Category Archives: Uncategorized

Health Policy Post! My Actual Day Job!

I work at a state Medicaid agency that’s planning to cut payments to doctors who can get that dough back by improving their patient outcomes. It’s generally called “paying for value.” Its opposite, “paying for volume,” pays docs for the number of services they provide, rather than their patients’ improved ability to bike to the river.

Clearly we need to pay for health care quality instead of for however many brains one can stuff into an MRI machine.

But we also know that social factors–jobs, education, immigration status, housing and food security–determine up to 80% of a person’s health. Not their doctor. Not their genes. Not their kale smoothies or meditation apps.

So paying doctors for outcomes may not make much sense for doctors who primarily serve people with low wage jobs in polluted neighborhoods and generally live without the kind of accumulated advantages that allow me, for example, to hit the bookstore for something to read on the airplane, which I’m flying tomorrow to a small town with a fantastic pastry shop and a famous theater.

Dhruv Khullar points out that scoring doctors who take public insurance against doctors who don’t, and paying them less when their patients inevitably can’t manage their chronic conditions as well, will probably result in lower-income people getting worse care.

And we haven’t yet figured out how to use the health care system to address people’s actual health needs: food, safe and secure housing, child care, decent wages.

I’ve been saying this around the office for a while, that value-based payments may punish doctors for poverty the same way that teacher evaluation systems punish teachers for poverty.

But Dr. Khullar is a doctor published in the New York Times, and I’m a pee-yoo-rocrat blogging for about 3 readers (hi guys!).

So not that I can do much about it, but I’ll spend my Fourth of July thinking about how to leverage health care funding streams to mitigate social inequity. Also cake. Happy Fourth.

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Why?

I know why a dude who pummeled his wife daily might also gun down a gay club on Latin night: gender norms are f-ing  lethal. Plus racism. 

But why oh why are assault rifles sold to Joe Q Public???????

All I want is for my friends and family to feel safe. They don’t today. 

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Peace Through Community Investment

Ok listen. They shot up a classroom of first graders. They shot up a women’s health care clinic. They shot up families watching a movie. They shot up a sorority party. They shot up people praying at the nation’s oldest AME church. They shot black children at the park. They shot their coworkers at their own goddam holiday party.

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TV Schizophrenia (#MadMen)

In 1961, Thomas Szasz crystalized a particular kind of countercultural trope: the “mentally ill” genius. His The Myth of Mental Illness asserted that people can be “disabled by life.” That one sensitive to the absurdities and senselessness of life may appear mentally ill, but really tells Truth in a hostile society.

By now it’s trite: Sherlock Holmes, House, the lady in Homeland. Hannah Horvath. Gonzo.

No one’s crying about the dude in One Flew Over the Cuckoo’s Nest anymore.

But Peggy cried about Michael Ginsberg.

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“Post-Truth” Politics and Journalism

Last week I twittered this super-rad article by Garance Frank-Ruta about journalists’ new responsibilities to correct electioneering lies.

Today James Fallows caught up with this piece and contextualized it with other promising events he puts into David Roberts’ rubric of “post-truth politics.”

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Shenanigans on the Floor!

Always-reliable Ezra Klein reporting on Congressional head-butting over Simpson-Bowles, the recommendations resulting from Obama’s bipartisan itty bitty fix-the-budget committee:

To Democrats, that bipartisan deal [the Budget Control Act of 2011], which ended the debt-ceiling standoff, set spending for the next two years, and the GOP is reneging on its word. Republicans counter that they consider the BCA as a ceiling on spending, not a floor, and they have every intention of trying to cut spending further.

Which is all to say that, on Wednesday, Conrad tried to do what so many in Washington said was necessary: Move to Simpson-Bowles. Make this debate bipartisan. Instead, Simpson-Bowles got trashed by Republicans and jammed into a protected, partisan process by Democrats. And the GOP provided more evidence that they want to undercut the Budget Control Act, which means we’re headed to a showdown over appropriations, and soon. Attempts at bipartisanship, in other words, showed just how partisan this issue really is.

Of course they did. Of course. Feverish obsession with TAXES!!!!!!!!!!!! has prevented anyone from thinking straight about how to spend, and save, public money.

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