The Best Of The Dish Today

Lexington 2

The story of how Mitt Romney helped Barack Obama is now no longer restricted to his terrible 2012 campaign and tone-deaf rhetoric. It also includes Romneycare – the state model for the federal ACA. And a new study on the impact of that reform on mortality is one that deserves to be taken seriously:

The study tallied deaths in Massachusetts from 2001 to 2010 and found that the mortality rate — the number of deaths per 100,000 people — fell by about 3 percent in the four years after the law went into effect. The decline was steepest in counties with the highest proportions of poor and previously uninsured people. In contrast, the mortality rate in a control group of counties similar to Massachusetts in other states was largely unchanged. A national 3 percent decline in mortality among adults under 65 would mean about 17,000 fewer deaths a year.

It’s not the most efficient way to reduce mortality. Harold Pollack argues that “some other interventions such as targeted prenatal care interventions to poor women or evidence-based therapies to help people quit smoking are probably more cost-effective.” But it’s real and suggests a bigger impact on the quality of people’s health than was suggested in the recent Oregon study (and one of the authors was involved in both). Jon Cohn writes it up here; Adrianna McIntyre here. Money quote from McIntyre:

If you think the study’s primary findings are impressive, consider their implications: “mortality amenable to health care” does not just magically decline. If fewer people are dying, that is almost certainly because diseases are being better treated, managed, or prevented—because of improved health. It’s hard to come by data on objective measures of health at the state level, but the “improved health” story is consistent with other findings in the paper: individuals had better self-reported health, were more likely to have a usual source of care, received more preventive services, and had fewer cost-related delays in care.

Since I spent part of today at the doctor’s and at a radiology center, and was using my Obamacare insurance, it was hard not to reflect on this. (I’m on the mend.) I don’t have an ideological position on healthcare – I can see the great benefits of the American private sector, but also its staggering inefficiencies – but I do hold as a pretty core belief that healthcare is not like other goods. It is the condition that allows us to enjoy all other President Obama Visits Boston To Talk About Health Caregoods. And we live in a golden age of medicine, in which my chronic HIV, a death sentence when I was diagnosed, can now be managed, my chronic asthma treated, and my apnea kept at bay. I seriously believe that a wealthy society that allows people to be sick and not have access to care is a disgrace to humanity. And so I believe that the ACA’s signal achievement already in reducing the numbers of the uninsured is a crucial step in the right direction.

Politically, this leads me to a simple conclusion. The GOP offers nothing that can achieve anything like this. They are content that working Americans have to suffer sickness on a regular basis, without care and with health problems metastasizing until they are both far more expensive and far more intractable. They have lied, distorted and confused millions with their propaganda on this. And it should sicken anyone. So, yes, at this point there is a moral difference here between the two parties – a glaring moral difference. And of all this president’s considerable achievements over the last six years, this one we will remember for decades to come. You want to call me an Obama sap for that? Make my fucking day.

Four posts worth revisiting: the rise of a new/old Russophile Germany; how to persuade creationists that global warming is real; a new paradigm in sponsored content (a documentary/advertisement – an adumentary?); and some dogs to make you happy!

The most popular post of the day was my latest takedown of Peggy Noonan’s mindless drivel, followed by the podcast with Hitch on Deep Dish (subscribe for full access!). I’ve been really moved by some of your reflections on that. One reader reaction:

This is me screaming like a prepubescent fagboy.


There are two voices in my head, vis–à–vis religion. One speaks through a manly beard, in tones decidedly not gay-sounding, but pleasantly transatlantic. The other is whisky-cured, and occasionally has a fire beneath it that would not, I sometimes think, sound out of place in the mouth of John the Baptist, or any of the old-school prophets (it’s funny Hitch railed so against tongues of flame, as he had one himself.)

One more:

There is a great hole in the universe where Hitch used to be and I’m very grateful for you and other intelligent, thoughtful, and talented souls (pardon the expression, Christopher) who continue to celebrate him.

I miss him as much as you do. Can you imagine him on Putin? I think he’d probably be in Donetsk as we speak, scribbling and drinking and finding new comrades through the night.

See you in the morning.

(Window view: Lexington, Massachusetts, 8.54 am.)