Paul Krugman says that the present economic crisis will result in millions more without health insurance, and that health care reform should be part of any efforts to stimulate the economy. Reading this, it’s easy to see his point:

People young and old crowd the hallway outside the locked door of the Arlington Free Clinic. They grip small pieces of paper that will determine whether they get in — or give up and go home.

It’s lottery day, and 45 county residents who lack health insurance and money to pay for medical care are competing for 30 openings on a cold afternoon in January.

Mary Gleason, a clinic volunteer, draws letters from a plastic box. Those holding matching letters will be ushered through the door for interviews. If they meet the clinic’s criteria, they’ll return in a couple of weeks to see doctors or other staff.

One by one, winners are separated from losers. Gleason plucks a Z, and a man holding a Z strides into the clinic. His broken arm had been set in a hospital emergency room, and he needs to see a specialist for follow-up care.

Another man, who has Parkinson’s disease and urgently needs drugs to treat it, leaves disheartened. He will have to return in two weeks and try again in the next lottery.

The lottery is just one example of the fate of the newly uninsured — the growing numbers who once had jobs and insurance and now seek treatment with neither. Although most of the clinic’s clients have low incomes, the nonprofit, privately funded operation and others like it in the region are seeing more people who used to be solidly middle-class. Victims of the deepening recession, they’re now wondering where to turn for help.

Add to that this story about a free dental clinic where hundreds waited in line, and many had to be turned away.

In a sense, many of us are playing this same lottery. Our health depends on our ability to keep well-paying jobs with insurance that might or might not evaporate in the midst of the worst economic downturn in decades. One day you might be covered under your employer’s high quality plan, and the next you might be riding it out on the Medicaid you get with unemployment (for a limited time.) Krugman is worried because Obama hasn’t made the big push for health care reform yet. I can understand why, but he’s right; there’s no addressing this crisis without addressing the fact that 48 million and rising face the devastation of illness and injury on their own.

Another group set to benefit from the stimulus package working its way through Congress? The uninsured and unemployed:

With little notice and no public hearings, House Democrats would create a temporary new entitlement allowing workers getting unemployment checks to qualify for Medicaid, the health program for low-income people. Spouses and children could also receive benefits, no matter how much money the family had.

In addition, the stimulus package would offer a hefty subsidy to help laid-off workers retain the same health plans they had from their former employers.

Altogether, the economic recovery bill would speed $127 billion over the next two and a half years to individuals and states for health care alone, a fact that has Republicans fuming that the stimulus package is a back door to universal health coverage.

[...]

Medicaid is normally for low-income people, and for decades it has been financed jointly by the federal government and the states, with the federal share averaging 57 percent of costs.

The economic stimulus bill prevents states from enforcing a means test, saying, “No income or resources test shall be applied with respect to any category of individuals” who become eligible for Medicaid because they are receiving unemployment benefits. The federal government would pay 100 percent of the costs for people enrolled under this option through December 2010.

Republicans said this proposal would take a big step toward federalizing Medicaid. For their part, Democrats said the changes took a major step toward their goal of coverage for all Americans.

At the same time, the legislation would provide a huge measure of fiscal relief to state Medicaid programs, at a time when state revenues are declining and the number of Medicaid recipients is rising because of the recession.

The bill would also offer a lifeline to workers who have lost health insurance along with their jobs. In theory, such workers and their families can keep their group health benefits for 18 months under a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1986, known as Cobra. But laid-off workers are often required to pay 102 percent of the full premium, including the employer’s share, so the cost now can be prohibitive.

Under the bill, the federal government would pay 65 percent of the premiums for a year. That subsidy would almost surely increase the number of laid-off workers choosing to continue coverage.

Thirty-five percent is still a lot, especially if someone recently laid off was used to their employer picking up most of the bill, but it’s a hell of a lot better than one-hundred and two percent, and at least gives people a realistic chance of maintaining their health care for (maybe?) long enough to get through this downtime (provided of course they can find employment that permits them even that.)

Last year we wrote about the increase in the infant morality rate in the South. There’s some good news today; the infant mortality rate nationwide declined in 2006. The bad news? The rate of 6.71 deaths per 1,000 live births still puts the U.S. at 29th in the world, tied with Poland and Slovakia. The U.S. might be doing better but for a rise in pre-term births, and we are apparently not doing so well regarding the number of women who die in childbirth as well:

Women in the United States have a 1-in-4,800 lifetime risk of dying in labor, according to a 2007 United Nations report—much higher than the 1-in-48,000 rate in top-ranked Ireland. In fact, the United States ranked a dismal 41st out of an analysis of 171 nations, which included underdeveloped countries like Sierra Leone. Even more troubling is that our mortality rate is the highest that it has been in decades, according to the latest report from the National Center for Health Statistics.

Both sets of numbers can be pegged generally to the lack of adequate healthcare for many moms in our country, as well as rise in obesity and a rise in the number of c-sections being conducted (many out of convenience) and rising maternal age. Fixing the problem can only be done by addressing the fundamental inadequacies of health care in our country.

…in the number of uninsured residents, topping out a whopping 1 in 4 who lack any health coverage whatsoever. According to the article, this prompted John Goodman, president of the ultra-generically named National Center for Policy Analysis here in Dallas (whose nonsense we’ve covered before) to opine thus:

Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

“So, there you have it. Voila! Problem solved.”

See, you’re not uninsured. You merely have an alternative means of payment! Never mind that debt collectors will hound you to your grave even if the government picks up the dime for hospitals that provide care for those who visit their emergency rooms, and NOBODY visits the emergency room for treatable but minor conditions that can worsen over time. With the flip of a magic wand, the health care crisis in this country is solved! Believe it or not, the total number of Americans without without insurance has declined, but only because more Americans have moved onto the Medicaid and Medicare rolls. Which actually, is a start.

UPDATE: I failed to note that Goodman has served as an adviser to the McCain campaign on the issue of health care. The McCain campaign is distancing from Goodman’s statement (something that seems to happens a lot around those parts) though as Jonathan Cohn explains, McCain’s approach on health care is still notably unserious.

Wow, who would have thought that Americans could get better health care in Mexico?

“EL PASO, United States (AFP) – With aching teeth and a need to cut expenses, throngs of Americans are marching into neighboring Mexico for dental care, and saving hundreds to thousands of dollars in the bargain.”

I really want to quote this whole article because it’s just so ridiculous the lengths people have to go to in order to get good dental care. It’s really an indictment of the American health care system. I suppose if you’re a libertarian this serves as an argument for globalization of the economy, but I still think it’s a damn shame the Americans, members of the most powerful and still the richest nation on Earth, should have to turn for health care to a nation we consider third-world!

Well, at least Americans have that option. British people sometimes have to resort to pulling their own teeth!

President Bush today vetoed an important and widely supported bi-partisan expansion of the State Children’s Health Insurance Program (SCHIP) (H.R. 976).
Texas bloggers erupt in righteous indignation, and WhosPlayin takes a look at what the blogs of the Texas Progressive Alliance are saying about this terrible move:

Adam at Three Wise Men writes: Bush uses veto pen to strike health care for kids

Blue 19th takes Randy Neugebauer to task for being willing to send billions to Iraq, but not to help children at home.

Blue 19th has uncovered a transcript of a secret press conference featuring the President, the Governor, and Rep. Randy Neugebauer. Put your sensibilities on hold and enjoy.

In examining President Bush’s veto of the SCHIP reauthorization and expansion, Vince at Capitol Annex notes that this is one of the President’s worst actions in office and also points us to statements on the veto from a pair of Texas Legislators: Mike Villarreal (D-San Antonio) and Ellen Cohen (D-Houston).

Muse interrupts her outrage at Bush’s SCHIP veto to send him a Bible verse, remind him that his approval numbers are half of the percentage of Americans who approve of the legislation and wonder if next up is clubbing baby seals and drowning kittens

Eye On Williamson calls Bush and Rep. John Carter on their votes against children, for private insurance corporations and urges the people to get involved, Bush Vetoes Childrens Health Care & John Carter Is Right By His Side.

Matt Glazer of Burnt Orange Report notes that the non-partisan Center for Public Policy Priorities urges Texans to encourage Senator Cornyn and the 18 Texas Congressmen who voted against it to change their votes to override the veto. Matt also suggests that Bush, Perry, Cornyn, and McCaul hate children and encourages us to show our outrage at a rally for kids health

Charles Kuffner of Off the Kuff notes that Bush is acting ashamed of this veto and explores the numbers needed for an override.

In his fourth such action, President Bush vetoed legislation today that would expand the State Children Health Insurance Program to double – from 4 million to 8 million – the number of low-income children covered. He does so despite the fact that this had bipartisan support and is supported by an overwhelming majority of the American people – in yet another sign he is intent on taking the entire Republican Party with him. No wonder he did it behind close doors and without “fanfare.”

His reason? Supposedly, he’s suddenly a fiscal conservative after years of increasing federal spending under Republican control. By comparison, we’re spending almost $10 billion a month in Iraq. But what it is really about is ideology. Bush and conservative Republicans think that we can’t expand government (unless it has to do with the president’s war-making and intelligence powers) to give mostly very poor children health coverage they can’t otherwise get. Well, most people don’t hold to such stupid and extreme libertarian views because they recognize that if the free market took care of everything you wouldn’t have all those kids without health care in the first place.

Unfortunately, while the Senate has the 67 votes to override Bush’s veto, the House does not have the 290 votes necessary on their side. However, House Democratic leaders are going to wait on scheduling an override vote for a couple of weeks to build up support. It is likely Democrats can get most or all of they eight members of their caucus that voted against the bill to vote to override and many have said as much. The question now is whether they can put enough pressure on Republicans and get the 25 more votes they need. Democrats and liberal groups are already launching attack ads against endangered Republicans in an effort to do so. Let’s hope it works.

NPR reports that the infant mortality rate in some Southern states (specifically Mississippi) is on the rise:

The most recent statistics show Mississippi had the biggest increase in the number of babies dying in their first year of life.

Historically, the state has had a higher infant-mortality rate than most of the country. But between 2004 and 2005, the number of babies dying in the state increased almost two points — to 11.4 deaths per 1,000 births.

No one seems to know exactly what the cause is, but there appear to be several contributing factors:

[Social worker] Johnson says even though Brown is on Medicaid and considered high risk, she can’t see a specialist. “It’s so rural that women have to travel 36 to 40 miles one way to see a doctor,” Johnson says. “When they go in, patients see a nurse practitioner. They see a physician in the eighth month [of pregnancy].”

Another problem, according to Johnson, is that many doctors in rural areas do not accept Medicaid.

To apply for Medicaid, women now need an original birth certificate, and they must appear in person. Many critics say this new policy is preventing women and babies from getting the medical care they need.

Race is another factor that contributes to the higher infant-mortality rate in Mississippi and the rest of the South. Nationally, black mothers are twice as likely to lose their babies as white mothers, and in Mississippi, about half of all babies are born to African-American women.

Even well-educated, affluent black women are more likely to have problem pregnancies than their white counterparts, but it’s not clear why.

What can be done about it?

Getting high-risk women medical and prenatal care when they are pregnant is not enough, Dr. Brann says. Medical experts should also monitor women between pregnancies to make sure they stay healthy and take care of any ongoing medical issues. A pilot program launched in Atlanta is addressing this need.

The cost of providing ongoing medical care for these women is about $2,000 a year. The cost of treating babies born prematurely — some with severe health problems — is tens or hundreds of thousands of dollars per child. Many never leave the hospital.

And why should we do this?

Sandy Reynolds’ son, Jeremiah, weighed just 1 pound, 15 ounces when he was born. He lived 11 months in a neonatal intensive care unit in Jackson, Miss.

Reynolds and her husband spent at least three days a week with their son.

“We dressed him up for Halloween and we had Christmas with him,” she says. “We never treated him like he was a sick baby.”

But Jeremiah’s underdeveloped lungs were so susceptible to infection that he died the day after Christmas last year, without ever going home. Reynolds still grieves.

“God gave us 11 months, and I don’t take back any of that time, because we enjoyed every day that we went with him,” she says.

This is the fourth child she has lost in 12 years.

If that doesn’t break your heart, then you’re not human.

I could launch into an anti-Bush screed here at this point, but the truth is problems like this are the fault and the responsibility of all of us. Poor people have enormous hurdles to overcome, but they have to be motivated to overcome them. Public health experts need to study this issue and inform the public as to possible solutions. We all need to understand that there’s really no excuse for infants to be born too soon, or sick, or die as a result of a lack of health care for their mothers. This is only one symptom of the terribly inequitable state of health care in this country today, but it’s perhaps the most tragic of all.

UPDATE: Here’s some context for those numbers above, from Heather Hurlburt at Democracy Arsenal:

Mississippi’s rate, 11.1 deaths per thousand babies, is worse than post-Communist states like Hungary and Poland, and Latin American countries like Costa Rica and Chile, all of which have lower per capita incomes. What country most closely matches Mississippi’s rate, I wondered while listening to the story? So I went and looked it up.

Russia.

Yeah, it’s that bad.