Robert David Sullivan 2

Will Grandma get her revenge in 2010?

Political pundit Charles Cook warns Democrats that 2010 may be the "Year of the Angry White Senior," leading to big Republican gains in midterm congressional elections. His reasoning is that younger voters (particularly those under 30, who went for Barack Obama by almost 2-to-1 last year) and minority voters tend not to bother going to the polls without the dangling carrot of a presidential race:

Put simply, older voters dominate midterms and have consistently been Obama's weakest age group... [M]idterm electorates typically skew older and whiter than those in presidential years.

According to exit poll data, voters over 45 comprised 54 percent of the total electorate in 2004 and just 53 percent of the electorate in 2008, but they were 63 percent of all voters in 2006. And diminished turnout on the part of African-American and Hispanic voters, which was a factor in 1994, looks like a double whammy for Democrats.

Now, an older electorate isn't always deadly for the Democrats. In 2006, there were several states in which Democratic Senate candidates actually did better among older voters (see Minnesota and Ohio) or, at least, suffered no major age gap (see Missouri and Tennessee, the latter contest featuring a black Democratic nominee).  

Still, Obama's "change" campaign may well have opened up a generational rift that will continue into next year -- especially now that the GOP is apparently abandoning its historic skepticism toward Medicare and is now arguing that health care for "the greatest generation" is its top priority.

UPDATE: New poll gives the Republican Party a 13-point lead among seniors. (The Democratic Party leads by a single point in the overall population.)

House GOP bets that a frugal image trumps a right-wing reputation

President Obama has apparently decided to offer House Republicans a bone by removing funds for "family planning" -- not only birth control, but also care for newborns -- from his economic stimulus bill:

Under the [likely to be deleted] provision, states no longer would be required to obtain federal permission to offer family planning services — including contraceptives — under Medicaid, the health program for the low-income...

While the debate surrounding the overall impact of the measure pits economists and their statistics against one another, Republicans quickly seized on the family planning money as evidence that the Democrats were advancing an agenda that went beyond the economy.

Initial reports are treating the elimination of family planning fund as a victory for the Republicans and a sign that Obama may be outmaneuvered in his dealings with Congress. But I wonder if Obama is gambling that the image of the Republican Party as far to the right of center on social issues may outweigh any gains the GOP is expecting from being tight-fisted with taxpayers' money.

What do roadside police details and glaucoma have in common?

The Lowell Sun reports on another "Why is Massachusetts the only state that...?" issue. Unlike the rest of America, we don't allow optometrists to treat glaucoma, instead saying that our neighborhood eye doctors must refer cases to more highly educated ophthamologists. Corrective legislation is virtually dead in the current session, but it's bound to reappear in 2009. Here's the con and pro:

"Patients overwhelmingly believe that their serious eye diseases should and must be treated by a medical doctor," [Dorchester opthalmologist Lisa] McHam wrote [in a letter to legislators]. "But the proposed bill would allow optometrists, who have no medical training, to treat medically complex and potentially blinding eye diseases." ...

"It all centers on having the patients have one visit, instead of two," said Dr. Steven Sikalis, a Lowell optometrist who has been practicing in the area for more than two decades. "If I diagnose a patient with glaucoma now, I have to refer him to an ophthalmologist so they can do the same test I just did and then write a prescription for drops. If I was 10 miles north in New Hampshire, I could write that prescription in a heartbeat."

Photo by ansik.

The state of the prostate in Massachusetts is "fair"

Massachusetts gets a "C+" from the National Prostate Cancer Coalition in its 2008 report card, but only 10 states got better grades. (No one got an "A"; Wisconsin got an "F".) Massachusetts finished near the top in terms of the percentage of men who get screened for the disease and near the bottom in terms of the mortality rate from the disease, but we lost points for not (yet) having a state law requiring insurance companies to cover screens.

Our worst category was "support of important legislation and initiatives by the Congressional delegation in the U.S. House of Representatives and the U.S. Senate," but practically everyone got lousy grades for that (New York was the only one above a "C"). The NPCA wanted not only increased spending for prostate cancer screening and research, but also a new "Office of Men's Health" at the Department of Health and Human Services; it got very little of what it asked for from Congress.

Evidently, the condition of our prostates won't warrant an "A" until Washington does something about the federal deficit.

Night Shift (spoilers for those about to have extended hospital stays)

You have good reason to be afraid of hospitals in the middle of the night, suggests an article in the latest New England Journal of Medicine. Dr. David Shulkin, CEO of Beth Israel Medical Center in New York, writes that reduced staffing in the wee hours may mean a "stark discrepancy in quality between daytime and nighttime inpatient services." From "Like Night and Day: Shedding Light on Off-Hours Care":

The consequences of service deficiencies during off-hours include higher mortality and readmission rates, more surgical complications, and more medical errors...

Financial constraints play a role in the lack of provider services. Shrinking reimbursements from government programs and third-party payers make it economically prohibitive for many hospitals to fully staff their facilities 24 hours a day. ... Another major obstacle is the nursing shortage. More-experienced nurses understandably choose desirable day shifts. As a result, night and weekend shifts are filled with a greater percentage of temporary or agency nursing staff, many of whom have less training and less familiarity with the hospital.

So if you're in for a long convalescence, perhaps it would be better to commute from home. Perhaps there's a nurses' carpool you can join.

Hat tip:  A Healthy Blog.

Expensive shrinks cost Massachusetts billions in lost productivity

The Milken Institute reported on Tuesday that the US economy took a hit of more than $1 trillion in 2003, all from lost workdays and lower productivity due to chronic disease. Click here to get the details, including a map showing which states suffered the most, as well as state-by-state data on cases of cancer, diabetes, heart disease, hypertension, strokes, pulmonary conditions, and "mental disorders."

That last category seems to be responsible for the odd geographic pattern of the "State Chronic Disease Index." Massachusetts ranks 40th (or 11th worst), between South Carolina and Alabama, even though other surveys have tagged it as one of the healthiest states. (See, for example, the United Health Foundation.) The explanation seems to be emotional: According to the Milken study, 17.5 percent of the population in Massachusetts suffered from "mental disorders," a figured exceeded only by Oregon (18.0 percent) and well above the national average of 10.7 percent. But there's reason to wonder whether this ranking was skewed by more accurate (or more aggressive) diagnoses of mental conditions here, and perhaps less stigma associated with those conditions than in other states (all data in the study were reported by patients themselves). Still, even these caveats don't seem to account for the fact that the mental disorder rate in Massachusetts was more than twice that in similarly stressed-out New York (8.5 percent), or why first-place Oregon is right next to last-place Washington state (5.1 percent).

By the way, Massachusetts also seems to lose points because the treatment of mental health is costlier here ($1,928 per person per year) than in any state but Alaska. For a chart of how we rank on mental health criteria, click here: Download mental_disorders_by_state_in_2003_selfreported.xls

The Milken report doesn't have much to say about the accompanying mental health data. The authors do point to the relatively high rate of cancer in Massachusetts (4.1 percent of the population, versus 3.7 percent nationally) as one reason for our low ranking on their index, but the difference isn't nearly as great as it is for mental disorders. And the state is relatively low in the rates of diabetes (4.6 percent vs. 4.9 percent), heart disease (6.3 percent vs. 6.8 percent), and hypertension (12.3 percent vs. 13.0 percent).

Given the wide regional variations in the mental health data, perhaps they should not have been treated separately, or not included in the study at all. People see mental health professionals for enough reasons already; there's no need to lay a statewide guilt trip over lost productivity.