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Waiting to see a doctor . . . waiting . . . waiting . . .
With the ignominious collapse of the Republican plan to overhaul the Affordable Care Act, Barack Obama’s signature law remains “the law of the land,” as House Speaker Paul Ryan ruefully conceded on Friday. That must mean that Massachusetts will continue to shine as an alleged Obamacare success story.
It has been 11 years since former Governor Mitt Romney signed into law the health-care overhaul that later became the model for the ACA. The chief architect of Romneycare was MIT’s Jonathan Gruber, who later played a key role in drafting Obamacare and famously said that there was zero difference between the two laws. (In Gruber’s elegant formulation: “It’s the same f---ing bill.”) With its three-year head start, Romney’s law was, in effect, Obamacare’s out-of-town tryout, and Democrats have often pointed to the Bay State experience as a preview of the benefits the Affordable Care Act would extend nationwide.
But the good news Romneycare and Obamacare have supposedly rained down on Massachusetts can be hard to glean from actual events. Some illustrative Boston Globe headlines:
Now comes some fresh data on how the transformation of the Massachusetts health-care landscape is working out.
A few days ago, the physician search firm Merritt Hawkins released the results of its latest national survey of more than 1,400 medical practices in major metropolitan areas. The bottom line is not encouraging: New patients are waiting longer than ever to get an appointment with a doctor. The nationwide average is 24.1 days, an increase of 30 percent since 2014.
According to the firm’s president, Mark Smith, “wait times are the longest they have been since we began conducting the survey.” Though there were variations among the different medical specialties tested — cardiology, dermatology, obstetrics/gynecology, orthopedic surgery, and family medicine — the bottom line was inescapable: “The nation is experiencing a shortage of physicians.”
Of the major cities Merritt Hawkins investigated, the worst was Boston.
The wait time for a new patient to get an appointment in Boston is now 52 days, up from 45 in 2014. But that was the average across all medical specialties. To be seen specifically by a physician who practices family medicine, the wait in Boston for a new patient is now 109 days — nearly one-third of a year! As recently as 2014, the wait was 66 days.
“Long wait times in Boston may be driven in part by the healthcare reform initiative that was put in place in Massachusetts in 2006,” the report says. “Other sources, such as the Massachusetts Medical Society, also have reported long wait times in Boston and in Massachusetts generally, which may be due in part to high demand for physician services . . . created by a population that is almost universally insured.”
Behold the Massachusetts health-care triumph: Government set out to control the health-care and health insurance markets through an ever-more-intricate web of mandates, subsidies, regulations, and price controls, and achieved near-universal health coverage. What that means in practice is that patients in Massachusetts not only pay a lot more money for insurance and medical care than they used to, but they also wait far longer to see a new doctor than they used to.
With successes like that, who needs failure?
Speaking of health care, a new study in Nature finds that approximately half of the platelets found in the human bloodstream are created in the lungs. If accurate, this is a striking correction of the longstanding medical opinion that platelets — essential components in the clotting process that stops wounds from bleeding — are produced in bone marrow. (See examples of the consensus here, here, here, and here.) Happily for the study’s authors, their field isn’t climatology. So they can expect to be saluted for usefully challenging what was thought to be settled science, not condemned as “deniers” for questioning a popular consensus.
‘London Bridge is down’
Queen Elizabeth turns 91 next month. No British monarch has reigned as long as she has, and it has been 65 years since the last one died: Her father, George VI, succumbed to heart disease and lung cancer in 1952. Elizabeth’s death will come sooner or later, of course, and Her Majesty’s Government has an amazingly intricate plan for what happens once that moment arrives. Sam Knight, writing in The Guardian, has taken a very deep dive into the details:
Her eyes will be closed and Charles will be king. His siblings will kiss his hands. The first official to deal with the news will be Sir Christopher Geidt, the Queen’s private secretary, a former diplomat who was given a second knighthood in 2014, in part for planning her succession.
Geidt will contact the prime minister. . . . [T]he plan for what happens next is known as “London Bridge.” The prime minister will be woken, if she is not already awake, and civil servants will say “London Bridge is down” on secure lines. From the Foreign Office’s Global Response Centre, at an undisclosed location in the capital, the news will go out to the 15 governments outside the UK where the Queen is also the head of state, and the 36 other nations of the Commonwealth for whom she has served as a symbolic figurehead – a face familiar in dreams and the untidy drawings of a billion schoolchildren – since the dawn of the atomic age.
After George VI was found dead in his bed, it took nearly four hours for the news to be conveyed to the BBC (which was traditionally the first media outlet to be notified of royal deaths). That will not happen again.
When the Queen dies, the announcement will go out as a newsflash to the Press Association and the rest of the world’s media simultaneously. At the same instant, a footman in mourning clothes will emerge from a door at Buckingham Palace, cross the dull pink gravel and pin a black-edged notice to the gates. While he does this, the palace website will be transformed into a sombre, single page, showing the same text on a dark background.
All news organizations will scramble to get films on air and obituaries online. At the Guardian, the deputy editor has a list of prepared stories pinned to his wall. The Times is said to have 11 days of coverage ready to go. At Sky News and ITN, which for years rehearsed the death of the Queen substituting the name “Mrs. Robinson,” calls will go out to royal experts who have already signed contracts to speak exclusively on those channels. . . .
Britain’s commercial radio stations have a network of blue “obit lights,” which is tested once a week and [is] supposed to light up in the event of a national catastrophe. When the news breaks, these lights will start flashing, to alert DJs to switch to the news in the next few minutes and to play inoffensive music in the meantime. Every station, down to hospital radio, has prepared music lists made up of “Mood 2” (sad) or “Mood 1” (saddest) songs to reach for in times of sudden mourning.
And that’s only the beginning. Both houses of Parliament will be recalled. The new king will be proclaimed and will be expected immediately to “tour the country, visiting Edinburgh, Belfast, and Cardiff to attend services of remembrance for his mother.” London will prepare for an assembling of diplomats on a scale not seen since the death of Winston Churchill. Thousands of preparations will be launched for Elizabeth’s funeral, which will be held in Westminster Abbey.
More overwhelming than any of this, though, there will be an almighty psychological reckoning for the kingdom that she leaves behind. . . . The second Elizabethan age is likely to be remembered as a reign of uninterrupted national decline, and even, if she lives long enough and Scotland departs the union, as one of disintegration. Life and politics at the end of her rule will be unrecognizable from their grandeur and innocence at its beginning.
There is no reason to believe that Elizabeth’s death is imminent — her mother, after all, lived to 101. But when the time comes, her reign will end amid a display of imperial pomp and theater few Britons have ever seen before, and none will ever see again.
We don’t do kings and queens in America — we turned our backs on royalty in 1776 and have never regretted that choice. Nonetheless, the passing of Elizabeth II will trigger events of intense drama and historical poignancy, sure to mesmerize even the most ardent of small-r republicans. Read Knight’s essay for an extraordinary preview.
Lawmakers’ lifetime tenure
Federal judges are appointed for life, while members of Congress can only stay in office if they win periodic re-election. I’ve long thought that there is a strong case to be made for ending judicial lifetime tenure, at least for the Supreme Court. The nation’s highest tribunal has become a far more autocratic institution than the Framers of the Constitution could have imagined or would have approved. Dramatically lengthened life expectancy now means that justices can easily expect to sit on the bench for 20 or 30 years. With a Supreme Court grown ever more unaccountable and geriatric, it’s long past time to give life tenure a serious rethink.
And yet, as veteran term-limits activist Paul Jacob pointed out the other day, even with lifetime appointments, Supreme Court justices don’t hold a candle in the longevity department to entrenched lawmakers. The longest serving justice in US history was William O. Douglas, who was on the Supreme Court for nearly 37 years. But 37 years doesn’t come anywhere near the record for congressional interminability. Over the years, no fewer than 80 members of the House and Senate have served in Congress for longer than Douglas was on the bench.
Indeed, Jacob observes, three current Judiciary Committee members — Senators Patrick Leahy (42 years), Chuck Grassley (42 years), and Orrin Hatch (40 years) — “have already served longer than any high court justice in all of American history.” Incredible but true: Extreme longevity is more prevalent in the modern Congress than on the modern Supreme Court. For the vast majority of lawmakers, re-election is only a formality: Last November, 98% of US House incumbents were re-elected. That is a disgrace. Congress has gamed the system so effectively that its members have little reason to fear elections.
Supreme Court justices, it turns out, are the ones who come and go. It’s Capitol Hill lifers who can’t be budged.
And a dog is a fish*
If Abbott and Costello were a Hebrew-speaking father and a sassy 7-year-old daughter, “Who’s On First” might have sounded like this.
*In Hebrew, the word for “fish” is dahg.
Then: Classic Comics. Now: classic clickbait and you’ll miss it
Condense a great work of literature into a 6-second video? YouTube put out that challenge, and a bunch of ad agencies responded. Some of them are obvious, like this take on Kafka’s Metamorphosis. Others are more devious, like this promo for Hamlet. You can watch the whole playlist here.
And these are even better! A Dallas bookstore is using “litbaits” — one-liners designed to lure Internet users into reading great novels for free. For example, “British guy dies after selfie gone wrong”. (Can’t guess the title? Scroll down to this week’s Last Line.)
My Sunday column was about the irritating practice of invoking the Bible to support this or that line item in a government budget. There is much wisdom and insight to be found in sacred texts, but the Torah and the Gospels don’t take a position on welfare-state benefits or federal arts subsidies. The Almighty is not a member of any political party.
My column Wednesday reiterated an old lament: Supreme Court nominees should have to give substantive answers to serious questions about constitutional interpretation and legal philosophy. But senators never insist on getting answers because they are more concerned with politics than with jurisprudence. It is commonplace to refer to the Executive and to Congress as the “political” branches of the federal government. But the judiciary — especially the Supreme Court — is steeped in politics too, and always has been.
Wild Wild Web
Botox, nose jobs, facelifts, testicle implants. For dogs.
During World War I, American military recruiters had the “Uncle Sam Wants You!” poster. Recruiters in Australia took a more ominous tack.
The last line
“He was withered, wrinkled, and loathsome of visage. It was not till they had examined the rings that they recognized who it was.” Oscar Wilde, The Picture of Dorian Gray (1890)
Arguable will be back next Monday. Have a great week!
Jeff Jacoby can be reached at email@example.com.