Wednesday, January 1, 2014

A new year

Happy New Year to all ShrinkRap readers.

The end of 2013 also marks my retirement from clinical practice, although I will continue to do some teaching and consultation for a while.

I will be taking a sabbatical/vacation for the month of January and will let ShrinkRap be silent.    Watch this space for a return in February.

Best wishes for renewed determination to keep our democracy:   fight attempts to restrict some citizens' right to vote;  counter ignorance and bigotry and discrimination;   work to reverse the rapid increase in income inequality;   insist that Congress keep the social safety net and women's right to choose.


Tuesday, December 31, 2013

Obamacare landmark

Over 2 million people have now signed up for health insurance, either through the federal exchanges or the state exchanges.    This is short of the 3.3 million originally expected by this time.  

But it is equally good evidence of how the exchange is working now.   A month ago, only 150,000 had been able to signed up through

Bashing Obamacare is rapidly losing its steam as a political weapon.   By the time the 2014 elections come around, it will be a dead issue.   Republicans will have to find something else to run on.


A brief history of health care reform in the U.S.

1912 -- Former President Theodore Roosevelt campaigned on a national health insurance plan in his bid to be re-elected following Howard Taft's intervening term.  He lost.

1935 -- President Franklin Roosevelt favored creating national health insurance, but the Great Depression intervened.

1942 -- Wartime president Roosevelt instituted wage and price controls.   Since they couldn't offer higher wages, companies began offering health insurance to workers.

1945 -- President Harry Truman called on Congress to enact national health insurance.  It was denounced by the AMA as "socialized medicine" and went nowhere.

1960 -- President John Kennedy campaigned on health care reform but couldn't get it through Congress.

1965 -- President Lyndon Johnson was able to get Congress to pass Medicare and Medicaid.

1974 -- President Richard Nixon wanted to require employers to provide health insurance to workers backed by government subsidies.   Watergate intervened and nothing got passed.

1976 -- President Jimmy Carter pushed mandatory national health insurance;  but economic recession intervened. 

1986 -- President Ronald Reagen signed into law the COBRA plan, whereby employers let former workers stay on the company's health plan for 18 months. 

1988 -- Congress expanded Medicare to include prescription drug benefits.   But older Americans complained about the extra costs and Congress repealed the law.

1993 -- President Bill Clinton assigned Hillary Clinton to head up a task force to plan for universal health insurance.   It died in the senate, with opposition from business lobbyists and conservative Congress members from both parties.

1997 -- President Bill Clinton signed bipartisan legislation that created a state-federal program to provide children from low income families with coverage.

2003 -- President George W. Bush persuaded Congress to pass a prescription drug benefit program for older citizens.   It specifically forbid government pressure on drug companies for lower drug prices.

2010 -- With no Republican support, Congress passed President Barack Obama's Affordable Care Act now known as Obamacare.

Nine presidents, six Democrats, three Republicans.   


Monday, December 30, 2013

Some advantages to being old-fashioned

Until I joined the digital generation with a super-smart phone (HTC One) a few months ago, I was one of the old-fasioned, troglodytes who only had an ancient flip phone, kept in my car for emergencies only.

Recently a New York City resident was held up at gunpoint in Central Park.   The mugger demanded his cell phone.   When the man handed him old flip phone, the guy looked at it with an expression that said "What the f--k is this?"

The would-be thief gave it back and walked away.

Apparently stealing and re-selling smart phones has become a $30 billion a year business.   So, in addition to my monthly fee, I've also become more vulnerable to mugging.

There's a lesson in there somewhere.


Sunday, December 29, 2013

Lower Pope Francis' rating to A minus

I have been full of admiration for Pope Francis for his emphasis on pastoral service rather than doctrinal purity -- for taking care of the poor, the sick, and the needy -- and for his personal humility and his criticizing the global greed and inequality.

His prior statements about gay people ("Who am I to judge"?) showed a fresh attitude of real compassion toward fellow human beings.

But he has also said that some church doctrines will not change, and today we saw evidence of that in his negative reaction to laws passed in Malta that will allow gay civil unions and adoption by gay couples.    So it reminds us that there is still a long way to go despite his kinder and more humanitarian positions.

Some will say opposition to gay marriage is still opposition to gay rights.   Agreed.   But it goes down better coming from someone who doesn't also judge and condemn.