health insurance: June 2012

Saturday, June 30, 2012

The Good, The Bad And The Blue Dogs

As Andrew Rosenthal writes in the Times: "Whatever you think about the House Republicans, you have to admit they stay focused. Yesterday, while the rest of the country was distracted by the Supreme Court decision on the most important piece of social legislation in generations, the House Republicans were concentrating on the big picture – the personal and political destruction of President Obama." (See more here.) Unfortunately, the response from the Democrats was typically muddled -- some were inspired, others less so, and then there were the 17 craven Blue Dogs who crossed over to the other side. -- Lovechilde

Jerk Democrats And Face-Palm Democrats Undermine Principled Democrats In Contempt Resolution Vote

By Meteor Blades, cross-posted from Daily Kos

There were three sets of Democrats in Thursday's contempt vote against Attorney General Eric Holder in the House of Representatives.

First—huzzah!—there were the 100+ inspired by the Congressional Black Caucus to walk out of the chambers rather than give the resolution any respect whatsoever. Minority Leader Nancy Pelosi and Whip Steny Hoyer were among those who left rather than cast their votes. It's a rare, rare day that such a move is justified. But today was one of those. Because, what the Republicans did was unprecedented, unconscionable, unpardonable and unhinged. The Democrats filing out the doors were precisely the rebuke deserved by the representatives who plunked that outrageous resolution into the hopper.

Then there were the 65 Democrats who voted against the resolution. That, of course, under normal circumstances, would have been the appropriate choice. Shoot down the resolution or, at least, stand unified against whatever nonsense or worse that the GOP had cooked up to impose on us.

But it was clear when the Oversight and Government Reform Committee approved the contempt resolution last week which direction the wind would blow. No way would this not pass. And no way would its passage get any traction when sent to the federal prosecutor. Such matters expire with the end of the Congress that okays them and this one is going to be on a slow six-month track to nowhere. Which the Republicans knew full well from the get-go.

In other words, it was all theater. Even more than usual. The walkout, though a principled move, was counter-theater. Treating the vote seriously, respectfully, by participating, even with a "nay," was useless and stupid. Especially given that the House leadership not only gave Democrats the stamp of approval for joining the walkout, they themselves boycotted the vote. Think of the imagery, the headlines, if those Democrats who stayed at their desks to push the "nay" button had added their numbers to the power of solidarity. Since their votes could not change the outcome anyway, what was their rationale for sticking it out? What statement were they making? Was it simple laziness? Did they decide to show solidarity with the two Republicans who broke from the jackal pack to oppose the resolution? Whatever the case, they went astray.

Finally, there were the 17 Democratic "aye" votes. What a fine crew that is. Our plague. Yes, yes, they are mostly in reddish districts and more liberal candidates could never get elected there, so we have to put up with them because better they than a Republican, yadda, yadda, yadda.

Even if one agrees that Blue Dogs and their ilk are the price of a Big Tent party, what good are they when they can't be counted upon to have the backs of fellow Democrats under a rancid assault whose only foundation is raw partisanship?

What good are they if they won't stand up against even the most extreme efforts of the National Rifle Association? That organization's grip on gun policy in Arizona and elsewhere lubricates the trafficking of tens of thousands of firearms into Mexico and makes the job of interdicting this lethal flow next to impossible. An organization whose string-pulling and budget-obstructing has frustrated the Bureau of Alcohol, Tobacco, Firearms and Explosives so much that it led to experiments like "Fast and Furious" in the first place.

These 17 Democrats didn't just suck up to the NRA. They didn't just turn their backs on colleagues. They provided the GOP the okay to say that even-some-Democrats agree Eric Holder is involved in a cover-up of a program that led to the death of a brave U.S. Border Patrol agent. By unspoken implication, of course, Obama is also involved. Providing Republicans with that kind of campaign ammo goes waaaay beyond any apologies that can be made for trying to make oneself a viable incumbent Democrat in a reddish district. Being that kind of turncoat screws other Democrats by helping to mobilize the nut-jobs to turn out in greater numbers at the polls.

Despicable, pathetic, myopic.

Every Democratic Rep. who voted for the contempt resolution should be a target for replacement in the coming years until they've all been retired. If they cannot be counted on to stand with fellow Democrats on a matter of principle so fundamental, how exactly is it that they fit in the Big Tent?
•••
The roster of 17 (asterisk indicates a Blue Dog):
Jason Altmire (PA-04, lost primary in PA-12) *
John Barrow (GA-12) *
Dan Boren (OK-02, retiring) *
Leonard Boswell (IA-03) *
Ben Chandler (KY-06) *
Mark Critz (PA-12)
Joe Donnelly (IN-02, running for IN-Sen) *
Kathy Hochul (NY-26)
Ron Kind (WI-03)
Larry Kissell (NC-08) *
Jim Matheson (UT-02, running in UT-04) *
Mike McIntyre (NC-07) *
Bill Owens (NY-23, running in NY-21)
Collin Peterson (MN-07) *
Nick Rahall (WV-03)
Mike Ross (AR-04, retiring) *
Tim Walz (MN-01)

Shape Up or Pack Up

Image courtesy of www.familyandfriends.org.uk

After some months of planning, the show of this controversial host finally aired. But prior to the that, CH received her share of intrigues. For a quite a time, she was relentless in attacking back her online bashers. When the messages got on her nerves, CH lashed back. In response to her messages, her followers answered with comments that questioned her character and her image. After a while, the public exchanges of online messages stopped.

However, to build up more interest in her new show, the messages that poked fun of CH were used as teaser ads for the show. After a number of postponements, the show finally aired. However, it did not generate as much interest as was expected. Some critics blamed the time slot. Others commented the show was a rehash and offered nothing new. Still, others lamented that CH has lost her luster.

After a month of airing, the show has apparently not improved its ratings. Hence, management sent a memo instructing the production to plan the remaining episodes, including the finale. It turns out, the replacement show is already being planned. Now, people are awaiting for CH's reaction regarding this latest development.

Can you identify who CH is? Please abide by the RULES in writing comments if you want me to post them. Initials and comments that are too explicit will not be accepted.

Follow micsylim on Twitter for the latest update. Please continue to send your juicy stories to michaelsylim@gmail.com. Thank you very much for loving Fashion PULIS.

Love blogging using my new Dell XPS 13 Ultrabook!

Like or Dislike: Dawn Zulueta for Preview

Friday, June 29, 2012

Therapy for smoking kills the pleasure of nicotine

Can't kick cigarettes? A vaccine may one day help by preventing nicotine from reaching its target in the brain, according to research published this week.

Most smoking therapies do a poor job of stopping the habit 70% to 80% of smokers who use an approved drug therapy to quit relapse. Scientists say this is because the targets of existing therapies are imperfect, only slightly weakening nicotine's ability to find its target in the brain.

So some scientists have been trying a different approach creation of a vaccine. It would work like this: People would inject the vaccine like a shot, and the vaccine would create nicotine antibodies, molecules that can snatch up nicotine from the bloodstream before it reaches the brain. The vaccine could be used by smokers who want to quit or people who are worried about getting addicted to cigarettes in the future.

Researchers have tried to create vaccines in the past, but the ones they've come up with have not been particularly effective. The authors of the new study say this may be because previous vaccines just didn't create enough antibodies to get rid of all the nicotine.

The new report, published in the journal Science Translational Medicine, attempts to solve this problem via gene therapy, in which a new gene is inserted into the body to do a particular job.

First the scientists at Weill Cornell Medical College in New York City put a gene that produces a nicotine antibody into mice. The gene was taken into the mice's livers, and the liver started producing the antibody. Once produced, the antibody connected with nicotine, trapping it and preventing it from making its way to the brain, where it would otherwise have caused the pleasurable, addictive effects it is so known for.

Because of this trick, the researchers say that the new vaccine should only have to be injected once, and it will work for life, continuing to produce new antibodies in the liver.

The vaccine was effective: When mice were given nicotine intravenously, ones with the vaccine had a 47-fold drop in levels of nicotine in the blood compared with ones that hadn't received the vaccine. The antibody had successfully captured the nicotine in the bloodstream before it could reach the brain.

The work is still preliminary, and the authors admit the technology is far from ready for human use; it has only been used in rodents so far. But given the results, and the continued public health effect of smoking, it may not be too long before all those boxes of Nicorette are replaced with a single trip to the doctor's office.

By Jon Bardin, Los Angeles Times

Sustainability Storytelling: Faith Morgan Honors Grandfather’s Legacy with Documentary Work

In talking with Faith Morgan, granddaughter of Dayton engineering visionary Arthur Morgan, for my historical novel, I was impressed with how she is keeping her grandfather’s legacy alive.

Arthur Morgan is the innovative engineer who established the Miami Valley Conservancy District and designed Dayton’s permanent flood control solution following the devastating 1913 flood.

What few people know is Morgan’s work as an apostle of small community. During the years of dam building throughout Dayton’s Miami Valley, Morgan created communities with schools and other institutions for his dam workers and their families.

Faith serves as executive director of the Arthur Morgan Institute for CommunitySolutions, a Yellow Springs, Ohio, non-profit organization founded by Arthur Morgan in 1940, after he retired. It advocates for small communities and develops solutions to our climate crisis. She also is an award-winning filmmaker who has delved into documentary filmmaking to shed light on the issues of peak oil and climate change.

Cuba, which experienced a sudden economic collapse in 1990 with the end of the Soviet Union, was the subject of her 2006 documentary film, The Power of Community: How Cuba Survived Peak Oil. The film opens with a short history of Peak Oil, a term for the time in our history when world oil production will reach its all-time peak and begin to decline forever.

Faith Morgan and Pat Murphy in Havanna in 2004, while filming the documentary.

Cubafaced an enormous crisis with the collapse of the USSR, which led to the loss of most food and oil imports to the tiny country.

In the film, we see how Cuba adapted, survived, and thrived because they mobilized their entire culture. Cubans made changes requiring cooperation, adaptability, and openness to alternatives. As one Cuban in the film remarks, “When told they needed to reduce energy use, everybody did it.”

In discussing the documentary, Faith told me that she has now begun work on a second film set in Cuba – this one she hopes to be feature length and to be completed in the next three years.

The new project was sparked after going back to Cuba’s alternative renewal energy conference that is held every two years. She plans to tell a deeper story about Cuba on what the country is doing around renewable energy and sustainable development told from the vantage point of average Cubans.

“It’s really remarkable what they’ve done,” she says. “Out of necessity, they are paving a way and showing how a culture can have decent medical care and have amenities through renewable energy. Their whole goal is to move away from fossil fuels as fast as possible.”

The idea that there are alternative ways to live was emphasized to Faith throughout her growing up years, by her mother, by her father, and by her grandfather.

Sustainability Filmmaking – A Family Affair

She also credits her interest in this type of filmmaking to her husband, Eugene (Pat) Murphy, research director of the Arthur Morgan Institute for Community Solutions. An engineer and a computer scientist, Murphy developed home-building software that reduced house construction waste from 19 percent to 3 percent.

Faith says after 9/11, she and her husband were interested in understanding the undercurrent of hostility that led to the terrorist attacks. They wrote an eye-opening paper called “Burning Times,” covering the history of European colonialism in Muslim countries. In December 2001, they heard a presentation by Richard Heinberg, author of The Party’s Over: Oil, War and the Fate of Industrial Societies.

“I was shocked. I came from an agricultural background,” recalls Faith, who immediately thought about food-supply implications for societies that continue to depend on petro-chemicals. The couple attended numerous Association for the Study of Peak Oil conferences in Europeand decided to write about the issue through their non-profit.

To date, they’ve written three books, the latest Plan C: Community SurvivalStrategies for Peak Oil and Climate Change.

I asked Faith how her grandfather would view her current work given that energy was not in the forefront when Arthur Morgan was alive.

Noting that he was an avid outdoorsman deeply in tune with the natural world, Faith says, “I think he would be moved by the destruction and depletion of resources that is occurring. He would be happy [about my work].”

As for her own passionate commitment to climate issues, renewable energy and sustainability, Faith concludes, “It goes with the family tradition to care about the world.”

______________________________________

Check out this LinkTV interview with Faith Morgan and Pat Murphy about the making of the documentary.

California's Cruel And Unusual Death Penalty 40 Years And $4 Billion After Furman v. Georgia

San Quentin State Prison

40 years ago today, the United States Supreme Court decided Furman v. Georgia, which struck down existing death penalty laws as unconstitutional in violation of the Eighth Amendment's cruel and unusual clause. California's death penalty was quickly reinstated.

Attempting to comply with Furman, the new statute made the death penalty mandatory for certain first degree murders and other crimes. But in 1976, the U.S. Supreme Court struck down death penalty laws that provided for mandatory death sentences. The California Supreme Court, relying on the high court's ruling, once again found the state's statute to be unconstitutional.

Undeterred, the California legislature passed a new death penalty law in 1977. This was followed in 1978 by a ballot proposition, known as the Briggs Amendment, which was similar but more expansive version that sought to encompass more -- virtually all -- categories of murder (including unintentional murders committed during certain felonies). Briggs passed and it is the law we are living with, so to speak, today.

Forty years after Furman: $4 billion dollars, over a thousand death sentences, over 720 currently on death row, and 13 executions, none since January 2006.

Tani Cantil-Sakauye, after one year as the Chief Justice of the State of California, has concluded that the state's capital punishment system is "not effective" and requires "structural changes" that the State cannot afford. Her predecessor, Ron George, who was Chief Justice for 15 years, came to the same conclusion, describing California's death penalty scheme as "dysfunctional."

An extensive study by Arthur Alarcon, long-time judge of the Ninth Circuit Court of Appeal, who, together with law professor Paula Mitchell, determined that California's death penalty system is currently costing the state about $184 million per year. They concluded that "since reinstating the death penalty in 1978, California taxpayers have spent roughly $4 billion to fund a dysfunctional death penalty system that has carried out no more than 13 executions."

Justice Byron White observed in Furman that:

When imposition of the penalty reaches a certain degree of infrequency, it would be very doubtful that any existing general need for retribution would be measurably satisfied. Nor could it be said with confidence that society’s need for specific deterrence justifies death for so few when for so many in like circumstances life imprisonment or shorter prison terms are judged sufficient, or that community values are measurably reinforced by authorizing a penalty so rarely invoked.”

The infrequency of executions and the randomness with regard to which condemned inmates actually will be executed have made a mockery of the supposedly rational justifications for the death penalty. In addition, given the current backlog and the serious problems identified by the California Commission for the Fair Administration of Justice (CCFAJ) -- problems that would require an enormous influx of state funds to fix -- it simply is not possible that defendants who are only now being sentenced to death will have their death sentences carried out. Because it is “so wantonly and so freakishly” used, California’s death penalty has become a wholly arbitrary punishment in the same sense as the death penalty laws that were struck down in Furman.

Justice Potter Stewart famously characterized the Texas and Georgia statutes at issue in Furman as being “cruel and unusual in the same way that being struck by lightning is cruel and unusual.” What he meant was that of all those who committed death eligible crimes, the petitioners were “among a capriciously selected random handful upon whom the sentence of death has in fact been imposed . . . [and] the Eighth and Fourteenth Amendments cannot tolerate the infliction of a sentence of death under legal systems that permit this unique penalty to be so wantonly and so freakishly imposed.”

Application of Furman’s benchmark for determining arbitrariness demonstrates that only a “capriciously selected random handful” of death-sentenced inmates in California will actually be executed. A new death row prisoner would have to get in line behind 720 condemned inmates. He or she would then have to wait years for appointment of appellate counsel (currently a 5 year wait) and even longer for the appointment of state habeas counsel (8-10 years). Even after these lawyers are appointed and appellate briefs and habeas petitions are filed, the case will not be heard and decided before the several hundreds of cases that have preceded it. And then, after all this time and expense, the California Supreme Court, in virtually every case regardless of the merits, will uphold the death sentence. Then the case moves on to federal court, which has its own backlog, and often requires new counsel, with proceedings currently averaging over six years in district court followed by over four years of appellate review.

Justice White noted in Furman that where the “penalty is so infrequently imposed that the threat of execution is too attenuated to be of substantial service to criminal justice” it is unconstitutional. As he stated, when the death penalty “ceases realistically to further [the social ends it was deemed to serve] . . . its imposition would then be the pointless and needless extinction of life with only marginal contributions to any discernible social or public purposes. A penalty with such negligible returns to the State would be patently excessive and cruel and unusual punishment violative of the Eighth Amendment.”

We have far surpassed this point in California.

The SAFE California Act is on the November ballot. If it passes it would replace California's multi‑billion dollar death penalty with life imprisonment without parole and require those convicted of murder to work and pay restitution to victim families through the victim compensation fund. It would also set aside $100 million in budget saving for local law enforcement for the investigation of unsolved rape and murder cases.

Please join the effort to replace the death penalty by clicking here: SAFE California.

Experts disagree on whether states will choose to expand Medicaid

Experts disagree on whether states will choose to expand Medicaid, a crucial, but voluntary, part of the federal health-care reform law. Yesterday, the Supreme Court ruled the federal government could not force states to expand the system for the poor and disabled, but that the expansion itself is constitutional.

Yesterday, both Gov. Steve Beshear and Senate President David Williams both indicated they are researching how Kentucky should proceed.

U.S. Sen. Lamar Alexander, R-Tenn., said "many states, maybe most, will decide that they simply cannot afford to choose to expand Medicaid." Though the federal government will pay for the newly eligible enrollees for several years after the law takes effect in 2014, states will eventually have to pay 10 percent of the cost.

Despite the expected cost, Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that "only a small number of states" will pass up the opportunity to expand, given the federal government's generous offer, reports Robert Pear for The New York Times.

The Medicaid expansion is central to the health care law, since about 17 million of the 30 million Americans who will newly qualify for health insurance will do so under Medicaid. In Kentucky, that translates to 280,000 more people enrolling in the program.

Senior administration officials said they feel sure states will choose to expand Medicaid, but Republican governors like Mitch Daniels in Indiana and Bob McDonnell in Virginia would not commit either way. Daniels said the expansion would cost Indiana $2 billion in the next 10 years.

And though U.S. Sen. Max Baucus, D-Mont., is one of the authors of the new law, he was not sure his own state would opt to expand. He did call the offer of federal assistance "a big juicy carrot." (Read more)

Useful list helps explain health care law and Supreme Court ruling

To learn more about the U.S. Supreme Court ruling on the federal health-care reform law, as well as the Affordable Care Act itself, the Detroit Free Press has put together a list of helpful websites that elucidate the issues.

The list would be helpful to reporters interested in localizing the impact of the law.

Click here for the list, compiled by reporter Pat Anstett.

Don't leave children in hot vehicles this weekend, officials warn

With extreme heat blazing over the state this weekend, the Kentucky Cabinet for Health and Family Services urges the public to avoid leaving children in vehicles.

"Extreme temperatures are cause for concern, so we advise the public to take necessary steps to keep cool and prevent harm," said Dr. Steve Davis, acting commissioner for public health. "Serious injury — particularly for children exposed to extreme levels of heat — can occur. Everyone should take steps to avoid these dangers."

Last year, 33 children died of heatstroke, also known as hyperthermia. In 2010, there were 49 deaths, according to a cabinet press release.

More than half of child heat stroke deaths happen because parents and caregivers forget the child is in the car. To prevent this from happening, drivers should place a cell phone, purse or briefcase on the floor in front of the child to trigger their awareness. They can also set an alarm to remember to drop their child off at day care.

Parents should not underestimate the risk, since vehicles can heat up very quickly even on relatively cool days. A child's body temperature increases three to five times faster than adults, making them especially vulnerable to heat.

Thirty percent of heat stroke deaths happen because a child was playing in a vehicle that was left unattended. Parents should remember to lock the vehicles to avoid the children being able to enter them.

If a bystander sees a child unattended in a car, he or she could call 911 immediately. (Read more)

New Kentucky Medicaid commissioner appointed

In the face of serious turmoil caused by the move to managed care for Kentucky's poor and disabled, a new Medicaid commissioner has been appointed. Lawrence Kissner starts his new job July 1.

Gov. Steve Beshear acknowledged the privatized system, now run by four managed-care companies, has run into some bumps and said he feels Kissner will "ensure that the Medicaid program is more cost efficient and, most importantly, more effective in providing high quality care to the Kentuckians we serve."

Kissner has nearly 30 years experience in the private insurance industry, 17 of which were specifically in managed care. Most recently he was president and CEO of Magnolia Health Plan in Jackson, Miss., a managed care company. In Kentucky, he will over see the program which serves more than 800,000 Kentuckians. He replaces acting commissioner Neville Wise, who has spent more than 22 years in various positions in the Medicaid program. He will remain with the department. (Read more)

Women's, Health Care Groups Applaud ACA Decision While Bishops Attack

By Jodi Jacobson, cross-posted from RH Reality Check

Reaction by women's groups and promoters of health reform to this morning's Supreme Court decision upholding the Affordable Care Act (ACA) was swift and laudatory, though numerous leaders also pointed the gaps that remain to be filled.

In a statement, Robert Greenstein of the Center for Budget and Policy Priorities said:

Today’s Supreme Court decision allows the nation to reap the very substantial benefits of the Affordable Care Act: health insurance coverage for millions of uninsured Americans, important consumer protections for millions of insured Americans whose coverage has serious gaps, and the promise of progress in slowing the growth of health care costs.

Still, Greenstein noted, "for both states and the federal government, much work lies ahead to establish health insurance exchanges, set up enrollment processes that work smoothly both for the exchanges and Medicaid, and complete other critical tasks by the 2014 deadline. The timeframe is short, particularly in states that have made little progress since the law’s passage."

Women's groups were particularly relieved at the positive outcome of the SCOTUS decision, because, on the whole, the ACA has been considered a huge advancement in coverage of preventive and other forms of care often out of reach of women, who make less than men overall throughout their lives, and who, as they enter retirement, are more likely to be poor.

The decision will have a “profound and concrete impact” on millions of people’s lives, Planned Parenthood Federation of America (PPFA) said today in a statement. Calling the Affordable Care Act “the greatest advance in women’s health in a generation,” PPFA said the law will:

"provide access to birth control and cancer screenings without co-pays, guaranteed direct access to OB/GYN providers without referrals, and an end to discriminatory practices against women, such as charging women higher premiums and denying coverage for “pre-existing conditions.”

In addition, noted the National Women's Law Center (NWLC) millions of women and their families can rest assured they will no longer be denied health coverage for having survived domestic violence or rape, or having had a Caesarean section, that maternity care will be included in all health care plans, and that tens of millions of women will gain financial access to coverage, whether through Medicaid or through help with insurance premiums.

Key benefits of the law that have already been realized, according to PPFA, include the following:

More than 45 million women have already received coverage for preventive health screenings at no cost since August 2010 – including mammograms and Pap tests – and millions more will be able to get free screenings in the coming years.

More than 3 million young adults have been able to stay on their parents’ insurance plan under the ACA to date, and in the next year, millions more who would have otherwise lost coverage will continue to be insured under their parents’ plan.

Women are guaranteed direct access to OB/GYN providers without a referral, as a result of the Affordable Care Act.

Starting in August, birth control will be treated like any other preventive prescription under the Affordable Care Act, and will be available without co-pays or deductibles.

As a result of the Affordable Care Act, notes PPFA, 17 million women will become newly insured.

Health care providers that focus on family planning increasingly contract with private insurance companies. According to the Guttmacher Institute, 33 percent of all family planning providers now contract with private insurers – and 49 percent of Planned Parenthood health centers have contracts with private insurance companies.

With this decision, "we are closer than ever to realizing the promise of health care for all," said Cecile Richards, president of PPFA.

The National Latina Institute for Reproductive Health (NLIRH) likewise applauded the decision as "a significant victory for Latinas, who are more likely than other groups to face structural barriers that prevent them from accessing health care and preventive services."

“Latinas have historically faced a disproportionate number of barriers to basic health care, and we can now envision a future where those barriers begin to crumble,” said NLIRH executive director Jessica González-Rojas. “Everyone has a fundamental right to quality, affordable health care. Today’s Supreme Court decision is an important step toward making that right a reality.”

Gonzales noted that, since it took effect, the ACA has already helped more than 736,000 young Latino/as retain health care coverage under their parents’ plans until they reach the age of 26, and has eliminated discrimination by health insurers against children with pre-existing conditions. In the coming months and years, she continued:

"ACA provisions will expand access to life-saving cervical cancer screenings and other preventive health services, increase support for community health centers and increase Medicaid coverage. Beginning in August, the ACA also provides access to contraception without expensive co-pays, ensuring that every woman can plan the timing and spacing of her children."

“The Affordable Care Act is a breakthrough in access to health care for Latinas,” said González-Rojas. “Today’s Supreme Court decision ensures that Latinas can make the healthiest decisions for themselves and their families.”

But, while the gains achieved in the ACA are a step in the right direction, Gonzales notes, much work remains to be done.

The law leaves many immigrants without access to essential care. In addition, opponents of expanded health care access continue to launch attacks on numerous benefits included in the law, particularly on the provision for contraception without co-pays. The National Latina Institute for Reproductive Health will continue to advocate for solutions that close these gaps in health care.

However, at least one group, the United States Conference of Catholic Bishops, made clear it would continue to fight to prevent women from accessing affordable reproductive health care under the ACA, using the same specious arguments it has made all along.

In short, today's decision was a huge step forward, but in reality just that... a step forward in an ongoing effort toward ensuring access to affordable health care for all.

GOP: Boldly Offering Solutions To Our Nation's Symptoms

By Tina Dupuy, cross-posted from her website

Nothing says leadership more than bravely standing up against a concern that’s not actually a problem. We’ve had a one-sided battle with Sharia Law in the U.S. No one is fighting for replacing U.S. law with an Islamic moral code, but nonetheless Republicans are heroically fighting against it. Same with aborted fetuses in commercial food stuffs: Not something that’s ever happened but earlier this year Republican freshman Oklahoma state senator Ralph Shortey had the temerity to introduce a bill to outlaw it.

Republicans love what they call “simple solutions” but it’s really just the easiest possible answer to a trumped up crisis. In short: busy work. America needs to streamline for the challenges of the future so we can remain competitive (blah blah blah). Yet Republican offers are akin to organizing all the paperclips in the office by color and size.

Republicans and bureaucracy are, after all, frenemies. Sure they tell the media they despise bureaucracy but secretly love it when it makes them appear to be doing something. Even better if it keeps them from doing anything difficult.

For example: We’re in the middle of an obesity epidemic. It’s the number two leading cause of preventable death in this country. The Center for Disease Control estimates 112,000 American deaths a year due to obesity, this is down from their previous estimate of 365,000 deaths from poor nutrition and physical inactivity. The CDC reports in 2008 Americans forked over $147 billion in medical costs on obesity. We’re dying and going broke from being too fat.

But what are Republicans trying to warn us against? Terrorism. China. Russia. Obamacare. ACORN. The New Black Panthers. The Fed. All of which cumulatively killed no Americans last year.
It’s (ironically) lazy to try to and scare Americans about some elusive menace in order to avoid the reality that we’ve become the proverbial elephants in our own living rooms.

Illegal immigration? Republicans say to secure the border—build a fence—arrest anyone who even looks illegal. Mitt Romney said Arizona’s infamous SB 1070 should be a model for the nation. Which would be something if Mexicans were still coming into the U.S. They’re not. Immigration from Mexico is now net zero. That is actually a way bigger problem than undocumented workers (whom we love in boom times for a way to circumvent the minimum wage and exploit a non-litigious underclass). It’s the fact we are no longer an attractive enough country to motivate Mexicans to come here.

But as we saw last week with the Supreme Court ruling on Arizona’s law, governor Jan Brewer’s just doubled down on a non-problem, “We cannot forget that we are here today because the federal government has failed the American people regarding immigration policy, has failed to protect its citizens, has failed to preserve the rule of law and has failed to secure our borders.”

For a party that likes to peddle free market and common sense they sure get a lot of traction ginning up irrational fears.

Our energy plan is stuck firmly in the last century, but that’s not the point the presumptive Republican nominee decided to make. In March Mitt Romney told Fox News President Obama “has done everything in his power to make it harder for us to get oil and natural gas in this country, driving up the price of those commodities in the case of gasoline.” Gas prices were the thing Republicans were going to fix by paying attention to them! With little fanfare, gas prices are down now by the way. Production has increased overall under the Obama administration. Republicans managed to sound the alarm and assign blame for a symptom while steadfastly avoiding the cause entirely.

Think I’m way off here? Remember this is the party that in the wake of September 11^th—an attack by citizens of Saudi Arabia, organized in Afghanistan by a leader hanging out in Lebanon—decided to invade (wait for it) Iraq.

Because things indirectly involved with real problems hate us for our freedoms.

Making a Comeback

Image courtesy of www.designers-books.com

Months before the launching of a new talent show, the creative team of the network had already conceptualized the format and the line up for their hosts. Those in charge included a manager turned network executive, a retired media executive, an award-winning director, an experienced producer, among others. Most of the members of the team were veterans from their former networks, so they knew what would make a show click with the audience. The hosting job was first offered to a hunk actor (HA). Negotiations failed because HA turned down whatever the network offered him. Besides, if HA had accepted the offer, then he would eventually bump into a controversial personality, with whom he had fallen out of grace. The other names that cropped up for the main hosting chores were sporty actor (SA), model host (MH), and poised actress (PA).

After the team handed down their proposal to top management, they were surprised with the choice of the host. Although he would have been the perfect choice, SA could not be the host because he had another assignment. SA publicly admitted that this assignment was one of the offers he considered when he made the big move. Top management had another name (AN) in mind. The team was shocked. Some reactions centered on AN’s being past his prime, therefore, he was no longer that popular. Then the media executive raised the point that AN is not a skilled host unlike MH and PA. Then, top management said that it was willing to double the prize for the show's grand winner as long as AN would be the host. The big pot can help boost the ratings and perhaps, rescue the career of AN.

Since the network had already ran out of personalities to pirate, and the directive came from the top, the team had to settle for AN. With this new assignment, AN firms up his position in the network. Will AN do wonders for the new talent show? Will the new talent show help the network gain a bigger share of the audience? Is top management showing early signs of favoritism as AN has only been recently signed up by the network?

Can you identify all the characters in the story? Please abide by the RULES in writing comments if you want me to post them. Initials and comments that are too explicit will not be accepted.

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Esquire Philippines vs. Esquire USA

Sign Krugman's "Manifesto For Economic Sense"

By Isaiah J. Poole, cross-posted from Campaign for America's Future

Tom Tomorrow

Economists Paul Krugman and Richard Layard, the latter of the London School of Economics, today posted a "Manifesto for Economic Sense" that lays out a sound framework for reviving the global economy.

"I’ve been arguing for a long time that policy makers have misunderstood the nature of our economic crisis, mistaking symptoms for causes, and responding in ways that make the situation worse," Krugman wrote yesterday on his blog at The New York Times. The goal of the manifesto is, in the words of the manifesto itself, to "offer the public a more evidence-based analysis of our problems" and change the direction of the economic debate away from austerity and toward using government as a kindle for rebuilding the middle class.

"A key priority now is to reduce unemployment, before it becomes endemic, making recovery and future deficit reduction even more difficult," the manifesto says.

Many of the signatures on the manifesto are those of economists and policy experts, but you are encouraged to sign the manifesto as well to show your agreement with its basic principles.

In an op-ed in the Financial Times, Krugman and Layard explained the thinking behind the manifesto. "More than four years after the financial crisis began, the world’s major advanced economies remain deeply depressed, in a scene all too reminiscent of the 1930s," the piece begins, because their economic leaders, and conservatives in the United States, insist on replicating the failed economic strategies of the 1930s before the New Deal.

Instead, the manifesto calls for economic experts and policy makers to speak up more loudly against the arguments that "austerity will increase confidence and encourage recovery"—there is no evidence that austerity policies are having that effect anywhere in the world—and that a key causes of our weak economic recovery are structural, rather than a general lack of spending and demand.

The statement echoes the same themes of our own 2010 "Don't Kill Jobs" economic manifesto, signed by more than 300 economic experts. That statement urged the president and Congress to "redouble efforts to create jobs and send aid to the states whose budget crises threaten recovery by forcing them to lay off school teachers, public safety workers, and other essential workers. It also makes sense to invest in public service jobs—and in infrastructure projects for transportation, water, and energy conservation that will make our economy more productive for years to come."

If our political leadership had taken that message to heart in 2010, it would not have been necessary for Krugman and Layard to post their own manifesto with the same message. But Washington conservatives still refuse to admit the failures of their policies and end their wrong-headed obstruction in Congress. It's exasperating to have to repeat the message over and over, but as the Krugman-Layard manifesto concludes, "The whole world suffers when men and women are silent about what they know is wrong."

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2 weeks:

Facebook's user growth rate in the U.S. is slowing sharply http://goo.gl/wGO4c

Making social media work professionally in sensitive jobs – teaching, the police, healthcare http://goo.gl/ywfSP

A Brief Social Media Guide for Authors of Medical Resources http://goo.gl/6n17e

Phil Baumann: I hope that there is never ever going to be a “Facebook for Healthcare” http://goo.gl/hh3cI

Are hospitals into social media? A worldwide map: http://goo.gl/AAly2

Cleveland Clinic summit on Patient Experience shares presentation slides - a must-read for those interested in #HCSM http://goo.gl/EnMbK

Vote for 100 Most Influential People in Heathcare http://goo.gl/LXOhd - Not a single medical blogger apart from @Bob_Wachter made the list

10 Survey Tools for Bloggers http://goo.gl/8z21Y

Doctors use YouTube to build their personal brand by putting their expertise on video http://goo.gl/BQkGU

Millions of Healthcare Hashtags in the Symplur project - a vast database of information that can mined http://goo.gl/099ld

4 ways social media can improve your medical practice - AMA MedNews http://goo.gl/4b2RZ

2012 Physicians Survey reveals dissatisfaction and gloomy outlook - Orthopedic surgeon Howard J. Luks, shows the way forward http://goo.gl/eBzUA

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive an acknowledgement in the next edition of this publication.

Thursday, June 28, 2012

R.I.P. Samuel Lopez

On June 27, 2012, Arizona executed Samuel Lopez for the rape and murder of 59-year-old Estefana "Essie" Holmes.

Lopez's attorneys argued that his trial lawyers provided constitutionally ineffective assistance by failing to present any evidence of Lopez's horrific childhood, which would have been critical to the jury's determination of whether he should be sentenced to life or death. The jury never learned, for example, that Lopez's childhood was filled with poverty, neglect, abuse and periods of homelessness during which he often had to sleep in cemeteries. Lopez dropped out of school in the ninth grade and became addicted to sniffing paint.

Lopez was originally scheduled to be executed on May 16, 2012, but received a temporary stay of execution because of serious issues with regard to the fairness of the clemency process. On May 7, 2012, defense attorney, Assistant Federal Public Defender Kelley Henry, walked out of the clemency hearing claiming the Arizona Board of Executive Clemency did not have the authority to hear the case. Henry contended that Arizona Governor Jan Brewer violated several state statues when she appointed three new members to the five member clemency board. Violations included that the new members had not completed training required by state statute, that their interviews violated open meeting laws by taking place behind closed doors, and that one new member is a lobbyist for a police association that advocates the death penalty.

The Arizona Supreme Court ordered a temporary stay so that the board members could complete a mandatory four-week training course but then another stay was sought on the grounds that Governor Brewer had appointed "political cronies" to the board, making a fair hearing impossible. That stay was rejected. Clemency was denied on June 22nd.

This is the 23rd execution in the United States in 2012, the fourth in Arizona.

Senior Life Insurance: Burial Insurance for Seniors up to 89 years old

Burial life insurance is designed to relieve financial burdens upon the death of an individual. Burial life insurance can be designed to pay one lump sum in the event of a death directly to a funeral home or if the policy is large ($25,000+), it can just be paid to a beneficiary who in turn will take care of burial costs and other obligations. There are no restrictions on how the money can be used but care should be taken to make sure that the policy is set up properly and paid out in the most favorable way to avoid unnecessary taxes and/or probate costs.

Type of Burial Life Insurance Plans

Burial Life insurance can come with three options, term life, whole life and universal life. Availability varies by age and health history. Universal life and Whole life insurance normally stay in force for the duration of Your life. Burial term life will expire after a pre-determined amount of time or if continued past a certain term period, rates will go up (at times very high).

Request a burial Life Insurance Quote

No Exam Burial Life Insurance

One popular plan, particularly with Seniors 65 to 89, is no exam burial life insurance. It allows an insured to secure a life insurance policy fast and simply. In most situations only an application and a phone interview is needed. The amount of coverage may be limited to $100,000 or less.

Most importantly, burial life insurance coverage should be designed to stay in force until death. If needed, a separate policy may be considered to provide more benefits and options for policy holders.

You do not have to meet with an agent to get the plan You need. We have developed a simple method to get seniors the coverage they need without having to waste time with in house or office visits from an agent or broker.

Request a burial Life Insurance Quote

Who should be the owner of the policy?

In most cases, if you, as the child, are paying for the policy, then you should most likely be the owner. On the other hand if your parent is paying for the life insurance, he or she has a bigger say in that decision. If your mother or father is relatively young 60 and under, then having them as the owner should be OK. You may still want to consider a shared ownership. If your parent is older than 60, we recommend that your take ownership of the life insurance policy or at least share in the ownership.

Why should you have any ownership rights?

The answer is actually simple. For as long as your mother or father is mentally capable then no problem. But, if at some time in the future they become unable to think for themselves, then, as the owner, they may not be able to make needed changes to the insurance policy or worse make the wrong changes without consulting anyone. Some children do have a power of attorney over their parent but we feel that full ownership or at least shared ownership is an important safety. The more you can keep things out of the legal system the better. Particular once problems arise.

Another issue that may arise is with medicare. When the government decides on what your parent qualifies for in medicare benefits, a whole life insurance may be an issue and your mother and/or father may get less or no benefits form the government. So, please check!

Call us at 813-964-7100 or get a quote: http://www.mintcofinancial.com/quotes/final-expense-life-insurance-quote/

Hail To The Chief Justice?

DonkeyHotey

Let's not get carried away by the fact that Chief Justice Roberts voted with the so-called liberal-moderate block to uphold the Affordable Care Act. Let's not forget, as Ethan Bronner of the New York Times writes, that "in the past, especially on campaign finance law but also on other socially sensitive issues like abortion and affirmative action, Chief Justice Roberts has not shied away from leading a conservative redraft of previously established law, causing some to accuse him of judicial activism."

But with the reputation, perhaps legitimacy, of the Supreme Court at stake, Roberts decided to find a way to validate the Act.

As Steven Teles predicted, Roberts did not want "a direct confrontation with the entire Democratic Party. Striking down the substance of the ACA would have created such a confrontation, and put the Supreme Court at the center of the next election. I don’t think Roberts had a stomach for that."

Teles uses a baseball metaphor to demonstrate the difference between Roberts' approach and that of his fellow conservatives on the bench:

The best way to understand the difference between Roberts and the dissenters is to think of two pitchers who are throwing to a batter who is crowding the plate. The first pitcher throws at the batter’s head, while the second brushes him back. At least in this decision, Roberts decided to be that second kind of pitcher. Roberts wanted to send a signal to the other branches that there are limits on government, and the ACA was really crowding the plate. But he didn’t want to hit the pitcher and invalidate the whole law. So declaring that the mandate violates the Congress’ power under the commerce clause but upholding it as a tax does what Roberts wanted to do: get Congress to pay closer attention to constitutional norms while not precipitating a bench clearing brawl.

I'm not sure I buy Teles' overarching point (and that of others, such as Laurence Tribe) in the wake of this ruling that Roberts is not really a radical ideologue. As Ed Kilgore observes, "Roberts exercised 'judicial restraint;' at the same time, however, he managed to deliver not only his 'brush-back pitch' but a nice, easy talking point about ACA relying on a 'tax.'"

And it is unrealistic to think that Roberts has magically undergone some kind of transformation. As law professor Adam Winkler points out, the Roberts Court has hardly been known before today for its judicial restraint:

Since John Roberts became Chief Justice in 2005, the Court has issued one landmark ruling after another. The Roberts Court gave us Citizens United, which struck down longstanding limits on corporate political spending. This Court also allowed new restrictions on women's right to choose; became the first Supreme Court in American history to strike down a gun control law as a violation of the Second Amendment; effectively outlawed voluntary efforts by public schools to racially integrate; and curtailed the reach of environmental protections.

In many of these decisions, the Roberts Court overturned or ignored precedent, including Rehnquist Court decisions less than a decade old. Prior to Citizens United, the Supreme Court had explicitly held in two cases that corporate political expenditures could be limited -- the most recent of which was handed down in 2003. Six years before the Roberts Court upheld the federal ban on "partial birth" abortion, the Rehnquist Court, which wasn't known for its liberal leanings, had overturned a nearly identical law.

Significantly, although Roberts agreed with the four conservative justices that the individual mandate was not a regulation of interstate commerce, he ultimately voted to uphold the constitutionality of the mandate by characterizing it as a tax. While his vote saved the Act, Justice Ginsburg cautioned that Roberts' view comprised a "novel constraint on Congress’ commerce power."

In the Social Security Act, Congress installed a federal system to provide monthly benefits to retired wage earners and, eventually, to their survivors. Beyond question, Congress could have adopted a similar scheme for health care. Congress chose, instead, to preserve a central role for private insurers and state governments. According to The Chief Justice, the Commerce Clause does not permit that preservation. This rigid reading of the Clause makes scant sense and is stunningly retrogressive.

As Amy Davidson notes, “stunningly retrogressive” is not the phrase most people are using this morning to describe Roberts’s opinion; he is being celebrated as a moderate, called a disappointment to conservatives. But Ginsburg’s caution is worth watching. (See Professor Tobias Wolff's comments on the extraordinarily disruptive potential of Roberts' reasoning.)

But, as Winkler notes, "with this deft ruling, Roberts avoided what was certain to be a cascade of criticism of the high court. No Supreme Court has struck down a president's signature piece of legislation in over 75 years. Had Obamacare been voided, it would have inevitably led to charges of aggressive judicial activism. Roberts peered over the abyss and decided he didn't want to go there."

Chief Justice Roberts undoubtedly had the Court's institutional legitimacy and his own reputation in mind when he voted to uphold the Affordable Care Act. And, more disturbingly, as Winkler predicts:

Roberts may have voted to save healthcare because he wants to preserve the Court's capital to take on other big issues heading toward the Court. Legal experts predict the Roberts Court will invalidate a key provision of one of the most important laws in American history, the Voting Rights Act, next term. And the Court is set to end affirmative action in public education. Both policies have been centerpieces of America's commitment to civil rights for over 40 years.

It is therefore ridiculous to analyze Roberts' legacy based on this one ruling. As Winkler concludes, "The Roberts Court has only just begun."

As high court upholds health care law, Beshear orders creation of state insurance exchange; questions remain about Medicaid

Journalists wait to hear the Supreme Court's ruling.
(Associated Press photo by Evan Vucci)

By Tara Kaprowy
Kentucky Health News

Voting 5-4, the U.S. Supreme Court has upheld the federal health-care reform law, the core of which requires individuals to get health insurance or pay a fine.

The decision means about 280,000 more Kentuckians will qualify for Medicaid, and about 220,000 will qualify for insurance under a state exchange where they can choose from various policies. More than 900,000 Kentuckians who were previously denied coverage for pre-existing conditions will now also be able to get coverage.

"More people will have access to health insurance is the short answer when it comes to the impact this will have in Kentucky," said Anne Hadreas, attorney for the Kentucky Equal Justice Center. "People with low incomes and moderate-income people will not have to worry about choosing between getting a breast cancer screening and putting food on the table."

Those who are newly eligible will be able to get health insurance in two ways. Individuals with an income as much as 400 percent above the poverty level will be able to buy insurance through a state insurance exchange, an insurance marketplace where people can choose from several plans. As he said he would, Gov. Steve Beshear ordered the creation of such an exchange today, noting that "Kentucky has been systematically preparing to meet the implementation deadlines set forth in the bill as a precautionary matter." Individuals who are part of the exchange will get federal subsidies to help pay their premiums.

The other means to get coverage will be through the law's expansion of Medicaid coverage. People who have an income 133 percent above the federal poverty level will qualify for Medicaid starting in 2014.

Though the Supreme Court also upheld the the law's Medicaid expansion, it ruled the federal government could not take away existing Medicaid funding from states that decide to opt out of the expansion. If Kentucky opts to expand Medicaid, it will eventually cost the state money. For the first five years, the federal government will foot the bill for those who are newly eligible. But in 2019, states will have to start paying 10 percent of that sum. Beshear has expressed concerns over how the state will do that. Spokespersons for Beshear and Senate President David Williams both said they are researching the matter.

John Barro of Bloomberg News predicts that all states will opt for expansion because the federal government will pay for it in the early years. "That's a pretty big carrot," he writes. "States that refused to expand Medicaid will be rejecting nearly free federal money. Such a rejection would be tantamount to saying that government health insurance for low-income people is so undesirable that a state is not even willing to pay 10 cents on the dollar for it." For more on Medicaid, the states and the politics of the issue, see this post on The Rural Blog.

At the center of the Supreme Court debate was whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. Insurance companies agreed to stop denying coverage due to pre-existing conditions because of the mandate, which grows their pool of customers by 30 million people. But if the mandate had been struck down and insurance companies still couldn't refuse customers because of pre-existing conditions, premiums would have skyrocketed.

The Obama administration said the individual mandate was constitutional under the commerce clause of the Constitution, which states that Congress can use its powers to regulate interstate commerce. Chief Justice John Roberts rejected that argument but sided with the court's four liberal justices because a penalty for refusing to buy health insurance — which is part of the mandate — is the equivalent of a tax.

Aside from more Kentuckians being eligible for health insurance, the law will mean:
• Children will be able to stay on their parents' insurance up to the age of 26.
• The Medicare "doughnut hole" in prescription drug coverage will be eliminated, something that will impact 129,000 Kentuckians.
• Health plans will be required to cover preventive services like screenings.

And, though "today's ruling is no way going to diminish the toxicity and politicking on both sides," most people agree children will benefit, said Terry Brooks, executive director of Kentucky Youth Advocates. He said the law provides additional oral health coverage, allows foster children to keep health insurance coverage until the age of 25; and provides "a dedicated stream of revenue for school-based health services."

But Sen. Mitch McConnell, R-Ky., issued a statement calling the law "terrible," saying it has "limited choices," "increased health care costs" and "made it harder for American businesses to hire." He said Congress must act to repeal what he called a misguided law.

Williams called the ruling a victory for President Obama and Beshear but not for Kentucky's small- or medium-size businesses owners.

Whether Kentucky has the medical infrastructure for 500,000 more people having health insurance is uncertain. In Jefferson County alone, 455 primary-care doctors will be needed by 2020 — almost as many who work in medical practices now, Patrick Howington reported for The Courier-Journal this year. "I think the provider shortage is definitely a concern," said Jodi Mitchell, executive director of Kentucky Voices for Health. "That's something to be looking at."

As for how individuals should proceed, Mitchell said Kentuckians "need to stay informed during implementation and stay engaged."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Distraught Muse

Image courtesy of www.metalbrasileirounderground.blogspot.com

Sometime ago, the model host (MH) announced to the world that she was very happy in having found a new relationship (NR). People were happy with the announcement of MH but some doubted that her relationship was that serious. After all, she has been known to have had several boyfriends in the past including a radio personality. NR, meanwhile, had just recovered from the break-up (and its messy aftermath) with a funny actress (FA). In interviews, NR cleared doubts that he was two-timing FA with MH. Let’s face it, FA was no match to MH when it came to looks. A few months into their relationship, NR proposed to MH. This engagement left people sceptical but most did not question the power of love. People who saw MH and NR together felt they were really in love. Besides, MH decided to move into the same building as NR.

Months later, while everything seemed quiet, a tragic event happened to MH. What surprised viewers was the absence of NR, who lived some floors away from the flat of MH. People speculated that NR might have been on location so he was not around. Later, MH admitted that she and NR have broken up, but there was no third party involved. As to why NR was not around during that moment, MH did not answer. From a reliable source, the reason why their relationship ended was that NR felt MH was suffocating him. MH was always around and he needed the space. Moreover, MH had terrible mood swings and was very jealous. Allegedly, she is bipolar.

When the tragedy happened, NR was not as bad as he was pictured. He checked on MH through the guards of the building. He just did not want to show himself to MH. NR also admitted that it was his fault that they got engaged too early. Well, it seemed that MH was not the muse NR was looking for.

Can you identify all the characters in the story? Please abide by the RULES in writing comments if you want me to post them. Initials and comments that are too explicit will not be accepted.

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Like or Dislike: Heart Evangelista for Cosmopolitan

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The Affordable Care Act Survives

DonkeyHotey

Before the Obama Administration embraced individual mandates as a compromise to push through health care reform, it was a Republican idea (endorsed, of course, by then-Governor Romney). And when Republican state Attorneys General began challenging the constitutionality of the law their actions were viewed with derision by most legal scholars. And prior to oral argument in the Supreme Court, it was widely assumed that the law would be upheld. Since then dire predictions about the fate of the law, of health care for Americans, and of President Obama's re-election prospects have dominated the media.

It was perilously close -- another 5-4 decision -- and it took Chief Justice Roberts to side with the majority in upholding the Affordable Care Act because the usual swing vote, Justice Kennedy, dissented.

From Scotusblog:

Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial — feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.

As Greg Sargent explains: "The court ruled that the mandate is defensible as a 'tax.' In so doing, it supported the administration’s argument that it’s within the proper scope of federal authority to incentivize the purchase of health insurance, in order to expand coverage to millions of Americans who have been left behind by the private market."

Democrats will breath a sigh of relief while Republicans plot their next move to gut the law. Which brings up a fascinating point about the entire debate on health care: how our polarized politics have radically altered what used to be a bi-partisan consensus on at least the ultimate goal -- providing health care to all Americans.

Ezra Klein explains that there was not always such a stark divide between Democrats who are committed to "provide every American with health insurance" and Republicans who are committed to "prevent any American from being forced to have health insurance."

Democrats and Republicans used to argue over how best to achieve universal coverage, but both agreed on the goal. The first president to propose a serious universal health-care plan was Harry Truman, a Democrat. The second was Richard Nixon, a Republican. In the 1990s, when President Bill Clinton was arguing for a national health-care system based on an employer mandate, Republicans were arguing for one based on an individual mandate.

In the 2000s, Romney used the individual mandate to make Massachusetts the first state to actually achieve near-universal coverage. On the national level, Republicans as diverse as Newt Gingrich, Lamar Alexander and Lott joined him. Republicans sometimes like to present their support for the individual mandate as a youthful indiscretion, but as late as June 2009, Charles Grassley, the ranking Republican on the Senate Finance Committee, was telling Fox News that “there is a bipartisan consensus to have an individual mandate.”

As Klein concludes: "The battle over the Affordable Care Act has largely distracted voters from this tectonic shift in the Republican Party. Yet unlike in past elections, in which even the most conservative Republicans argued that we should 'ensure that all Americans would have affordable, quality, private health coverage,' voters this year will choose between one party that supports universal health care and one that doesn’t, with health insurance for as many as 50 million voters hanging in the balance."