the low-income Part D subsidy to 150 percent of the federal poverty level. In 2025, it caps drug costs for Medicare beneficiaries at $2,000 per year. And between 2026 and 2029, it will negotiate costs for an increasing number of expensive medicines each year.

While health care is only part of the IRA, which also addresses climate change and tax fairness, those are significant steps in the right direction and Senator Manchin was instrumental in sealing the deal. Of course, no legislation is perfect. Lots of West Virginians, myself included, worked hard on what would become the IRA for the last year or so. We didn’t get all we wanted and got some of what we didn’t, but there are still things to celebrate.

(This ran as an op-ed in the Charleston Gazette Mail last week.)

It's working, continued

Between road trips, I've been blogging a good bit lately about the Affordable Care Act and how it is impacting West Virginia. Here's the latest, via my friends at West Virginians for Affordable Health Care:

*Enrollment in the expanded Medicaid program is now at 137,448. This is higher than I ever thought it would go. Even after a stellar job of signing people up, I expected new enrollments to level off and decline. Instead, it seems to be continuing at a rate close to 1,000 people per week. 

As Joe Biden might say, "Golly, that is a rather significant deal." (On second thought, he probably wouldn't use those exact words.)

*State Medicare recipients are reaping huge savings as ACA provisions that close the  prescription drug "doughnut hole" kick in. Specifically, 15,575 state residents saved over $12 million or $779 per person. Nationally, savings to beneficiaries were $1.3 billion this year and $11.5 billion since 2010.

It really is working.

CONNED

Caption: Seamus McGoogle does not like to be conned.

El Cabrero is winding up New Year's week by highlighting some important books about current events published last year. Today's pick is The Big Con: The True Story of How Washington Got Hoodwinked and Hijacked by Crackpot Economics. The title is kind of self-explanatory. The author is Jonathan Chait, one of El Cabrero's favorite writers at The New Republic.

The book is one of several with the how-did-we-get-in-this-mess theme. Here are the first two paragraphs by way of a teaser:

I have this problem. Whenever I try to explain what's happening in American politics--I mean what's really happening--I wind up sounding a bit like an unhinged conspiracy theorist. But honestly, I'm not. My politics are actually quite moderate. (Most real lefties, inf fact, think I'm a Washington establishment sellout.) So please give me a chance to explain myself when I tell you the following: American politics has been hijacked by a tiny coterie of right-wing economic extremists, some of them ideological zealots, others merely greedy, a few of them possible insane. (Stay with me.)

The scope of their triumph is breathtaking. Over the course of the last three decades, they have moved from the right-wing fringe to the commanding heights of the national agenda. Notions that would have been laughed at a generation ago--that cutting taxes for the very rich is the best response to any and every economic circumstance, or that it is perfectly appropriate to turn the most rapacious and self-interested elements of the business lobby into essentially an arm of the federal government--are no so pervasive they barely attract any notice.

Chait does a good job of tracing the rise of supply side economics from the fringes to center stage and suggests that the main thing that has changed about US politics over the last few years is that the right wing has moved from a moderately conservative position (think Eisenhower) to an extreme position. That's the key to our current so-called polarization. He does a good job of lambasting the media for not noticing this and attempting to portray moderates as people who split the difference between yesterday's consensus and the far right.

It's worth a look. Here's a link to the NY Times review.

SPEAKING OF THE WHOLE BUSINESS LOBBY THING, the lobbyist-written Medicare Part D prescription drug plan is about to stick it to seniors this this year.

MORE ON MINE SAFETY is here.

THE HEALTH GAP. According to new research,

the relative advantage in child mortality rates and health associated with social and economic advantage was about the same at the end of the 20th century as it was at the beginning of the 20th century. People with more money, more education and higher status jobs experience consistently better health and lower child mortality rates.

GOAT ROPE ADVISORY LEVEL: ELEVATED

THE FLEXIBILITY OF MEMORY

Caption: This guy can't remember where he was going but won't admit it.

In addition to comments and links about current events, this week's Goat Rope provides a daily dose of Nietzschean nuggets for your dining and dancing pleasure from his odd little book Beyond Good and Evil.

Even though Nietzsche had a mental breakdown in his later years and was arguably unsteady all along, he had some occasional great psychological insights which have been appreciated by Freud, Jung and many others.

Today's selection highlights the pliability of our memory. It's long been known that autobiographies are anything but objective accounts of past events and that two or more people who experienced the same events will have widely differing memories of them.

How does that happen?

'I have done that,' says my memory. 'I cannot have done that'--says my pride, and remains adamant. At last--memory yields.

CALLING CONGRESS. If you haven't already, please consider calling your representatives today using AFSC’s toll free number: 1-800-965-4701 and urge them to override President Bush's CHIP veto. All WV's delegation is on board but congresspeople from other states need a push.

THE NOBEL PRIZE FOR ECONOMICS went to members of the reality-based community this year. Winners included Eric Maskin, Leonid Hurwicz, and Roger Myerson who studied the limits of the market for delivering public goods (like education and health care). Here's an excerpt from Reuters:

Societies should not rely on market forces to protect the environment or provide quality health care for all citizens, a winner of the 2007 Nobel Prize for economics said on Monday.

Professor Eric Maskin, one of three American economists to receive the award, said that he "to some extent" takes issue with free-market orthodoxy championed by U.S President George W. Bush and some other western leaders.

"The market doesn't work very well when it comes to public goods," said Maskin, a slight, soft-spoken 57-year-old who lives in a house once occupied by Albert Einstein.

Adam Smith said pretty much the same thing in his 1776 Wealth of Nations, but this empirical work is welcome and needed these days.

WOMEN STILL LAG behind men in earnings despite gains in educational attainment. One equalizer seems to be a union card.

CORPORATE WELFARE DEPARTMENT. According to the AP,

Seniors and other taxpayers could have saved nearly $15 billion this year if the government slashed administrative costs in the Medicare drug program and negotiated the same kind of discounts it does for poor people under Medicaid...

BONUS VAMPIRE FEATURE. If you're wired for sound, here's an amusing NPR story on the many faces of Dracula.

DINOSAUR UPDATE. We interrupt previously scheduled programming to report on the discovery of a new dinosaur that

was as tall as a four-story building. From nose to tail it was longer than a pair of tractor trailer trucks laid end-to-end -- or, if you're a dinosaur junkie, half again the length of a small brontosaurus.

The beast was unearthed in Patagonia and is believed to have lived around 80 million years ago.

UNEMPLOYMENT AT RECORD LOW IN WV. WV's Chicken Littles keep trying to create a climate of panic in the hope that this will give them the opening to unleash their version of economic shock and awe. Alas for them, the news isn't all bad all the time.

SINCE YOU GUYS HAVE BEEN PRETTY GOOD TODAY, here's a special treat via YouTube: Jesse Jackson reading from Green Eggs and Ham.

YOU TELL ME where else you can find a blog with Nietzsche, dinosaurs, Dracula, and Dr. Seuss all in the same post...

GOAT ROPE ADVISORY LEVEL: MUY ALTO

VANITY OF VANITIES, THE MOTHER OF ALL FISH TALES, AND MORE

Caption: Something's not kosher about these guys.


The guiding thread of this week's Goat Rope is a series of reflections on the Bible, although you are liable to find most anything else here too.

El Cabrero was lucky to have a good Bible teacher when I went to (we are) Marshall U.

He was a rabbi from a local synagogue (Reformed I think) who really made the Hebrew Bible (the Christian Old Testament) an open book and also taught about later Jewish writings.

It helped to learn about exactly what was there and to get a sense of scholarly opinion about when and why various parts of it were written and how the religion of Judaism developed over time.

It would be tough to pick out favorite parts, but El Cabrero's selection for Greatest Hits, Vol. I would have to include:

*Genesis, which is pretty cool as long as you don't use it as a science book. The family saga might make you feel pretty good about your own...

*Ecclestiastes, which gave us the title of today's post. Who said tragic existentialism was a 20th century thing?;

*The Hebrew prophets, who contrary to currently popular opinion were not obsessed with "end times" events but rather with social justice. The latter parts of the book of Isaiah top would top my list; and a special shout out to...

*Jonah, which appears in the books of the prophets but is really a short story and can even be read as a kind of practical joke played on the unwilling prophet by God to teach him a lesson about compassion. There is something lovable about this most unlovable of characters.

When God tells him to preach repentance to the people of Nineveh, he gets the hell out of Dodge, hopping a ship bound for Tarshish, the ends of the earth for Jonah. When a storm arises, the sailors toss him overboard to appease some angry god. Everybody knows the fish story.

When he gets vomited up by the fish at Nineveh, he reluctantly tells the people to repent lest they be destroyed. And--to his great disappointment--they do. Instead of being glad, he's angry with God for his mercy and asks to be put to death. God, in therapist mode, asked, "Are you right to be angry?"

Then he goes and pouts, sitting under the shade of a gourd vine. The vine is about the only thing in the world Jonah seems to like. But then...

God prepared a worm when the morning rose the next day and it smote the gourd that it withered.

And it came to pass, when the sun did arise, that God prepared a vehement east wind; and the sun beat upon the head of Jonah, that he fainted, and wished himself to die, and said, It is better for me to die than to live.

And God said to Jonah, Doest thou well to be angry for the gourd? And he said, I do well to be angry, even unto death.

Then said the LORD, Thou hast had pity on the gourd, for the which thou hast not labored, neither madest it grow; which came up in a night, and perished in a night;

And should I not spare Nineveh, that great city, wherein are more than sixscore thousand persons that cannot discern between their right hand and their left hand; and also much cattle?

The story ends there. If Jonah had anything else to say we don't know what it might have been.

I think one reason I like Jonah is his reluctance. There are way too many people in the world today who like to think of themselves as God's mouthpiece. I wish they'd take a ship for Tarshish...

THE WAL-MART TAX. There's been a lot of stuff about Tax Day lately. Here's something from Wake-Up Wal-Mart about how that corporation and others not only avoid fair taxation but also pass on the public costs of low wages and benefits to the rest of us.

THE COMMON GOOD. One aspect of Roman Catholic social teaching that I particularly admire is the ancient idea that the role of government and social institutions is to promote the common good. In his new book, Pope Benedict XVI criticizes both totalitarian collectivism and cut throat capitalism:

"After the experiences of totalitarian regimes, after the brutal way in which they trampled on men, mocked, enslaved and beat the weak, we understand anew those who hunger and thirst for justice," Benedict writes.

"Confronted with the abuse of economic power, with the cruelty of capitalism that degrades man into merchandise, we have begun to see more clearly the dangers of wealth and we understand in a new way what Jesus intended in warning us about wealth."

WHILE PRESIDENT NERO FIDDLES, at least some businesses are taking global climate change seriously. This from Business Week:

Remember the arguments for not taking action against global warming? Just a few years ago the claim was: "There's no evidence that the climate is changing." Then it became: "Well, maybe it is, but humans aren't to blame." That morphed into: "Warmer could be better, and we can easily adapt." And all along, we heard that cutting emissions would cripple the economy--and wouldn't make much difference because China and India weren't on board.

Forget all that. For most companies, the science debate is ancient history. The current argument, which could turn ugly, is about how the government should act to curb carbon emissions...

ROAD BLOCK. It looks like efforts to fix the Medicare Part D prescription drug benefit hit a brick wall in the Senate.

GOAT ROPE ADVISORY LEVEL: ELEVATED.

GROWING UP BIBLICAL

Caption: This man likes to dress up for church.

This week's Goat Rope involves musing on biblical themes among many other things and was inspired in part by recent surveys that suggest many Americans--even those who claim to believe every word literally--are biblically illiterate.

But first, there is a vicious rumor out there that El Cabrero would like to put to rest.

The rumor is this: that Episcopalians don't read the Bible. That is like sooo not true. We do...in case we're ever on Jeopardy.

I actually (now) consider myself lucky to have been dragged to Episcopal services throughout my childhood by my Maternal Unit in part because it really steeps you in biblical literature. In general, Anglicans of our variety don't take it literally (as a biology, geology, or astronomy textbook, for example) but do take it seriously.

A typical service involves at least four readings, including a psalm and another reading from the Hebrew Bible (the Christian Old Testament), one from the gospels, and one from the other New Testament writings. A lot of the rest of the liturgy is also drawn from biblical texts.

As a result, I wound up as a kid involuntarily memorizing sections of psalms, canticles, and other passages. There was no way not to.

I noticed something strange in the inevitable religious discussions with other kids. While some viewed the Bible almost superstitiously as a magical oracle, they had little idea of how it went aside from a few "proof texts."

(Proof texting is a vile habit that has probably done as much as anything else to promote biblical illiteracy.)

One thing I got out of all that was the lifelong habit of reading it, regardless of how my religious opinions morphed or occasionally disappeared over time. It's some of the best time I ever spent.

When it comes to religion, El Cabrero's mind is kind of like an AM car radio driving on mountain roads; sometimes you pick up a signal and other times it's just static, although I seem to have would up pretty much where I started.

Question for you, Gentle Reader. What role has the Bible, positively or negatively/by its presence or by its absence, played in your life?

IT'S HOW THEY'RE COUNTED, as we like to say about votes in El Cabrero's beloved state of West Virginia. In this case, however, we're talking about poverty. This editorial from the New York Times is about more accurate measurements than the old federal poverty level:

According to the Census Bureau, nearly 37 million Americans — 12.6 percent of the population — were living in poverty in 2005. That means that four years into an economic expansion, the percentage of Americans defined as poor was higher than at the bottom of the last recession in late 2001, when it was 11.7 percent. But that’s not the worst of it. Recently, the bureau released 12 alternative measures of poverty, and all but one are higher than the official rate.

The alternative that hews most closely to the measurement criteria recommended by the National Academy of Sciences yields a 2005 poverty rate of 14.1 percent. That works out to 41.3 million poor Americans, 4.4 million more than were officially counted. Those higher figures indicate that millions of needy Americans are not getting government services linked to official poverty levels.

It calls for expanding the Earned Income Tax Credit and early childhood education to help combat poverty.

MEDICARE PART D. West Virginians United for Social and Economic Justice and the WV Citizen Action Group issued a statement yesterday calling for negotiated prices on the prescription drug benefit. This could save WV taxpayers $225 million per year ($30 billion at the national level.) The press release drew attention to this report by the Institute for America's Future.

GOAT ROPE ADVISORY LEVEL: ELEVATED