Health-care disaster in Mississippi

Access to affordable health care in the United States has been a major problem for years. Perhaps nowhere has it been worse than in Mississippi. And the Affordable Care Act (ACA), often referred to as Obamacare, has not made health care more accessible or affordable in Mississippi, according to two journalists there.

Writing for Columbia Journalism Review, Trudy Lieberman praises Sarah Varney, a senior correspondent for Kaiser Health News, and  Jeffrey Hess of Mississippi Public Broadcasting, who contributed research and reporting, for a “Letter from Mississippi,” which thoroughly and poignantly details “how the poorest, sickest state got left behind by Obamacare.”

Their account, published in the November/December issue of Politico Magazine and on the Kaiser Health News website, analyzed “Obamacare’s year-long struggle for respectability and viability in the poorest state in the union,” writes Lieberman.

They asked the following question: Can a private system of health insurance and subsidies for buying coverage work in a state with very poor people who have high rates of disease, lack education, and for whom buying insurance is like learning Turkish? “Add to that an uncooperative political infrastructure,” writes Lieberman, “and the answer at this point seems to be no.”

Given that Mississippi suffers from a high incidence of diabetes, heart disease, obesity and the highest mortality rate in the nation, Obamacare barely registered there. In fact, according to one analysis Varney cites, “Mississippi would be the only state in the union where the percentage of uninsured residents has gone up, not down.”

Varney blames many factors on this failure, including “political infighting, an overwhelmed federal agency and a surprise decision from the Supreme Court.” Only about 20 percent of the state’s residents eligible for Obamacare coverage have signed up. The “most significant drag on sign-ups,” Varney writes, “was Mississippi’s decision not to expand Medicaid,” which left some 138,000 low-income residents, most of whom are black, without insurance options.

Varney also points out inequalities that are part of the ACA, such as high deductibles and other high cost-sharing requirements. A 54-year old waitress got a policy for $129, Varney writes, only to discover she first had to pay $6,350 out of pocket. She cancelled the policy.

These articles focus on Mississippi, which also has the highest rate of leg amputations in the country (for African Americans, this number is particularly “startling,” Varney writes) and a high rate of breast cancer deaths despite a low incidence rate. However, many of the problems with health care apply as well to many other states.

Lieberman makes the point that this story is not being told many places. She writes: “Several of the issues Varney details—like inequality, the loss of federal funds for safety-net hospitals, and the continuing political hostility to health insurance for the uninsured—are not unique to Mississippi and merit attention from reporters around the country.”

In my own state of Kansas, for example, where Medicaid is not being expanded, health care is not being addressed adequately.

While politicians play political football with Obamacare, health-care costs continue to rise.

One culprit (of many), according to an article in Pacific Standard (July/August) notes the overuse of CT scans, often done before doing a simple physical exam. When one patient whose problem was already identified objected to having a scan done because of the exorbitant cost, the doctor said, “Why do you care? Your insurance will cover it.”

The trouble is, too many of us don’t care. And those making the decisions seem to care even less about these costs.

Are machines taking over our work?

This may sound like the question a Luddite would ask. But several articles recently have addressed the fact that machines are doing more and more work that humans have done, and these articles ask, Is this good or bad—or a mixture?

I read a novel not long ago (Flimsy Little Plastic Miracles) that mentioned “the Singularity,” the moment when a computer “wakes up, becomes self-aware, gains consciousness.” This is also the premise behind the Terminator movies. But I’m not addressing that—not yet.

In a Jan. 24 Associated Press story, “Imagining a Future When Machines Have All the Jobs,” Paul Wiseman refers to the book The Lights in the Tunnel by Martin Ford. Ford describes a nightmare scenario, Wiseman writes: “Machines leave 75 percent of American workers unemployed by 2089. Consumer spending collapses. Even those who are still working slash spending and save everything they can; they fear their jobs are doomed, too. As people lose work, they stop contributing to Social Security, potentially bankrupting the retirement system.”

“Smarter machines will make life better and increase wealth in the economy,” Ford says. The challenge, however, “is to make sure the benefits are shared when most workers have been supplanted by machines.” He recommends “imposing massive taxes on companies, which would be paying far less in wages thanks to automation, and distributing the proceeds to those left unemployed by technology.”

In a Feb. 2 New York Times article, “Raging (Again) Against the Robots,” Catherine Rampell cautions against alarmist views of new technology. She recounts some of the dire warnings over the centuries against automation that takes over human labor and notes how laborers welfare has improved in the past 200 years, due largely to new technology, something Ford does not deny.

She goes on to quote economists who range from an optimistic Joel Mokyr, an economic historian at Northwestern University, to a more pessimistic Erik Brynjolfsson, an economics professor at M.I.T. and co-author of the book Race Against the Machine.

Mokyr says: “Every invention ever made caused some people to lose jobs. … In a good society, when this happens, they put you out to pasture and give you a golf club and a condo in Florida. In a bad society, they put you on the dole, so you have just enough not to starve, but that’s about it.”

Brynjolfsson argues that we have reached a sort of inflection point in productivity growth and that “any job that can be reduced to an algorithm will [lead] to the displacement of workers in industries as diverse as retail and radiology.”

In the March issue of The Atlantic, Jonathan Cohn’s article “The Robot Will See You Now” shows how machines are replacing human workers in health care.

Cohn writes: “IBM’s Watson—the same machine that beat Ken Jennings at Jeopardy—is now churning through case histories at Memorial Sloan-Kettering, learning to make diagnoses and treatment recommendations.”

This practice is becoming widespread. Cohn notes that “in Brazil and India, machines are already starting to do primary care, because there’s no labor to do it. They may be better than doctors. Mathematically, they will follow evidence—and they’re much more likely to be right.”

And one doctor says he doesn’t think physicians “will be seeing patients as much in the future.” They’ll become “super-quality-control officers.”

These changes will likely be good for some and bad for others. Rampell writes: “Historically, the children of displaced workers have benefited from mechanization, but the displaced workers themselves have often been permanently passé.”

This all makes me think of a line from a Bruce Springsteen song, how we all need "just a little of that human touch." And robots, like too much of our society, lacks a heart.