I’m pro-life: in favor of Medicare for all, a healthy environment, and gun control

I’m pro-life for adults and for later-term fetuses, but I’m pro-choice for early-term fetuses.  However, it seems that many conservative Americans are pro-life only for fetuses but not so much for children and adults.

Real pro-life includes everyone, not just fetuses. So, I’m in favor of government-guaranteed medical care for everyone.  And I’m in favor of stringent environmental regulations.

Here are some links about how harmful auto and truck traffic are to human health.

Many daycare centers and schools are dangerously close to busy roads.

Living near highways bad for lungs

Living close to a major roadway could increase dementia, study says

Roads are harmful to pregnant women

Road pollution associated with increased breast cancer

Road pollution bad for heart health

Then there are the indisputable negative effects of carbon pollution on the climate change.

Don’t repeal what’s working; fix Affordable Care Act

I am a lucky person. My jaw is broken, but that is not why I am lucky.


I have good health and dental insurance. So when my jaw was fractured last month, I didn’t have to worry about how I could afford to fix it. Sure, I will pay some significant cost-sharing, but it will not make me poor. And this final fact overrides all the inconveniences of having my teeth wired and banded so the jaw can heal.

That’s why I am lucky.

Before the Affordable Care Act, millions of people in our state did have to worry about the cost of health care. If they had “pre-existing conditions” they were forced to get their coverage through the state’s high-risk pool, which was very expensive. If they had insurance, their premiums or their share of premiums went up and up every year. The deductibles and out-of-pocket costs went up as well. If they didn’t have insurance, they lived in fear of being sick or getting hurt, or they simply played the odds and thought they could get by. Some did. Others didn’t. They were saddled with tens of thousands of dollars of costs for their care. And the hospitals to which they went for emergency care accrued hundreds of millions of dollars in costs for uncompensated care.

The proportion of people without insurance in our state has fallen by 10 percent between 2010 and 2015. That’s means that about 700,000 people now have health coverage that they did not have before passage of the Affordable Care Act. Our rate of uninsured is at an all-time low – 5.8 percent in 2015. It has fallen further since then. This is an equal opportunity benefit. The uninsured rate for whites fell 7.5 percent between 2013 and 2015. For blacks it fell 10.2 percent. For Hispanics it fell 13.2 percent. For Native Americans it fell 14.3 percent.

How did this happen? The Affordable Care Act enabled coverage of young adults under their parents’ employer-provided health insurance until age 26. The act disallowed insurance companies from denying coverage on the basis of pre-existing conditions.

The act expanded our state’s Apple Health coverage up the income ladder, so that all citizens with incomes below 138 percent of the federal poverty level could get health coverage. (That’s $16,400 for a single person and $33,500 for a family of four.) The act created the individual health insurance exchange and enabled immediate tax credits for people with income up to 400 percent of the federal poverty level who purchased their coverage through the exchange. That comes out to subsidize coverage for individuals with incomes up to $47,500. The act created subsidies for out-of-pocket costs for people up to 250 percent of federal poverty level — $29,700 for a single person and $60,750 for a family of four.

Today 1,838,000 people get their health coverage through Apple Health and another 173,000 get their coverage through the health benefit exchange. Apple Health now covers over 136,000 people in Snohomish County. The individual exchange covers another 16,500. So in Snohomish County, as is true for the entire state, 1 out of every 4 people get their health coverage through the Washington Benefit Exchange.

We all know the Affordable Care Act is not perfect. Out of pocket costs can be up to $6,000 per person. When your income goes up from $16,000 to $20,000, you have to go from Apple Health, with zero cost, into the exchange, which, even at that income, will cost you almost $1,000 for your share of the premium and up to $2,500 more if you get sick and need care. As your income further increases, your health care costs get more out of whack.

So, the Affordable Care Act could and should be improved. But it does work. Millions of people in our state alone have health coverage that they did not have before.

What we need to do now is to decrease health care costs and eliminate wasteful unnecessary care. That means driving down the costs of pharmaceuticals, hospitalization and specialty care. But that would mean taking on the “swamp” of special interests in Washington, D.C. Donald Trump and the Republican-controlled Congress swim in that swamp. They want to repeal the Affordable Care Act. They don’t have a replacement. That’s their plan for making America great again. But that’s not our America.

Original: Everett Herald »

Trump's lies about Canadian health care

No, Trump, Canadians do not flee en masse for US health care. In fact, few do — pretty much just rich people.

Myths About Canadian Health Care: “Myth #1: Canadians are flocking to the United States to get medical care. … Myth #3: Canada rations health care; that’s why hip replacements and cataract surgeries happen faster in the United States. Myth #4: Canada has long wait times because it has a single-payer system.”

Health Coverage in King County: Progress to date – and steps still to be taken

King County residents, especially those with U.S. citizenship, have benefitted greatly from the expansion of health coverage via the Affordable Care Act. Between April 2014 and March 2016, the number of residents covered through Apple Health (Medicaid) and the Qualified Health Plans offered through the Washington Health Benefit Exchange grew by 55%, from 256,000 to 396,000.[i] As a result, one out of five King County residents now has health insurance through Apple Health or Qualified Health Plans.[ii]

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These expansions have driven a noteworthy decrease in the number of uninsured residents in King County. Data from the Washington State Office of Financial Management (OFM) and Public Health – Seattle & King County shows a systemic decline in the number of uninsured across the board: by ethnicity, age, employment status, citizenship and income level between 2013 and 2014[iii] (prior to the 140,000 person increase in health coverage through the Health Benefit Exchange in 2016.)

Between 2013 and 2014, King County realized a 38% proportional decrease in the number of uninsured, as the number of people without health insurance decreased by 82,000. Compared to a 35% drop in the uninsured across the state, and a 20% drop in the uninsured nationally, this makes King County a high performer relative to other jurisdictions.[iv]

Of particular note: disproportionate drops in the rate of uninsured occurred among African Americans, Asian Americans, people with incomes below 138% of federal poverty level, the unemployed, and naturalized citizens. These numbers indicate the success of the Affordable Care Act across all population cohorts, while highlighting those cohorts which still disproportionately lack health coverage.

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Who Doesn’t Have Coverage in King County

In spite of the advances in coverage made possible through the Affordable Care Act, 139,000 residents of King County still did not have health insurance as of 2014.[v] These individuals are particularly concentrated among adults not in the labor force (35,546), non-citizens, those who with incomes below the median income (112,040), Hispanics (35,785), and people between the ages of 25 and 45 (75,233). These are overlapping cohorts. For example, thousands of Hispanics reside and work in Washington state are both poor and do not yet have citizenship status.

It is important to note that since 2014, over 140,000 additional people have gained health coverage through Apple Health or the Health Benefit Exchange (an additional 60% on top of 2014’s totals). At the same time, King County’s overall population has grown by 89,000 people. Without knowing the numbers of employees who have been switched from employer health coverage to coverage through the Health Benefit Exchange, we can only imprecisely estimate the number of residents who remain uninsured in King County. Our estimate is that of the 2.1 million residents of King County, fewer than 80,000 people, or less than 4% of the County’s population, lack health coverage.

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Price Walls and Affordability

A decrease in the number of uninsured does not mean the Affordable Care Act has “solved” problems with the nation’s health insurance coverage. Current coverage rates still don’t match the levels found in other developed countries around the world. And even King County residents who have health insurance remain vulnerable to losing coverage or being financially unable to meet their “cost-share” for health coverage.

The price wall people encounter when their income exceeds 138% of federal poverty level is another significant problem. With an annual income of $16,284 or less, an adult is covered by Apple Health, with minimal, if any, cost to the individual.[vi] But if that same person gets a wage increase and thereby earns $20,650 (175% of federal poverty level), the combined premium and out-of-pocket costs can exceed $2,300 – more than 12% of their income – even after receiving federal subsidies. For a person earning $23,600 (200% of federal poverty level), the combined premium and out-of-pocket costs can exceed $2,800.[vii]

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The Price Wall Problem

Imagine a hypothetical community college student named Brenda, who is working 32 hours a week at the minimum wage in Burien. At $9.47/hour, her income is $14,773 and she qualifies for Apple Health (i.e. no-cost health insurance.) The following year, she takes a job in Seattle that pays $12.50/hour. Her income goes up to $20,800, a bit above 175% of federal poverty level.

Brenda now no longer qualifies for Apple Health, and so moves into the commercial health benefit exchange. While premiums and out-of-pocket costs are subsidized by the federal government, they can still be sizeable. If she gets ill and needs care, she can lose 40% of the increase in her wages – over $2,300 – to payments for her health insurance coverage. If her income increases to $29,500, she could pay as much as $6,152 for health care in premiums and out-of-pockets costs – more than 20% of her total income.

Solutions for Advancing Health Coverage in King County

King County can improve health insurance coverage by paying particular attention to those populations with continued high rates of uninsurance and underinsurance – that is, individuals below 138% of federal poverty level (who qualify for Apple Health but may have difficulty accessing it), and those between 138% and 199% of federal poverty level.

For people in the former category, that corresponds to: less than $16,284 for a single person; less than $22,107 for a two-person family; less than $27,820 for a three-person family; less than $33,534 for a four-person family; and less than $39,247 for a five-person family. The county should make every effort to expedite coverage for this population through Apple Health, while recognizing that many residents and workers at this income level will still not be able to gain coverage due to citizenship status.

For those with incomes between 138% and 300% of federal poverty level, there is not a straightforward solution regarding affordability – particularly for premiums and out-of-pocket costs that challenge family budgets. One avenue is for the county to explore re-instituting Washington state’s Basic Health Plan at the county level, using the same parameters for cost-sharing that were in place when the people passed Initiative 773 in 2001 to expand Basic Health coverage.

The county could also work with the state and federal government to increase the threshold for coverage under Apple Health from 138% to 150% of federal poverty level. If this were to happen, about 13,000 people currently in the commercial exchange could move into Apple Health.[viii] Another possibility is for the county to work with the state in developing a federal Basic Health option, as provided by the Affordable Care Act’s section 1331.

The county could also continue to dedicate and increase resources to providing care for those excluded from coverage under the Affordable Care Act, particularly recent immigrants. King County has already laid out an agenda for action, outlined in the July 2015 report, “Access to Health Care After the Affordable Care Act”[ix] and the October 2015 report, “Affordable Care Act Enrollment in King County: Early General Population Impacts.”[x]

King County, Washington state, and the United States have embarked upon systemic and significant advances toward achieving health coverage for all. While progress has been made, there is much more to do. This work will take innovative and creative policy development, increased public funding, and, most importantly, the political will to meet the health needs of and establish health security for all residents.


[i]     Washington Health Benefit Exchange Enrollment Reports: http://www.wahbexchange.org/wp-content/uploads/2016/02/HBE_EN_140422_April_Enrollment_Report.pdf, http://www.wahbexchange.org/wp-content/uploads/2015/12/HBE_EN_160607_March_Enrollment_Report.pdf

[ii]     Population grew in King County from 1,981,900 to 2,052,800 between 2013 and 2015, an increase of 70,900, or 3.58%. See http://www.ofm.wa.gov/pop/asr/default.asp Washington state Office of Financial Management, Population, Estimates of April 1st population, county data tables.

[iii]    The OFM data is for the total population (that is, including Medicare recipients 65 and older, and children under 18 years old, whose coverage is very high, thanks in large part to Apple Health. The King County data focuses on the 18-64 age population. Further, OFM adjusted data to take in account an undercount of Apple Health enrollment in the 2014 American Community Survey (ACS). These differing methodologies and populations account for the difference in the rates of uninsured.

[iv]    Affordable Care Act Enrollment in King County, presentation by Public Health – Seattle & King County, http://www.kingcounty.gov/healthservices/health/%7e/media/health/publichealth/documents/data/affordable-care-act-enrollment-king-county.ashx, p. 10 and 11.

[v]     American Community Survey 1-Year Estimates on the American FactFinder; Wei Yen, OFM Forecasting and Research Division

[vi]    Washington State Health Care Authority: Apple Health Federal Poverty Level (FPL) Chart – Find out if you’re eligible http://www.hca.wa.gov/medicaid/publications/Documents/19_031.pdf

[vii]    Washington Health Plan Finder: https://www.wahealthplanfinder.org/HBEWeb/Annon_ShowIndividualFamilyPlans

[viii]   Washington Health Benefit Exchange, March 2015, Health Coverage Enrollment Report, page 8: http://wahbexchange.org/wp-content/uploads/2015/08/991427407310_2015_Enrollment_Report_2_032615.pdf

[ix]    Access to Health Care After the Affordable Care Act, presentation by Public Health – Seattle & King County, http://www.kingcounty.gov/healthservices/health/%7e/media/health/publichealth/documents/data/Access-Health-Care-After-ACA.ashx

[x]     http://www.kingcounty.gov/healthservices/health/%7e/media/health/publichealth/documents/data/affordable-care-act-enrollment-king-county.ashx

Originally published at EOI Online

It takes a web of public support to keep ourselves healthy

Mention “the web” and many people will think you’re talking about the Internet. But when you’re having a serious medical problem, you see an entirely different network in action.

Two weeks ago, as my body tried — at first, in vain — to fight off a serious infection, my family and friends were the first set of those connections. They took me to the doctor and dentist, made sure I took antibiotics, talked to me, and comforted me. I’m grateful. I certainly was not in any condition to do that on my own. But I’m also grateful for the many other connections that supported them and made my care possible. Family and friends can only do so much.

Consider the doctors, l technicians, nurses, medical assistants and dentists who help us. We have this professional workforce thanks to public investments in the University of Washington’s medical school and nursing school, numerous community colleges and other universities and colleges across the state and nation. Not only was their cost of education subsidized by the state, but all the capital investments in building and technology for medical education came from the state’s taxpayers.

Consider the growing list of MRIs, CT scans, biologic drugs and cancer treatments now available. These advances are possible because of government investments in health research and development, through the National Institutes of Health. Anti-cancer drugs like Taxol, that have saved my sister’s life and thousands of others, were initially developed by the federally funded National Cancer Institute.

These are public triumphs for everyone’s health. But even those require a network to succeed. The priorities we set as a society, and enact through our democracy, are the foundation for everyone’s protection, health and quality of life.

Consider the roads leading to and from our homes and nearby medical facilities. No single person builds and maintains them. We chose to pool our resources via collective taxation to shape our transportation network.

Consider that half of all people in Washington have health insurance through government financing, whether via Apple Care, Medicare, Obamacare the State Health Benefit Exchange, or as public employees of school districts, fire districts, the state, counties and cities. My wife, sister and brother-in-law are part of this network. So is anyone over 65, all kids under 18, and many retired fans of Donald Trump and Ted Cruz. This woven web of coverage isn’t perfect, but it beats handing your fate over to a private market interested more in profits than patients.

Consider that now in Seattle and Tacoma and Spokane, you can take a work day to care for yourself or sick family member without fear of losing your wages or your job. That’s only possible because the Seattle, Tacoma, and Spokane city councils passed ordinances to make it so. Initiative 1433, the statewide ballot measure now gathering signatures, would extend this network of law to all workers in the state.

When you are sick, you gain a new perspective on life. It tends to diminish one’s own sense of self-importance. That humbling is a good thing. We all need some perspective about ourselves away from the noise and ego of everyday life. It shatters the self-made, up-by-my-bootstraps, don’t-need-any-help edifice that too often masquerades as some kind of American ethos.

A person is only able to lead a healthy life because of the entire web around them: of society, government, health professionals, friends and family. Keep that in mind as certain presidential candidates invoke the founders of our country or other contemporary leaders as paragons of self-sufficiency. None of us are or were — not the founders (whose quality of life was enabled through the slave labor), not Donald Trump (whose wealth is protected by bankruptcy courts and civil law), and not Bernie Sanders and Hillary Clinton (who, like many of us, benefit from publicly provided health coverage).

We are all in this together, no matter what the color of our skin or the accents and language of our voices. It’s time to bury the hubris and take a large dosage of humility — maybe like some of our great-grandparents took a spoonful of cod liver oil each morning. Then we need to figure out how to advance as a nation of interconnected and interdependent individuals striving for lives of purpose, hope, happiness and solidarity.

Originally published at the Everett Herald

The NY Times' deceptive summary of yesterday's Clinton-Sanders debate

In In Democratic Debate, Hillary Clinton Challenges Bernie Sanders on Policy Shifts the NY Times summarized last night’s debate by saying “Hillary Clinton targeted Bernie Sanders’s electoral appeal with some of her strongest language yet in a debate on Sunday night, seizing on Mr. Sanders’s recent policy shifts on universal health care and gun control to try to undercut his image as an anti-political truth teller.”

Both the headline and the summary strike me as inaccurate. Benie Sanders has been pretty consistently in favor of single payer health care. (For example, in 2013 Sanders introduced the American Health Security Act, S. 1782 which required “each participating state to set up and administer a state single payer health program.”)

Probably the shift that the NY Times writers are referring to concerns the shift from Obamacare to a single payer system:

With Mr. Sanders gaining on her before the Feb. 1 Iowa caucuses, Mrs. Clinton cast herself as the defender of Mr. Obama’s record and Mr. Sanders as playing into Republican hands with proposals like replacing the Affordable Care Act with a single-payer plan, which Mr. Sanders describes as “Medicare for all.”

But if that’s the shift they’re referring to, it’s not a shift in Sanders’ position — the way he arguably has shifted his views on gun control — but rather a shift in the nation’s policies.

The New York Times needs better editing.

The incredible venality and cruelty of Big Pharma

The Denver post is reporting:

A bold federal effort to curb prescribing of painkillers may be faltering amid stiff resistance from drugmakers, industry-funded groups and, now, even other public health officials.

The Centers for Disease Control and Prevention was on track to finalize new prescribing guidelines for opioid painkillers in January. The guidelines — though not binding — would be the strongest government effort yet to reverse the rise in deadly overdoses tied to drugs such as OxyContin, Vicodin and Percocet.

But this highly unusual move — the CDC rarely advises physicians on medications, a job formally assigned to the Food and Drug Administration — thrust the agency into the middle of a long-standing fight over the use of opioids, a powerful but highly addictive class of pain medications that rang up over $9 billion in sales last year, according to IMS Health.


Over-prescription of opioids is causing an epidemic of addiction and overdoses.   And the high price of drugs in America and the stranglehold that Big Pharma has over Congress are reasons for outrage.

In The Truth about the Drug Companies, a former Editor in Chief of the New England Journal of Medicine writes of the drug industry, “Instead of being an engine of innovation, it is a vast marketing machine. Instead of being a free market success story, it lives off government-funded research and monopoly rights.” See also The Horrifying Hidden Story Behind Drug Company Profits.

The corruption of Big Pharma is an disgusting. The profit from human suffering. The public should be protesting.