The fateful US Supreme Court ruling on the legality of many subsidies for Obamacare health insurance premiums (the case known as King v. Burwell) is nearly upon us. Perhaps it will come as soon as Monday (June 22) although the betting seems to be that the big reveal will be stretched out theatrically to the last possible moment, Monday week (June 29).
I’m struggling to explain this ridiculous labyrinthine case simply. First, Obamacare = the Affordable Care Act (aka ACA). The claim that federal subsidies are illegal is based on a contorted reading of the ACA completely incongruent with its intention and even its language, which is at worst sloppy. I wrote a detailed explainer here at On Science Blogs last fall when the Supremes agreed to hear the case. For a really dark view of the prospects, see especially the comments I quoted from Supremes expert Linda Greenhouse.
No way in logic does the claim make sense. It is entirely, nakedly, political. And everybody knows it. Anyone making this argument must engage in mighty struggles to keep a straight face. I admire the performance art in Stuart Taylor’s remarkably even-handed, rigorously middle-of-the-road explanation, which can be found at Kaiser Health News.
But the potential consequences are not ridiculous at all. If the justices rule that insurance purchased through the federal exchange healthcare.gov cannot legally be subsidized, an estimated 6.4 million people will be forced to pay their entire premiums themselves, according to Sarah Kliff at Vox. (Many estimates are higher.) She also estimates that premiums could rise as much as 650%.
However, those who oppose any kind of national health insurance program (even one like the ACA, which is in no sense socialism, since it is market-based and exists entirely to put money in the hands of insurance companies) have experienced an epiphany of sorts. They have begun to grasp that 6.4 million pissed-off people (and lots of Democrats making righteous bellowings on their behalf) will not be good for Republicans.
So there is talk of finding legal ways to extend those subsidies after all. Which raises the question of why bring suit in the first place, but keep in mind that this is politics, where the only logic is the strategy for winning.
Here are some blogs that have been following the case closely; you will find many relevant posts here. First, the blog of the journal Health Affairs. Some noteworthy posts: “A Market-Based Contingency Plan for King v. Burwell” authored by several stars, both right and left, in the policy firmament. “What Are The States Doing To Prepare For King v. Burwell?” A 3-part series. Part 3 here, with links to Parts 1 and 2. “GOP King v. Burwell ‘Fixes’ Not Fixes At All, Would Make Health Care Worse.”
The National Center for Policy Analysis, based in Dallas, seeks to privatize Social Security, Medicare, and a bunch of other things. So it opposes the ACA strongly, but its Health Policy Blog is sometimes not as snarky as you might expect.
Kaiser Health News compiles links to relevant articles and commentary, for example this summary of pieces about preparations for a Supreme decision against subsidies. But it also produces original material like the Taylor post cited above. Find all material related to health care law here.
NPR’s health care blog Shots has followed the ACA story too, posts collected here.
Philae has phoned home from the comet 67P/Churyumov-Gerasimenko!
In our last episode in November, Philae, sent from the Rosetta spacecraft to land on the comet 67P/Churyumov-Gerasimenko, had landed all right. But the landing was in an unknown shady place on the comet, and Philae needs the sun for power to function. After 211 days of silence, the comet has, huzzah, moved into a position where Philae is getting some sun at last. The lander has, well, phoned home.
The incomparable Emily Lakdawalla has all the details and a look at what’s next at the Planetary Society’s blog. Here’s the blog at the European Space Agency, home to the Rosetta mission. Despite the Philae contact, it’s still not known exactly where the lander is on the comet.
Is the best yet to come for the female Viagra?
Is there anything good to be said about flibanserin, aka (incorrectly) as the female Viagra, which may be on the verge of FDA approval? Except, perhaps, that it’s a kind of declaration that women should get equal opportunity for great sex, even if it’s only (on average) .7 times more per month? And forget the health risks (sudden low blood pressure, sleepiness, interactions with booze and other drugs)?
The drug, which is of course a pink pill, diddles with neurotransmitters in the brain, making it a completely different proposition from Viagra. Viagra, inevitably a blue pill, which researcher Jayne Lucke calls a fix for “the hydraulics of erectile dysfunction,” increases blood flow to the penis to maintain an erection. Viagra is taken when an occasion arises. Flibanserin (trade name Addyi) must be taken daily.
Sprout Pharmaceuticals, which makes it, is reporting a 46% to 60% success rate. I can’t help wondering about the placebo effect here, which must certainly be relevant in a situation that takes place as much in the head as in other bodily regions. OTOH, the placebo effect is, undeniably, an effect. So maybe the proponents are right, and the oddly named Addyi is better than nothing?
David Kroll explains the technicalities (and is remarkably even-handed about the semi-political pros and cons) at his Forbes pharma blog. Martha Kempner’s post, reprinted at the Our Bodies Ourselves blog, lists a number of additional reasons why approving this drug might be a bad idea.
At HealthNewsReview, Alan Cassels is scathing, calling the push to get the drug approved an Astroturf campaign (i.e., definitely not real grassroots.) At LiveScience, Elizabeth Palermo lists 5 reasons a woman might not be interested in having sex, none of which seem very likely to respond to flibanserin. Not on the list, for some reason, is a partner who’s just not that titillating.
Which thought is a natural segue to The Onion, which has a brief report on FDA approval of a man who enhances female libido and provides 40% more orgasms per month. (HT to HealthNewsReview.) Oddly, the photo depicts a guy who needs a bra. Not my type at all. And The Onion warns that “when mixed with alcohol, the man becomes much less effective.”