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A Clean Bill of Health?
Jacob S. Hacker, Ph.D., is the Stanley B. Resor Professor of Political Science at Yale University and a Resident Fellow at the Institution for Social and Policy Studies. He is also a Fellow at the New America Foundation in Washington, D.C., and a former Junior Fellow of the Harvard Society of Fellows. His 2007 proposal for universal health insurance, "Healthcare for America," was instrumental in bringing the "public option" to the forefront of the national healthcare debate. He has testified before Congress and written articles for a variety of publications, including The New York Times, The Washington Post, The Nation, and American Prospect. His most recent book, "The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream," was published by Oxford University Press in 2006 (paperback, 2008).
Question: What is your opinion of the House healthcare bill?\r\n
Jacob Hacker: Well, I think the major strengths of the healthcare bill passed by the House of Representatives is it makes a very strong commitment to affordable coverage. It does two things that are going to essential if we're going to have affordable coverage. It regulates the insurance companies quite significantly to make sure that they're providing coverage to everyone who needs it and not just cherry-picking the healthy.\r\n
The other thing it does, which I think is equally crucial, is it puts in place measures to make sure that that coverage would be affordable. There are two that I think need to be emphasized above all else. One is it has real money for subsidies to provide health insurance, to make it more affordable for people to buy health insurance. The bottom line is no matter what the government does to try to bring down premiums, you're going to have to pay a pretty substantial amount of the premium for middle-class and less affluent Americans if they're going to be able to afford our super-expensive coverage.\r\n
Then the second thing that it does is it creates a competitor to the private insurance plans in the form of a public health insurance option. There has been some concern that this public health insurance option isn't as strong as it should be. It's certainly not as strong as I originally had advocated or had wanted, but it's still a pretty good plan. It's going to be created by the federal government, it's going to be run by the Secretary of Health and Human Services in the same way that the Medicare program is. It will be available to Americans in every exchange, so if they're not getting coverage through their employer or if they work for a small employer that can't afford to get coverage on its own, they're going to have access to this public health insurance plan. And the public health insurance plan has a lot of tools available to innovate in the payment for and delivery of care to help bring down costs.\r\n
So I think it's a really strong element of the bill. If you take those two things together, the commitment to regulating the insurance industry and the emphasis on affordability, you have a very secure foundation for building in the coming years. I mean, we certainly are going to have to address much more forcefully than even the House bill does to long-term cost containment problem. The only way I think we're going to bring down costs over the long-term is to create real countervailing power in the market. That means countervailing power to the insurance companies from a strong public health insurance plan and countervailing power on the part of insurance companies in this public insurance plan. These are the providers of care. This doesn't mean just ratcheting down rates, it means changing the way in which care is paid for and, thereby, the way in which care is delivered. That's going to take time, but I think that that's—that you need to have that secure foundation such as the House bill has to be able to move in that direction.\r\n
If people aren't guaranteed affordable care and affordable coverage, then it's very hard to address the underlying drivers of care. So much of the cost gets shifted from people who aren't insured to people who are insured. Providers figure out ways to move the payments from one insurer to another. The insurance companies complain that they can't bring down care costs systematically because they're having this turning of people in and out of coverage, so you need to have a secure foundation in the form of broad commitment to affordable coverage if you're going to really address the big drivers of cost.\r\n
Question: What do you expect to happen to the bill in the Senate?\r\n
Jacob Hacker: Well I think there's no question that the pressure in the Senate to pull back from where the House is is going to be very strong. But I actually am optimistic and think there is a real possibility that the Senate bill will be pretty good too and they'll go to the conference committee with two strong bills able to bring together those bills for a very good final product. The problem in the Senate side is pretty clear. It is that you don't just need a majority. If you're going to go through the normal Senate process, you need to 60 votes. You have to overcome a filibuster and that means that the center of political gravity isn't a Democrat in the sort of roughly the middle of the party. It's a very conservative Democrat or a moderate Republican from Maine, like Olympia Snow or Susan Collins.\r\n
So that's the reality that's faced and that's why everyone's recognized from the beginning that the Senate is going to be the tougher nut to crack; however, Harry Reid basically has said, "Look, we want to have a good bill. If that requires that we really build on our on own majority, the partisan Democratic majority, so be it. He's trying to put together a strong bill and get a favorable read on that bill from the Congressional Budget Office and move forward to try to bring in wavering Senate Democrats and the two independents that caucus with the Democrats. We hear lots of speculation about whether he can do it, but I think that if he moves forward, as he moves forward, the pressure on those wavering Democrats is going to be very strong to at least support a debate on this issue. I mean, after all, this is something the House has moved ahead, Americans want healthcare reform, President Obama was elected on this issue and it really would be amazing to me, but perhaps it's not inconceivable, if Senate Democrats or those who caucus with them actually stood in the way of their being a debate.\r\n
All they have to do is say, "Okay. We'll let debate go forward. We will support a motion to end a filibuster but we won't necessarily vote for the final bill." So this is, to me, the right and honorable path for those Democrats who have concerns about the bill, it's to say, "I may not want to vote for it in the end, but I support the idea that we should have a democratic process where the votes of the majority are allowed to be heard."
Recorded on November 9, 2009
Interviewed by Austin Allen
Yale political science professor Jacob Hacker grades the 2009 House healthcare bill and predicts its fate in the Senate.
Join The Daily Show comedian Jordan Klepper and elite improviser Bob Kulhan live at 1 pm ET on Tuesday, July 14!
Gender and sexual minority populations are experiencing rising anxiety and depression rates during the pandemic.
- Anxiety and depression rates are spiking in the LGBTQ+ community, and especially in individuals who hadn't struggled with those issues in the past.
- Overall, depression increased by an average PHQ-9 score of 1.21 and anxiety increased by an average GAD-7 score of 3.11.
- The researchers recommended that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders—even among those with no prior history of anxiety or depression.
Study findings<p>For the study, <a href="https://link.springer.com/article/10.1007/s11606-020-05970-4" target="_blank">published in the Journal of General Internal Medicine</a><em>, </em>Flentje and her team evaluated survey responses from nearly 2,300 individuals who identified as being in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Most of the participants were white, while nearly 19 percent identified as a racial or ethnic minority. Multiple genders were represented with cisgender women (27.2 percent) and men (24.6 percent) making up a majority of the participants. Sixty-three percent had been assigned female at birth. For the most part, participants identified their sexual orientations as queer (40.3 percent), gay (36.5 percent), and bisexual (30.3 percent).</p><p>The JGIM study participants were recruited from the 18,000-participant <a href="https://pridestudy.org/" target="_blank">PRIDE Study</a> (Population Research in Identity and Disparities for Equality), which is the first large-scale, long-term national study focusing on American adults who identify as LGBTQ+. It conducts annual questionnaires to understand factors related to health and disease in this population. </p><p>Participants filled out an annual questionnaire (starting in June 2019) and a COVID-19 impact survey this past spring. Flentje noted that on an individual level, some people may not have experienced a big change in anxiety or depression levels, but for others there was. Overall, depression increased by a <a href="https://patient.info/doctor/patient-health-questionnaire-phq-9" target="_blank">PHQ-9 score</a> of 1.21, putting it at 8.31 on average. Anxiety went up by a <a href="https://www.mdcalc.com/gad-7-general-anxiety-disorder-7" target="_blank">GAD-7</a> score of 3.11 to an average of 8.89. Interestingly, the average PHQ-9 scores for those who screened positive for depression at the first 2019 survey decreased by 1.08. Those who screened negative for depression saw their PHQ-9 scores increase by 2.17 on average. As for anxiety, researchers detected no GAD-7 change among the study participants who screened positive for anxiety in the first survey, but did see an overall increase of 3.93 among those who had initially been evaluated as negative for the disorder. </p>
Risks among gender and sexual minorities<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fc3fd1ae68b77bbbf58a6995638d6d65"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/EnUqDjCqg0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The LGBTQ+ community is a vulnerable population to mental health concerns because of their fear of stigmatization and previous discriminatory experiences.</p> <p>Previous research by the Human Rights Campaign has found "that LGBTQ Americans are more likely than the <a href="https://medicalxpress.com/tags/general+population/" target="_blank">general population</a> to live in poverty and lack access to adequate medical care, paid <a href="https://medicalxpress.com/tags/medical+leave/" target="_blank">medical leave</a>, and basic necessities during the pandemic," said researcher Tari Hanneman, director of the health and aging program at the campaign.</p> <p>"Therefore, it is not surprising to see this increase in anxiety and depression among this population," Hanneman said in the release. "This study highlights the need for <a href="https://medicalxpress.com/tags/health+care+professionals/" target="_blank">health care professionals</a> to support, affirm and provide <a href="https://medicalxpress.com/tags/critical+care/" target="_blank">critical care</a> for the LGBTQ community to manage and maintain their mental health, as well as their physical health, during this pandemic."</p>
What should health care providers do?<p>The authors of the study recommend that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders in members of that community—even among those with no prior history of anxiety or depression.</p><p>As cases of COVID-19 continue to mount, the sustained social distancing, potential isolation, economic precariousness, and personal illness, grief, and loss are bound to have increased and varied impacts on mental health. Effective treatments may include individual therapy and medications as well as more large-scale coronavirus support programs like peer-led groups and mindfulness practices. </p><p>"It will be important to find out what happens over time and to identify who is most at risk, so we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways," said Flentje.</p>
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The team caught a glimpse of a process that takes 18,000,000,000,000,000,000,000 years.
- In Italy, a team of scientists is using a highly sophisticated detector to hunt for dark matter.
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