A right-wing hero was born this past Sunday during the combination bikini contest and civics test that is the Miss USA pageant. In an effort to probe how she’d solve our nation’s problems, host Julianne Hough asked Miss Washington DC (aka Kara McCullough) if she believed “affordable healthcare for all US citizens” was “a right or a privilege,” and why. McCullough answered by saying:
“I’m definitely going to say it’s a privilege. As a government employee, I’m granted healthcare and I see firsthand that for one to have healthcare, you need to have jobs. So therefore, we need to continue to cultivate this environment that we’re given the opportunity to have healthcare as well as jobs to all American citizens worldwide.”
Currently unemployed people, as well as those with bad jobs that don’t provide healthcare, are presumably out of luck. That McCullough wants to help women find work in Stem jobs is admirable, but does nothing to help the vast majority of people.
Of course, her statement is technically true. As things currently stand in the US, healthcare is a privilege, and one you likely need a job to access. (And not just any job … a salaried and/or union one, a holy grail that’s fast disappearing.) As a person with both a job and healthcare, she’s observed this firsthand. But as Ms McCullough is a nuclear scientist, I will assume she understood the question was about how she believes things should be, not how they are. In which case, she’s as wrong and out of touch as any DC royalty currently making policy on this issue.
Now, I’ll admit it’s tough to prove beyond the shadow of a doubt that people deserve basic levels of physical safety simply by virtue of being human. To do so would require a philosophical deep dive above my level of expertise. But our founding documents — which I’d hope someone with the surname “USA” respects — have already sided with the “yeas” on the existence of certain inalienable rights, chief among them “life.” And an estimated 45,000 Americans die each year from lack of health insurance. This is not just another commodity, but a necessity on the level with food and shelter. Which, to be fair, Republicans also want to take away from the poor.
Beyond that, it comes down to a simple matter of preference: do you want to live in a society that codifies some level of responsibility to our fellow citizens, or would you rather roll the dice on a Randian dystopia where the lazy, unlucky or otherwise uncompetitive are liquefied into paleo shakes for rich people? Maybe I can’t objectively prove which is “better,” but I know which I’d prefer. Contrary to what social Darwinists would tell you, one cool thing about being human is we (theoretically) get to decide which ideals we want to pursue.
When healthcare is a for-profit enterprise, costs skyrocket and access plummets. While the Affordable Care Act reined in some of the industry’s worst abuses, an estimated 27 million are left uninsured under it, a number that’s slowly climbing as companies raise premiums and pull out of exchanges.
Even those who are insured report problems paying for care due to high deductibles, and, more generally, to being insured by companies whose business model is to dole out as little coverage as they can legally get away with. The Republican party is currently in the process of turning 27 million into 52 million with their ironically named “American Healthcare Act.” Soon, 45,000 deaths a year will seem like the good old days.
As every other country in the developed world knows, the only way to increase coverage to 100% — as well rein in absurdly high per capita spending on a bloated private industry — is with a system of state-funded healthcare. It works everywhere else, and many experts say it would work here.
The American people are on board. A 2017 Economist/YouGov poll found about 80% of Democrats and 40% of Republicans — yes, Republicans! — favor a federally funded health insurance system that covers all Americans. All race, age, income, and gender demographics favor it by simple majorities, and many — particularly the most marginalized — by strong ones. Even Republicans and conservatives approach 50%. Those who voted for Hillary Clinton favor it at a rate of some 85%.
Unfortunately, this is one of many areas where the country’s political class refuses to even remotely entertain the will of the people. Neither Democrats nor Republicans are willing to do the empathetic, fiscally responsible thing.
We all know Republicans will happily let people die to pay for oligarchs’ tax breaks. But even most elected Democrats remain irrationally committed to compromising with an industry that wants you dead. This becomes more comprehensible when you look at the amount of money the insurance lobby gives to both parties. Despite its immense popularity with voters, single-payer will be on neither party’s agenda in 2018.
In stating that affordable healthcare is a privilege that should be reserved for gainfully employed people, McCullough showed she’ll fit in just fine with the other undemocratically elected rulers in DC. President Trump might not own the Miss USA pageant anymore, but his cutthroat spirit lives on.
Many healthcare organisations want to dump the term “patients”, according to participants at a major event in London yesterday called the Future of People Powered Health. “Patient” is widely disliked – with its connotations of having to wait patiently, quietly and uncomplainingly to be the passive recipient of a doctor’s largesse. “Customer” isn’t much better; “client” or “service user” have some takers, and “partner” may be the best of a bad lot. But do we need a term at all?
Halima Khan, executive director of Nesta Health Lab who organised the event in partnership with Guy’s and St Thomas’ Charity , says the debate about whether to ditch the term “patients” has been bubbling up for some time. Many feel that the word, derived from the Latin “patiens” (one who suffers) is now obsolete. There’s support from patient and professional groups to consider changing the language in the hope that some entrenched attitudes will change too. “The Royal College of General Practitioners, for instance is teaching trainee GPs to talk to and about patients in a different way.”
But mental health campaigner Gillian Lamb (not her real name), who has been treated for serious mental health problems, sectioned and admitted to psychiatric units, says she couldn’t care less what she’s called so long as she’s treated with dignity and respect. “I’ve never minded being called a patient because I don’t feel inadequate, secretive or ashamed of having a mental illness. But I know others who are very sensitive about the medicalisation of their condition, and they do object to the term.”
Opponents of ditching the word “patient” say the original meaning of the word doesn’t matter, there’s no suitable alternative, it doesn’t carry connotations of passivity any more, attitudinal change can occur without ditching the name, and changing the name may not lead to meaningful change.
One suggestion is to borrow the language of intentional and therapeutic communities, set up like house-shares in which people are called members and are all expected to muck in and have equal status even if they have different roles. Lamb says that on her ward, “patient meetings” were called “community meetings” – or a “coalition of the unwilling” as an off-message staff member called it.
But the language that organisations use can reflect their philosophy and intended style of delivery. So an upmarket care home wanting to sell itself as being like a hotel may call residents “guests”. The term “service users” has become popular in the NHS though it’s (unintentionally) ironic given that accessing services is often a key problem for people suffering from chronic conditions – “service hopefuls” might be more accurate. “Stakeholders” crops up a lot; I have no idea what it means; don’t we all have a stake in our health and social care?
As a GP and occasional “patient”, I don’t see the need for any term at all. We have 4500 people registered at our surgery. Every person who comes into see me is, just that, a person. When I was in hospital recently for an operation, I didn’t morph into a patient when I entered the ward. I was the same person that I am in the street, but requiring a particular service. After a particularly dehumanising experience with a night nurse, I felt like screaming “I am not a patient, I am a free person”, in a parody of the The Prisoner. Needless to say, I didn’t do that but instead behaved nice and patiently. I say, let’s ditch the term patient altogether and replace it with … person.
Let us imagine that you would like to redistribute hundreds of billions of dollars from working class people to the rich, and wouldn’t hesitate to risk the lives of tens of thousands of people to do so. Well, as luck would have it, there is a bill— the “American Health Care Act” (AHCA)—that does precisely that.
On Thursday, it squeezed through the House of Representatives. Trumpcare – at least for the moment – has been triumphant.
Many of us thought – or hoped – that Paul Ryan’s bill was as good as dead on 24 March, when, in a pleasurable political moment (a rare event these days), he admitted he lacked the votes to push it through. But where there is a will to degrade the healthcare safety net, there is a way. And, to the House Republicans’ credit, they indeed found a way to ram this grotesquerie through.
To do so, the hard right had to compromise with the harder right, which made the current version of the AHCA fouler than the original.
The harder right found much to like about the original bill – like its historic gouging of Medicaid. The problem was that it left too much of the regulatory infrastructure of the Affordable Care Act (ACA) intact. Rules that insurers must cover 10 “essential health benefits” and cannot discriminate against those with pre-existing conditions? Eliminate those provisions, and let healthcare freedom reign.
The compromises worked. First, there was the MacArthur amendment, which permits states to redefine “essential health benefits” (this would allow insurers to exclude coverage of some types of healthcare, such as maternity care), or to allow insurers to charge people with pre-existing conditions higher premiums if they failed to maintain coverage.
Trump lauds House vote to repeal and replace Obamacare – video
As Timothy Jost noted on the Health Affairs blog, the latter provision “could effectively make coverage completely unaffordable to people with pre-existing conditions”, notwithstanding the clearly inadequate high-risk pools.
So far, so good.
However, in appeasing the harder right, the House leadership risked estranging the less hard right. But the latter proved to be a cheap date: they were bought off by the Upton amendment, added at the eleventh hour, which gave another $ 8bn to the fund theoretically designed to cover those left behind by the AHCA. Though this was a drop in the bucket relative to the size of the problem created by the AHCA, it brought just enough moderates back on board to secure a winning vote.
If the AHCA were signed into law by Trump – an unlikely but not impossible proposition given the headwinds it faces in the Senate – the negative impact on ordinary Americans would be enormous.
Given that the House GOP didn’t bother to wait for the Congressional Budget Office (CBO) score before voting, we don’t know just how bad it will be. But relying on the CBO’s initial estimates, we can say that the AHCA will, over a decade, reduce spending on Medicaid alone by more than $ 800bn.
Together with savings from having less adequate, skimpier insurance subsidies, these reductions will allow hundreds of billions of dollars to be channeled to the wealthy and corporations in the form of tax cuts.
US House passes Republican healthcare bill – video
By enriching the rich in this manner, the AHCA would leave an estimated 24 million more uninsured by 2028. Similar calculations have already been done, but it’s worth briefly revisiting the blood-arithmetic on this.
Colleagues of mine recently reported estimates, in the American Journal of Public Health, of how many newly insured people there would have to be to prevent one death per year. These estimates, which, being estimates, aren’t perfect, were based on five studies. The numbers ranged from 300 to 1,239 people.
If we were to pick a round number on the conservative end of that range – say 1,000 – we would estimate that stripping insurance from 24 million people would produce an estimated 24,000 additional deaths annually. That is 40% more than the sum total of all murders, estimated by the FBI at 14,429 for 2014 (using somewhat different numbers, Vox’s Julia Belluz makes this point and comes to the same figure).
Now, in all fairness to House Republicans, as a critical care physician, I too get blood on my hands when I go to work. The only difference is I can wash mine off.
Modern medicine saves lives, while stripping healthcare coverage from millions to fund tax breaks for millionaires takes lives. There’s no way around it, whatever some may tell themselves to help them sleep at night.
This, of course, raises an even larger issue, namely the injustices of the healthcare status quo, wherein 28 million remain uninsured and even more without adequate coverage – shortcomings that leave open the door to continued attack from the right.
This execrable, homicidal bill must obviously be stopped. But that’s not all we must do. The most enduring defense against the rightwing saboteurs is not continued championship of a flawed status quo, but instead the promise of a better tomorrow: healthcare for all, through a single-payer universal system. That alone will put an end to these deadly assaults on healthcare.
I don’t know why everyone in America is so obsessed with health care reform and why it causes endless debate. It seems obvious that there is a very simple and very fair solution to this endless reform rigmarole: let poor people die.
This may sound sort of harsh but bear with me. I didn’t arrive at this conclusion without a rigorous analysis of the facts and a long hard look at cold hard reality. And it’s this sort of objective thinking that’s really needed when it comes to health care reform. The one thing we must be careful not to do is get emotional about things like life and death to push a political agenda.
Take Jimmy Kimmel for example. On Monday the talkshow host delivered an emotional monologue about his new son, who was born with severe heart defects requiring emergency surgery. At the end of this he urged Americans to support the Affordable Care Act.
Kimmel noted that before the ACA was introduced, “if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition and if your parents didn’t have medical insurance you might not live long enough to even get denied because of a pre-existing condition. If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.”
While Kimmel’s story is obviously tragic he’s not exactly qualified to decide important policy issues for America. I mean, the guy is a celebrity, not a politician. Further, it is selfish to suggest that Americans should feel some sort of responsibility for their fellow citizens. It doesn’t matter how sick someone might be or how many pre-existing conditions they might have, if they’re hardworking and motivated they can pull themselves up by their bootstraps and find a way to pay for themselves.
As Joe Walsh, a former Congressman, tweeted on Tuesday afternoon: “Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.” Walsh, by the way, doesn’t even want to pay for his own kids’ healthcare – at one point he owed $ 117,000 in child support. Now there’s a guy who truly understands the American values of individual freedom and choice.
Oh, you know what? I give up. There’s no point attempting to satirize the sick state of America’s attitude towards health care – it’s already beyond parody. I mean, on Monday, Republican Congressman Mo Brooks of Alabama implied that people with pre-existing health conditions just aren’t living their lives “the right way.” Kimmel’s son may have been fresh out of the womb but he must have done something wrong to be landed with heart problems, right?
And remember when Utah Republican Jason Chaffetz compared heath care to iPhones? “Americans have choices,” Chaffetz explained. “Maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest it in their own health care.” An iPhone costs around $ 800. A simple appendectomy can cost up to $ 180,000. But making your own choices? That’s priceless.
And then there’s the imitable Paul Ryan who reminded us that “Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.” He forgot to add the bit about freedom being the option to die when you can’t afford to buy what you want to fit what you need.
Health insurance simply doesn’t work on the free market. It’s not a bloody iPhone. In a free market, it makes no sense for insurers to cover people with pre-existing conditions. In a free market, it makes sense for CEOs of insurance companies to earn millions of dollars while poor people die.
Health insurance also isn’t efficient on a truly free market. According to the Bloomberg Health-Care Efficiency Index America has one of the least efficient health care systems in the world because it is so fragmented. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower in the countries assessed.
For decades, Americans have been aggressively sold the idea that a national health care system is a socialist nightmare that runs counter to American values of freedom and choice. This started after the Second World War, when President Truman proposed a universal national health insurance program. His project failed in large part because it was fiercely attacked by the once-influential American Medical Association.
The AMA invoked fears about communism and branded the idea of universal healthcare as “socialized medicine” and un-American. Truman retorted “I put it to you, it is un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.” Well, it’s not the sort of Christianity that Republicans practice it seems.
You must have been born with un-operable heart defects not to agree with Kimmel’s statement that “if your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.”
The fact that Kimmel can make headlines for pointing out what should be the obvious – in a supposedly civilized country – is just mind-boggling. The health care debate may seem complex but at its core it boils down to a simple question of who matters and who doesn’t. And it seems very clear that, in America, if you’re poor you don’t matter.
Six years after the recession, Americans with mental illness still had limited access to treatment, according to researchers.
US laws meant to improve that access, including the Affordable Care Act (ACA), were unable to overcome the crippling financial impact of the recession on the millions of Americans seeking care, according to a study published Monday in the journal Psychiatric Services.
“The study creates this picture of people who may have been marginally functioning, who were pushed over the edge and they just couldn’t get back: they couldn’t get jobs, they couldn’t back to the life they had before,” said Judith Weissman, the study’s lead investigator.
More than 8.3 million people have serious psychological distress (SPD), which indicates a person is likely to have a mental health problem that interferes with their life.
In 2014, the year the ACA was fully implemented, 9.5% of Americans with SPD did not have access to health insurance that could connect them with a counselor or psychiatrist, a small rise from 2006, when 9% of the population reported the same thing, according to the study.
Weissman, a research manager at New York University’s Langone medical center, said this population was worse off in 2014 than it was in 2006 when it comes to healthcare utilization, which is measured by things including an inability to get needed prescription drugs or delays in accessing treatment. “There is something very broken about the way we provide mental healthcare in the country,” she said.
Patterns in access to care between 2006 and 2014 were similar among adults with and without SPD. Both groups experienced a steep rise in lack of health coverage after the recession in 2008 and experienced a return to 2006 coverage levels in 2014.
But from 2006 to 2014, adults with SPD who could not afford medication continued to increase, which the study said “suggests they may not have had as complete an economic recovery as adults without SPD”.
Weissman said that while this early analysis suggests the mental health system has failed to bounce back from the economic recession, people are using available healthcare at increasing rates because of changes made under Obamacare. “I think that what we’re seeing now is that – really, likely the impact of the recession on people with mental illness,” Weissman said.
She was one of several researchers at Langone to conduct the analysis, which took four years to complete and is thought to be the first of its kind in more than a decade.
Their study provides a conservative estimate of mental healthcare access and utilization because it does not include the homeless population. In January 2016, one in five people experiencing homelessness had a serious mental illness, according to the Substance Abuse and Mental Health Services Administration.
John Snook, executive director of the Treatment Advocacy Center, a mental health advocacy organization, said he hopes the benefit of the ACA and other laws that expanded mental healthcare access will show up “more robustly” in future studies.
“What you hear from families all the time is it is still a really difficult process to get mental illness treatment – even in states that have expanded Medicaid,” he said. “There may be only one psychiatrist that’s available; she may be an hour and half away.”
He said this analysis provides data that the group has been seeking – and pushing policymakers to collect – for years, to support things the group has observed anecdotally.
Snook said: “As we get better and better data, what we are overwhelmingly finding is that we are doing a terrible job of prioritizing their care and we, as a result, are costing ourselves a huge amount of money and not benefitting this population.”
Vicky Frost is joined by Guardian members; Sarah Boseley, the health editor of the Guardian; Professor Jane Dacre, president of the Royal College of Physicians; Helen McKenna, senior policy adviser at the King’s Fund, an independent healthcare charity; and Denis Campbell, the Guardian’s health policy editor. They consider the current state of the National Health Service in the UK, President Trump’s approach to healthcare reform in the US, and the global approaches that seem to be working best. What can we learn from each other about funding effective healthcare? And are our expectations realistic?
• In the next episode of this series, we will be discussing the global rise of nationalism. Find out more, and submit your questions to our panel here.
There was dancing to the Jailhouse Rock when a community choir formed in a prison in Northern Ireland was named overall winner of annual awards for therapists and health scientists.
Organisers, supporters and past members of the Voice of Release choir burst into an impromptu chorus of Elvis Presley’s hit in celebration of their success at the 2017 Advancing Healthcare Awards, held at Chelsea Harbour in London.
The awards, for which the Guardian was media partner, aim to highlight the achievements around the UK of allied health professionals and others who work with them outside the medical and nursing professions.
The Voice of Release was founded in 2014 by occupational therapists at Hydebank Wood women’s prison in south Belfast as a way of trying to engage prisoners who were vulnerable or at risk of suicide or self-harm.
Women who stepped forward to take part led development of the venture, winning a Dragons’ Den-style pitch for initial funding. The choir has since gone on to make a CD, put on paid performances – with some members being allowed out of prison to do so – and involve prisoners from a men’s jail without incident. A follow-on project has been set up for choir members to continue singing after release.
Regular monitoring of those taking part has shown a decrease in stress levels, improvement of mood and a greater sense of hope thanks to the “choral cure”.
The scheme, run jointly with The Right Key, a Lisburn-based community interest company, won the mental health category of the awards before scooping the overall prize. This new category, sponsored by the Guardian, attracted a record number of entries for the awards, which were in their 11th year.
The NetPark Wellbeing Project, an arts therapy scheme developed by the Metal Arts Organisation and Southend council, using digital technology in the setting of a public park, was highly commended in the same category.
Full list of winners
Overall winner and Guardian award for innovation in mental health services – Lynsey Grierson and Sheila Smyth, South Eastern health and social care trust and The Right Key; highly commended Emma Mills, Metal Arts Organisation
Faculty of Public Health and Public Health England award for contribution to public health – Gillian Rawlinson and Helen Slee, Salford Royal hospitals NHS foundation trust; highly commended Ruth Crabtree and Tom Heywood, Yorkshire ambulance service NHS trust
Health Education England and National Institute for Health Research award research champions – Lisa Roberts, University of Southampton and Southampton hospitals NHS foundation trust
Chamberlain Dunn award for entrepreneurship – Jo Godsall and Daniel Thomas, Chroma Arts Therapies
Macmillan award for leadership and innovation in cancer rehabilitation – Laura Caley and Jervoise Andreyev, Royal Marsden NHS foundation trust
Scottish government award for improving quality: measuring and demonstrating impact – Fraser Ferguson, NHS 24
Academy for Healthcare Science award for innovation – Mark Bowtell and Lorna Tasker, Abertawe Bro Morgannwg university (ABMU) health board
Welsh government award for prudently advancing practice – Anita Smith, East Sussex healthcare NHS trust
NHS Employers award for outstanding achievement by an apprentice, support worker or technician working alongside an AHP or healthcare scientist – Jennifer Hopton, Newcastle upon Tyne hospitals NHS foundation trust
Northern Ireland award for maximising resources for success – Fiona Talbot and Janey Milligan, South Eastern health and social care trust
Scottish government award for driving improvement, delivering results – Fiona McMillan and Catrina MacGregor, NHS Ayrshire and Arran
Health Service Laboratories’ award for rising stars – Dimitra Verra, Central London community healthcare NHS trust; Rachel Ball, University hospitals Coventry and Warwickshire; Mark Edwards, ABMU health board; Fiona Brannan, Warwickshire Music; Erin Wilson, Warrington and Halton hospitals NHS trust; Ruth Louise Poole, Cedar, Cardiff and Vale university health board
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Obamacare will be the law of the land for the “foreseeable future”, the speaker of the US House of Representatives, Paul Ryan, admitted in the aftermath of the abject failure of Donald Trump or the Republican party to “repeal or replace” Obama’s flagship Affordable Care Act (ACA) after seven years of bleating about it. The colossal and humiliating collapse of the proposals was met with jubilation last Friday by millions of people, especially the poorest and disabled, who were in line to lose access to healthcare if the American Health Care Act had been successful.
Watching the events unfold I wondered: what if there had been a similar sudden downfall of the austerity programme in the UK in those early days when the dire warnings of the harm it would unleash were being shouted from the rooftops? How many people would not now be turning to food banks or battling to access social care if austerity had been stopped in its tracks?
The political rollercoaster in the US as the new health bill failed to garner the necessary votes to be passed in the house (partly because rightwing hardliners wanted an even harsher version) was stunning. The debacle came against a backdrop of months of anxiety and fear at what would unfold if it were passed and, the closer the vote deadline got, the more it hit home how much ordinary citizens would suffer. Across the country, individuals and groups rose to oppose it, highlighting the potentially devastating consequences for access to reproductive health services and the disproportionate impact on low-income women and children. Disabled campaigners worked tirelessly to draw attention to the particular injustices they would face if the law passed. Last Wednesday, more than 50 disability rights activists were arrested in Washington DC for protesting against it.
As longtime campaigner Bruce Darling from the disability rights organisation Adapt explained, many people risked being placed in institutions rather than supported in their own homes if proposed cuts of $ 880bn (£705bn) to Medicaid, the government-funded programme that assists the very poorest and disabled people, went ahead. “Disabled people will die,” Darling told me.
Leading up to the healthcare vote I talked to people who were terrified about the impact of the new act. One of these was Marta Conner, a charity consultant from Virginia whose seven-year-old daughter, Caroline, has Rett syndrome, a neurological condition that severely limits her control over her body and means she needs round-the-clock care, expensive medication and specialist equipment. Conner was like many of those speaking out. She told me she felt “it was important to have our voices heard” because children like Caroline and millions more disabled and seriously ill people could lose a lifeline.
Paul Ryan on failed healthcare bill: ‘This is a disappointing day’
According to independent analysis from the non-partisan Congressional Budget Office, the AHCA would have seen 24 million people lose health cover in the next decade – and sent insurance premiums for older people rocketing. And, just to rub salt in the wounds, it would have meant a doling out of tax breaks to the rich.
Nevertheless, despite the healthcare reprieve, if you are poor or disabled in the US right now, the fight for rights to support and quality care is far from over. For a start, the healthcare debate isn’t going to disappear: health insurance remains prohibitively expensive for many and even with the advances of Obamacare, it is not a universal system.
But there are other reasons why complacency is not an option. The attack on the poorest is coming on multiple fronts. Trump’s “blueprint” budget, which was also published this month, is a source of widespread anxiety. It has been overshadowed somewhat by the healthcare issue, but with clear echoes of cuts in Britain, initiatives that help the most vulnerable could be decimated if Trump gets his way.
In a similarly absurd vein to Tory claims of “compassionate Conservatism” while they slash budgets, preside over soaring levels of child poverty and pummel the NHS, Republicans have had the gall to argue that culling anti-poverty programmes such as after-school nutrition initiatives and Meals on Wheels are acts of compassion towards taxpayers. The question now is, can these radical proposals come crashing down as the healthcare bill did? For the sake of the most vulnerable, let’s hope so.
Donald Trump understood the average Republican voter well enough to disregard the party’s tired orthodoxies and still win the presidency. He figured out that most Republicans could care less about shredding entitlements and adhering blindly to Milton Friedman’s soulless economic agenda, as long as he was bashing immigrants. To this day, Trump still won’t fulfill Paul Ryan’s Ayn Randian fever dream of gutting Social Security and Medicare.
But he does promise to do Ryan’s bidding and repeal Obamacare, a move that is all but guaranteed, if successful, to make a lot more people who voted for him sick. This probably doesn’t worry Trump too much in the short term, since senior citizens in the West Virginian hollows and dead factory towns of Ohio can’t afford dues at Mar-a-Lago anyway. Republicans in Congress, unused to and uninterested in governing, want to tear up Barack Obama’s signature achievement as quickly as possible because that will fill the emptiness of a nihilist campaign vow.
Few rational people think Ryan’s American Health Care Act is anything but a disaster-in-waiting. Swapping a mandate for ungenerous tax credits and eventually killing the Medicaid expansion while preserving the most expensive and popular aspects of Obamacare (not discriminating against people with preexisting conditions and letting everyone under 26 remain on their parents’ health plans), the AHCA will strip coverage from 24 million people by 2026, according to estimates from the Congressional Budget Office.
Were Trump a cannier tactician – or just a very different man – he would try to co-opt a beleaguered Democrat party by actually bolstering Obamacare, triangulating to save his party’s historic majority. Imagine if Trump’s team seriously considered the flaws of the ACA and tore a page from the playbook of the most populist Democrats to address them.
We already know there’s an overlap between the people who voted for Obama and Bernie Sanders and those who eventually chose Trump. The desperate working class of this country, white and black and brown alike, are seeking answers as automation and globalization threatens to sideline more and more laborers forever. Trump can gratify his own galactic ego and do some good by actually saving them.
As it stands, Trump’s obsession with pushing Ryan’s catastrophic bill is the best gift an otherwise pathetic Democratic Party could envision. Republicans control every branch of government, two-thirds of governorships and far more state legislatures than Democrats, a level of dominance unseen in more than a half century. But the sooner any version of the AHCA becomes law – no sure thing as Senate Republicans and moderates in the House balk – the more furious the backlash against the party of Trump will be.
Democrats are giddy that Republicans are on the verge of owning a healthcare catastrophe. Smarter Republicans are catching on. Arkansas Senator Tom Cotton, usually a reliable ideologue, recently said voting for Ryan’s bill would put the Republican’s formidable House majority at risk.
As unlikely as this scenario would be, the Trump White House could heed Cotton’s warnings and change course. Support increasing subsidies for the lower and middle class people who truly find Obamacare unaffordable. Expand Medicaid coverage. Try to entice younger, healthier people to buy insurance or just force them. Discover the unreliable New York liberal lurking somewhere in that tanned hulk and back a cheap public option to compete with private insurers, driving prices down.
Rebrand the effort. Obamacare can become Trumpcare, except Trumpcare will actually work for everyone. For all his business failures, Trump does know something about marketing and reinvention. What’s the best way to stick it to his bête noire, Obama, and punish Democrats for good? Make Obamacare (Trumpcare) better.
It’s easy to snicker about a Republican president doing this. But Trump owes his party little, and its orthodoxies even less. He is a cult of personality, a ringmaster who can command his legions of followers to the end of the Earth, no matter what he says or does. The working class white Americans and Midwestern swing voters who put him in power won’t punish him for making government more generous and welcoming.
Trump can choose the courageous and practical path of attempting to usher in an era of affordable, universal healthcare coverage to a nation in profound need of both. Or he can punish the American people and his own party with Ryan’s dreadful legislation.
Paul Ryan is promoting Trumpcare as if it were some sort of medical Magna Carta – a brave declaration of healthcare freedom. “We’re not going to make an American do what they don’t want to do. You get it [healthcare] if you want it. That’s freedom” he recently said on Face the Nation. Freedom to die uninsured, that is.
It’s not that House Republicans are proposing some libertarian healthcare promised land wherein open heart surgeries and rounds of chemo are bartered and traded like tubes of toothpaste – far from it. Instead, the bill largely relies on Obamacare’s blueprint, although it mangles its details for the benefit of the rich while stripping coverage from a staggering 24 million people by 2026 (according to Monday’s estimates from the Congressional Budget Office).
Ryan’s healthcare bill would, like the Obamacare, provide subsidies (or tax credits) for the purchase of private insurance policies. Yet these tax credits would be comparatively more regressive and less generous than those in the Affordable Care Act (ACA); many Americans would thus be freed from having affordable premiums.
The Republican bill also discards Obamacare’s cost sharing subsidies for low-income individuals, who would henceforth have the freedom to pay higher copayments and deductibles. Additionally, it prevents tax credits from being used for the purchase of plans that cover abortion, freeing more women from control over their own reproductive systems.
The bill would also punish those with low incomes by squeezing federal funding of Medicaid beginning in 2020, effectively emancipating millions of poor people from the ranks of the insured.
Trumpcare would at the same time cut the ACA’s taxes on the wealthy, which, as the New York Times recently reported, would redistribute upward some $ 144bn over a decade to millionaires. Now in fairness, this provision would increase freedom for some: freedom, for instance, to buy a second vacation home, or a first yacht.
And finally, what Ryan seems to see as Trumpcare’s greatest emancipatory element – the elimination of the ACA’s unpopular individual mandate – would simply be replaced by a 30% premium penalty, assessed by insurers, for those who spent time uninsured. As Patrick Henry might have put it: give me a continuous coverage premium surcharge as opposed to a tax penalty, or give me death.
Unbelievably, Ryan sees “freedom” in all of this devastation.
For Ryan and those in his ideological camp, freedom in healthcare is basically the freedom of the consumer, who should be free to buy – or not buy – the particular insurance plan that suits his or her needs and tastes. Hence the bewilderment of Representative John Shimkus who recently asked why, exactly, men should be compelled to buy plans that cover maternity care (Trump’s pick to lead the Center for Medicare and Medicaid Services, Seema Verma, has said something similar).
Ryan thus offers a peculiar vision of healthcare freedom. For the medical literature tells us – to no one’s surprise – that the uninsured are more likely to die. And as noted, the CBO has now estimated that Trumpcare will increase the ranks of the uninsured by 24 million in a decade from now.
The bill would thus increase our freedom to die of health conditions that are amenable to modern medical care, and thereby liberate tens of thousands of people a year off of the face of the planet.
The Ryan formulation of healthcare freedom is thus a false freedom. Real healthcare freedom would look vastly different, though it would also go well beyond what the ACA has accomplished.
Healthcare freedom worthy of the name would mean knowing that one will never – and can never – be uninsured. It would provide the liberty to choose the doctor and hospital of one’s choice.
Healthcare freedom would ensure women’s control over their reproductive health. And critically, true healthcare freedom would mean that we can all make healthcare choices based on our medical needs and personal preferences – not our bank balances – which means eliminating today’s increasingly onerous copayments and deductibles.
Trumpcare would take us in the opposite direction on each of these fronts.
This more egalitarian vision of healthcare freedom may sound utopian, but it is entirely achievable: it emerges when societies create social rights to healthcare through the development of universal healthcare systems.
The conservative vision of healthcare freedom offered by Ryan and company, in contrast, is not a form of freedom at all: indeed, by serving the class interests of the rich at the expense of the welfare – and the very lives – of the poor and the sick, it is better seen as a form of oppression.
John Oliver has criticized the latest healthcare reform, referring to it as “shitty Obamacare”.
On Last Week Tonight, the comic took apart the American Health Care Act, championed by the House speaker, Paul Ryan, saying: “You may not have wanted it, it looks awful but it’s here anyway” which he likened to “Pirates of the Caribbean 5: The Curse of Johnny Depp Getting Divorced & Needing the Money.”
He then discussed the negative reaction the bill has already encountered, even from many Republicans. “Much like the life behind Melania’s eyes, the AHCA looks dead by the time it was introduced in Washington,” he said.
Oliver called it “shitty Obamacare, the way Old Navy is a shitty version of the Gap” before talking about the mechanics of the plan. Older people will get more money towards their healthcare leading him to joke: “The older you get, the more money you get. Think of it as the exact opposite of being a woman in Hollywood.”
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Despite all of the negativity, Ryan has been doing the publicity circuit, explaining why the bill is so great. Oliver joked during one of his TV calls-ins that “somehow you can almost hear his erection during that”.
He then played the much-criticized clip of congressman Jason Chaffetz recommending that people should reconsider buying an iPhone if they plan to need any form of healthcare.
“It’s frankly a little hard to take a lecture on good choices from a man who presumably entered a barbershop and said give me the wet poodle pubes,” Oliver said.
He then highlighted that the people who will be most affected by the reform will be poorer Americans who voted for Trump. “It’s like if the people in Pompeii voted for the volcano,” he said.
When asking who exactly will benefit from the plan, Oliver showed stats that prove richer Americans will receive major tax cuts as a result. “So this plan is literally taking money from the poor and giving it to the very rich,” he said. “It’s essentially a reverse Bernie Sanders which is also the name of a sex act which consists of very aggressive fingering.”
In discussing the response, Oliver referred to it as “almost universally hated in Washington” and “truly the Ted Cruz of healthcare legislation”.
He also played footage from Sean Spicer’s press briefing where he used two different paper stacks to somehow prove the new bill is better. “That is the most aggressively stupid thing I have ever seen and I just saw Jason Chaffetz suggest paying for health insurance by retroactively not buying an iPhone,” he said.
Trump has spoken this week about how no one knew how difficult and complicated healthcare was until now. “It’s like saying ‘who knew King Tut was dead’ – everybody did!” Oliver said.
The president is also not attaching his name to it or talking about it at great length. “Trump is not clamoring to put his name on this bill and he has put his name on some of the shittiest products in human history,” he said.
Oliver ended by talking about his plan to get a message to Trump about how awful the new plan is: he’s bought ad time on Fox & Friends, a show the president clearly watches. The ad will feature an older actor explain in detail how his life will be harder from now on. It will air in the DC area on Wednesday morning.
• This article replaces an earlier story that was based on an incorrect agency report.
A private healthcare provider has signed a deal with Uber to transport its carers and home patients.
Cera said it had struck a deal with Uber to transport its London-based carers to their patients, while its disabled customers will be able to use UberAssist and UberWav to get out and about.
In a separate deal, Cera is to provide on-the-go care to patients of several NHS hospitals, covering five million people. Specifically, at Barts Health NHS trust, the largest NHS trust in the country, Cera will deliver care for patients, including those with dementia and cancer, in their homes.
A spokeswoman for Barts said, however, that its contract with Cera did not cover patient transport, as had been incorrectly reported by the media [including the agency report on which the earlier Guardian article was based].
“We do not have any contracts with Uber to provide non-emergency patient transport,” she said. “When patients need assistance getting to and from our hospitals we provide ambulances and medi-cars, driven by trained experts.
“We are working with a number of registered organisations, including Cera, to make sure patients get vital support in their own homes. This includes physiotherapy, nursing or domestic support to help people recover after a stay in hospital.”
Cera was launched in November 2016 and is regulated by the Care Quality Commission.
In a statement announcing the deal with Uber, Cera said: “The partnership will enable Cera’s London-based carers to use Uber to get to the people they are caring for as quickly and seamlessly as possible.
“It will also give those who need care the freedom to book cars so they can get out and about when they would otherwise have been housebound, or had to rely on someone else.
“Disabled customers, or those who need a little extra help, will be able to book UberAssist – or a fully wheelchair accessible vehicle through UberWav – driven by one of Uber’s hundreds of fully licensed and top-rated partner drivers, who have been through a specially designed disability equality training course.”
Dr Ben Maruthappu, a former doctor and Cera’s co-founder, said the Uber deal would “radically integrate care and transport through technology”, adding: “Older people and those with disabilities will now have access to the highest-quality drivers, while carers will be able to efficiently travel to ensure they can provide services in the right place at the right time.”
The Unison general secretary, Dave Prentis, said: “Social care and the NHS are in such a state of crisis that any initiative to ease the pressure will be welcomed by patients and staff.
“But the funding chasm between what is needed and the pitiful amount councils currently have to commission care is too deep. Nothing short of an emergency injection of cash in the budget, followed by the sustained and realistic funding of health and care will be enough.
“The government must also ensure that all companies that win care contracts don’t exploit staff and pay at the very least the minimum wage. Sadly there are still many out there breaking the law and getting away with it.”
David Mowat, the minister for community and social care, said: “This is an interesting and innovative proposal which will help raise awareness of the challenges faced by the vulnerable elderly, and those with specific conditions that are becoming increasingly common in our society.”
Calvin Kasulke was living with his parents when he came out to them as a transgender man. All of a sudden, he recalled gingerly, “I was disinvited from living at home.”
He needed a new place to stay. And Ithaca, New York, where he had gone to college, was the obvious choice. He would have friends there, he figured, and a place to live.
“And also,” he said, “Planned Parenthood was there.”
Unbeknown to many, Planned Parenthood is one of the largest sources in the US of transgender healthcare. The embattled provider offers hormone replacement therapy, which helps a person’s body appear more masculine or feminine, at dozens of its locations, and a growing share of its staff are trained to perform routine sexual health exams for trans patients.
“They are one of the most important providers of trans healthcare in the country,” said Harper Jean Tobin, the director of policy for the National Center for Transgender Equality, adding that their clinics are some of the few transgender healthcare providers located outside major cities. “Many of their clinics are the only places for miles around that trans people can go to for hormone therapy, HIV tests, and pap smears, and not face discrimination.”
With Congress on the brink of attempting to defund Planned Parenthood because of its role as an abortion provider, those services could easily be caught in the crossfire. Each year, Planned Parenthood is reimbursed hundreds of millions of dollars for family planning services it provides at little or no cost to low-income Americans. If Congress were to freeze Planned Parenthood out of those funding streams, it could force an unknown number of health centers to close. Health providers have long warned that this would have a detrimental impact on women’s health. But, Tobin said, the cuts could be particularly “disastrous” for trans people.
“As it is getting more real, in the back of my head I said, ‘Oh shit. What am I going to do now?’” said Raven Green, a patient of Planned Parenthood of the Southern Finger Lakes. “I don’t know where else I would go.”
The state of transgender healthcare in the US is already a fragile one. In one survey after another, large numbers of transgender people report difficulty accessing both basic and specialized services because of biased providers or the distance to the nearest provider with adequate knowledge of trans health issues. Only about two-thirds of trans people who want hormone replacement therapy, a common treatment during gender transition, have actually received it, according to a major survey of transgender adults taken in 2015, and 23% have avoided getting essential care out of fear of harassment. Thirty-three percent have had a negative experience with a healthcare provider, like needing to teach their doctor the fundamentals of transgender care. And 29% reported having to travel at least 25 miles for transition-related care.
The result is that thousands go without care every year.
“Everything is stacked against trans people” in the healthcare system, said Casulke, who now volunteers with Planned Parenthood part-time. “There’s always an extra layer of, am I going to have to educate my own provider? Is it safe to come out to this person? You’re having to advocate for yourself in a really vulnerable situation.”
Planned Parenthood in recent years has sought to address that problem. And it has made its clinics a magnet for thousands with few other options. Starting with Planned Parenthood of the Southern Finger Lakes, in upstate New York, a growing number of its health centers have become places where trans people can begin to transition medically, as well as get basic reproductive services. Its centers use a newer model for gender transitioning that gives the patient input on whether to start their transition, rather than turning the decision over entirely to a psychiatrist. Some clinics have staff with detailed knowledge of how to update driver’s licenses, passports and social security cards to reflect someone’s name and gender.
“It’s this little oasis in the middle of nowhere,” said Luca Maurer, the program director for Ithaca College’s LGBT center. His center has a partnership with Planned Parenthood. Previously, he said, many trans students and locals would drive to Manhattan or Philadelphia, at least four hours each way, for prescriptions and the routine checkups that accompany gender transition. A handful even crossed the Canadian border for treatment in Toronto.
Luca Maurer, the program directors for Ithaca College’s LGBT center, which partners with Planned Parenthood. Photograph: Jenn Foy Photography
“If I didn’t have them available to me, I’m not sure what I would do,” said Maurer, who is trans. “It would be a crisis. And I’m saying this as a person whose job it is to help others navigate healthcare systems.”
Upstate New York is a microcosm of the hurdles facing transgender people when it comes to medical care. In 2015, LGBT healthcare providers surveyed local trans people and learned that 57% had run into barriers because there were not enough providers trained to address their needs. A full quarter had been turned away by one of their doctors. Without the Planned Parenthood in Ithaca, there would be limited places for several hundred trans patients to turn. The only local endocrinologist, who specializes in hormonal therapy, is not able to absorb so many new patients. And a local primary care doctor who offers transgender care is near capacity.
The need is not limited to transgender-specific care. Doctors and other healthcare providers frequently refuse to treat trans people for conditions having nothing to do with their gender identity – what trans rights activists have sardonically termed “trans broken arm syndrome”.
In Florida, where Planned Parenthood recently began to offer transgender care at about a dozen of its health centers, some of the group’s physicians are offering trans patients basic treatments for diabetes, high blood pressure and the common cold.
Gina Duncan, an advocate with Equality Florida, said Planned Parenthood’s affiliates in Florida have been instrumental in pushing other providers to acquire the knowledge to care for trans patients. “Where Planned Parenthood has filled such a huge gap, is it’s a known, reliable, quality source for healthcare,” Duncan said.
In that region, too, Planned Parenthood is the major provider to trans people of hormone replacement therapy and general care.
Dinah, a trans woman who did not want her real name printed, used to drive 120 miles round-trip every time she needed basic blood work before the Planned Parenthood in her city began to offer hormone therapy.
“We have patients who are grateful that they only have to drive two hours,” said Dr Suzie Prabhakaran, the vice-president of medical services for Planned Parenthood of south-west and central Florida. The 11 health centers Prabhakaran oversees began offering hormone replacement therapy in October and are now treating 80 patients and counting. Four out of every five are starting hormone therapy for the first time.
As Planned Parenthood comes under fire, the prospect of possibly losing those services is throwing patients into turmoil.
Dinah says the care she has received at Planned Parenthood has been lifesaving. Recently, she worked up the courage to schedule her first physical in years. It was her first such exam since her transition, and during the breast cancer screening, she began to cry.
“It’s another thing that makes it real,” she said. “It meant that I’m a woman and I have to be treated like one.”
It’s 30 years since Trevor Clay challenged his fellow nurses to rise up and make their voices heard. The profession had been “remarkably insular”, he wrote, and to its lasting cost had taken little heed of the social, political and economic forces that shaped its practice.
Clay, the charismatic leader of the Royal College of Nursing (RCN) during its period of explosive growth in the 1980s, argued that nursing’s great strength – its overriding focus on the needs of the patient – was at the same time its great weakness. “Too many nurses take that suppression of their individual feelings on a daily basis into political life,” he said. “Nursing is perhaps the most unassertive profession in the UK.”
Three decades after Clay made that claim, it’s timely to revisit it. If he was still alive today, would he be satisfied or still frustrated at the standing of nursing in the UK?
Nurses are certainly not the handmaidens of any other profession
He would certainly find the profession’s agenda changed – or, more to the point, extended. The three core issues he identified as pay, education and advancing the nurse’s role remain valid. But events and trends have added three more: staffing levels and the mix of qualified and support workers; nursing’s response to the changing healthcare agenda; and the recurring accusation that the profession has somehow lost its soul.
The Mid Staffs scandal, which exposed alarming attitudes and practice on the part of some nurses, and the inquiry into fatally poor standards of infection control at the Vale of Leven hospital in Dunbartonshire, Scotland, have unquestionably scarred nursing’s reputation.
Janet Davies, the present chief executive and general secretary of the RCN, argues that care quality, staffing levels and skills mix are inextricably linked. Mid Staffs was as much about insufficient numbers of qualified practitioners as about lack of compassion, she says, and she worries that understaffing – with almost every hospital reportedly now falling short of targets for qualified staff – may be causing “compassion fatigue”.
“Compassion is the absolute essence of nursing, but being one of two nurses with 15 or 20 highly dependent patients is hardly conducive to doing your job in the most compassionate way,” she says.
Compassion was one of the “six Cs” at the heart of the last nursing strategy, led by Prof Jane Cummings, England’s chief nursing officer. That was an approach explicitly designed to help restore the profession’s pride in the wake of Mid Staffs. Her new strategy, launched last summer, shifts the focus to 10 commitments to challenge unwarranted variation in outcomes for patients, their experiences and use of resources.
This represents, in part, a recogniton that nursing must adapt to the new reality of healthcare, with the emphasis shifting away from treating illness towards preventing it, strengthening public health and supporting 15 million people living with long-term conditions.
At the same time, the profession must deal with the implications of Brexit – for recruitment from the rest of the EU – and the likelihood of continued severe pay restraint for the rest of this decade. There is also a raft of workforce reforms coming into effect in England this year, including the end of training bursaries and the removal of a cap on intakes at universities.
The reforms have sparked controversy and nurse leaders have faced criticism for failing to take a clear and united position. Peter Carter, Davies’s immediate predecessor, who is broadly in support of the changes while remaining cautious about the effect of ending bursaries, says: “The profession doesn’t really have a coherent take on these initiatives, but they could ameliorate the shortfall in numbers coming into the profession.”
Davies defends the RCN’s scepticism about the reforms – not least because of the strain they will heap on an already struggling NHS – and insists that the profession overall is in good shape. Since Clay’s era, she points out, it has become graduate-only entry, has adopted three-yearly revalidation and has greatly enhanced its research base. “Skilled nursing is the one thing that really makes a difference in healthcare,” she says. “We’ve always known that, but now we can show it.”
With the advent of a new nursing degree apprenticeship route to complement increased university intakes – as well as the option of becoming a nursing associate – the profession should have no shortage of new blood.
But has nursing found an assertive voice? “Nurses today have much more of a role in the taking of key decisions,” says Davies. “They are certainly not the handmaidens of any other profession.”
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In the West, there is a widespread consensus that costs of living and social status always mirror one another. The more one can afford the wealthier one is. If this adage is no longer true, maybe was it never true at all. Many among the middle class, who still can purchase some form of healthcare insurance, have realized that their security hangs by a thread. Each year health insurance premiums are set to further skyrocket. The average employee receiving benefits through an employer doesn’t feel safer either as the out of pocket (before the insurance kicks in) ever increases. The out of pocket for a minimum coverage varying between 5,000 dollars and 2,500 respectively.
If getting health insurance through the employer is a big plus, a 2,500 dollar expense for family of four still represents financial stress. In 2013, a CNN analysis estimated that 76% of Americans were living from pay check to pay check. Considering that the average household has a mere thousand dollars in savings and credit cards close to being maxed out, financial flexibility has become elusive.
Overbilling Is Only A Fraud Among ‘Many’ Others
Although many have access to programs such as medicare, the latter are such in deep red ink. Medicare liabilities amount to $ 30 trillion. Obamacare did more harm than good. Though realistically speaking, the Trump administration won’t be able to fix anything. Such programs have been the main drive behind healthcare costs and insurance premium increase for many decades. They have fueled the dynamics of demand and supply and reversing the trends is practically impossible. Any new policy attempting to lower the costs in favor of the patients will send the healthcare industry into a tailspin.
Many hospitals and medical professionals have overbilled insurances for quite some time now. The whole industry is inflationary. So on one end, we find that bad health is often linked to bad eating habits, a stained food chain and various chemical invasions; and on the other end, we have a sector profiting from sickness as if there were no tomorrows. One doesn’t need to be a PhD – nor a prophet – to predict how this will end.
There have many articles lauding the efficiency and affordability of the Swiss healthcare system. Though even Switzerland has a massive pension fund headache to resolve within 4 years from now. The country could just go under if nothing is done, contended a Financial Times article in 2010. Aging population is a dire problem because the birth rate in the West went drastically down compared to 70 years ago. Financial projections were based on 3 or 4 kids per household. Today the birth rate is about 1.2 or three times less. It is not just Switzerland but the entire West that should be extremely concerned.
Major Economies As Health Hazards.
America and Europe being major economies, money printing to delay the day of reckoning remains a solution. The Federal Reserve has already done that several times since the 2008 crisis. Unfortunately, the price tag has still yet to come. Switzerland and ECB will also have to resort to the printing press. However, we can always cynically speculate on a war causing mass casualties to fix this mathematical equation. While this really sounds like an absolute worse case scenario, world tensions are rising. Something is definitely brewing.
The majority assumes that assessing the quality of healthcare systems is a tricky business. That all methods and prognostics have their own flaws. Well, if one is going to monetize the ‘gift of life‘, there are more incentives to profit from diseases to start with. On the other side of the Atlantic, the U.K seems to have the worst healthcare system by far. The latter could collapse at any moment as over 3 million people are on the NHS waiting list. According to the telegraph.uk, hundreds unnecessarily died between 2006 and 2009 waiting to see a doctor! But here comes another aberration. Instead of improving services at home, the U.K is currently projecting to support ‘care in the community for elderly’ people in China stipulates the Telegraph.uk again. In Canada the state of affair isn’t better at all and care rationing begins to look much like that in the UK.
Capitalism and Socialism Banding Together
By now the trend should rather be obvious: socialized healthcare wouldn’t go anywhere without capitalism and otherwise. Both are putting the Gift Of Life on life support. It all becomes crystal clear when probing the overbilling disaster. Capitalism is antagonistic to efficient treatments. And socialism seeks to further regulate, all of which gives the industry and big-pharma alike more power. According to Malcolm Sparrowd, a mathematician at Harvard, the overbilling fraud estimate adds up to a minimum sum of $ 270 billion a year or at least ten percent of all health care expenses. Regulations never work because there’re drafted by the one-sided profits hunters themselves and a bunch of aggressive lobbyists buying politics. Any genuine action to fix the mess will destroy healthcare as we know it. Meanwhile corruption continues unabated.
To read this long investigation into the monetization of the Gift Of Life further and learn about The Earth Custodians Movement, please go to:
Some of the sources (and many more at the original link)
The Crime of Overbilling Healthcare https://blog.nader.org/2014/08/29/the-crime-of-overbilling-healthcare/
How doctors and hospitals have collected billions in questionable Medicare fee https://www.publicintegrity.org/2012/09/15/10810/how-doctors-and-hospitals-have-collected-billions-questionable-medicare-fees
American patients treated by internationally educated doctors have slightly better outcomes than those treated by their American-educated counterparts, a new study has found, as Donald Trump’s ban on travel from seven Muslim-majority countries is expected to stop some immigrant physicians from coming to the United States.
But that is not because American medical schools are falling short, the authors of the report in the British Medical Journal said.
“We’re not saying medical school in the US is not doing a good job, it’s only about selection,” said Yusuke Tsugawa, a research associate at Harvard University’s TH Chan School of Public Health and lead author of the study. Self-selection, to be more specific.
“They are highly motivated,” Tsugawa said of doctors educated outside the US. “They are not random doctors from their home country, they are the best doctors.”
Trump’s executive order banned people from entering the US from seven countries – Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen – for 120 days following the order. The order also stopped the Syrian refugee resettlement program indefinitely.
Researchers looked at 1.2m hospital admissions of patients on Medicare, the American public health insurance program for the elderly, who were treated by more than 44,000 physicians. The rate at which patients died or were readmitted was used to measure patient “outcomes”.
Despite the study’s findings that internationally educated doctors were slightly more likely to treat a sicker population – people with more chronic diseases, as well as more likely to be from racial minorities and more likely to be low-income – outcomes were slightly better than among their American-educated peers. That held when comparing doctors in the same hospitals. Patients treated by both international and US graduates were about the same age on average, approximately 80 years old.
“Our findings indicate that current standards of selecting international medical graduates for practice in the US are functioning well for at least one important dimension: inpatient outcomes,” researchers wrote.
By the numbers, researchers found that when patients were treated by internationally educated doctors, they died at a rate of 11.2%, versus 11.6% for US-educated physicians, in comparisons of doctors working in the same hospitals.
Readmissions showed the same trend. Patients returned to the hospital within 30 days at a rate of 15.4% for internationally educated doctors, and 15.5% for US educated doctors, when comparing doctors in the same hospital.
Tsugawa said he and his colleagues undertook the study because other research showed there “was a bias against foreign medical graduates, both from colleagues and patients, so they are thinking quality of care might be worse than US medical graduates.
“Given that 25% of the doctors in the US – or in the UK as well – are foreign medical graduates, we want to make sure they are providingquality medical care,” he said. Tsugawa said he expected to focus on the race of doctors in his next study.
“To do the residency program in the US, the bar is really high; only 50% of the candidates can get the slot in the residency program,” said Tsugawa. “There are multiple ways they are highly selected, and highly motivated, and that is the reason they have better outcomes.
“Those who come to the US are the brightest and the best,” he said.
About one quarter of physicians working in the US were educated abroad, multiple studies show. But many workforce experts believe that even if the immigration status of hundreds weren’t suddenly in question, there still would not be enough doctors coming to the US to make up shortages faced by ageing and rural Americans.
For example, the largely rural Alaska already needs an additional 60 doctors per year, the Atlantic reports. And a 2015 New England Journal of Medicine article argued that programs that brought 8,000 doctors to the US each year would fall far short of the primary care needs of the country’s ageing population.
Research from 2013 showed that 299 doctors from Iran, Iraq, Libya, Sudan, or Syria applied to train in the US as residents that year, with an acceptance rate of just 40%, a New England Journal of Medicine article reported.
Syria is also one of the top exporters of physicians to the US in another program that places doctors in high-need rural and inner-city areas, the J-1 visa program. In 2014, 165 Syrian doctors moved to the US under the program, according to the same article. If the ban continues beyond 120 days the number of doctors – and therefore patients – affected could escalate very quickly.
“Physicians with J-1 waivers are filling clinical jobs in areas of need,” the NEJM authors wrote. “An executive order that has not taken into account the widespread ramifications may lead to further shortages of physicians in areas that are already in dire need.”
When the lifelong Republican Jeff Jeans recently questioned the House of Representatives Republican speaker, Paul Ryan, about the party’s healthcare proposals, Ryan probably expected him to oppose Obamacare.
However, Jeans, who was diagnosed with a treatable form of cancer aged 49, now relies on the insurance put in place after the 2010 introduction of Obamacare – formally known as the Affordable Care Act (ACA). So to Ryan’s surprise, he said: “I want to thank President Obama from the bottom of my heart because I would be dead if it weren’t for him.”
His story is far from isolated but following the spectacle of Donald Trump signing an executive order within hours of entering the Oval Office on Friday that directed government agencies to unravel the act, it is all the more poignant. Thanks to Obamacare 20 million more people had insurance in 2016 than in 2010 – many of them poor or on low incomes, but also people who couldn’t previously afford cover due to pre-existing medical conditions that made insurance policies prohibitively expensive. For many, Obamacare was the first time they had ever had health cover. For some it was also the difference between a health condition being treated or not, or bankrupting a family.
In Britain, reports of families being left destitute in the US because they couldn’t afford private health insurance have been rightly judged as scandalous and prompted many people to fear any hint of NHS privatisation. While the NHS is currently under enormous pressure (courtesy of the austerity-obsessed Tories), including bed shortages, the crisis in A&E and cancelled operations, to say nothing of social care cuts making a bad situation worse, access to healthcare is still seen as a fundamental right for all.
In the US, where access to even basic healthcare has historically been seen as a luxury not a right, it’s easy to understand why so many embraced Obamacare. It was hardly a flaw-free initiative, but it was a start.
Even though Trump has repeatedly dismissed the ACA as a disaster and Republicans have ratcheted up efforts to dismantle the programme (they’ve been trying since its inception, saying it’s “big government” gone mad), the latest surveys show Obamacare is growing in popularity. Half of Americans polled by NBC and the Wall Street Journal this month said the law was working well, while the same proportion had little or no confidence in Republican proposals to change it. To a degree this reflects how politically split the country is, but as NBC News pointed out, 45% of people said they thought the law was a good idea – more than at any time since the question was first asked in 2009. Judy Solomon, the vice-president of health policy at the Center on Budget and Policy Priorities, says this may be down to more people having first-hand experience of the ACA. “I think people are really beginning to understand what this thing is and what it does and they don’t want to lose it.”
The Republicans say they would repeal key provisions while keeping others and then replace it later with something better. However, this month the non-partisan Congressional Budget Office (CBO) released an analysis of the party’s proposals from 2015 (the Restoring Americans’ Healthcare Freedom Reconciliation Act, which Obama vetoed) that painted a damning picture should this strategy be followed. Within a year of repeal 18 million people would lose their insurance, it found. The CBO also estimated that insurance premiums would soar by 20%-25% in the year following a dismantling of the law.
If the worst happens it’s hard to contemplate what people like Jeans will do. Rebecca Vallas, a director at the Center for American Progress, in a reference to Trump’s inaugural speech, concludes that its eradication would be “the real American carnage”. Josh Hoxie, a director at the Institute for Policy Studies thinktank, says the impact on lower-income people, and on inequality more broadly, would be dramatic, and not just in terms of access to healthcare. He points to research showing that dismantling the ACA would result in 7 million low-income people becoming instantly poorer because they stand to lose premium tax credits included in the ACA. Meanwhile – and perhaps illuminating why Republicans may be so keen to overthrow Obamacare – the same research found that the 400 richest Americans would get a combined tax cut of $ 2.8bn (£2.3bn) as a result of repeal.
Whether it’s austerity in the UK or lining the pockets of the rich in the US, healthcare is about political choices. The wrong choices can be devastating, which is why they should be fought at every opportunity.
Mary O’Hara writes on social affairs and is the author of Austerity Bites
In the remote western plains of Texas, the Midland-Odessa region is separated from the nearest major city by hours of open road. So when the Planned Parenthood clinic in Midland closed down in late 2013 – a casualty of legislative cuts that targeted Planned Parenthood directly – it served as an isolated experiment in what happens when the government defunds the largest women’s healthcare provider around.
“I hate to say it, but I think an awful lot of women just opted to go without care,” said Mike Austin.
Austin is chief executive of Midland Community Healthcare Services (MCHS), a federally-funded network of providers that has emerged as the only major alternative to Planned Parenthood in the area. His clinic offers all of the same services the Midland Planned Parenthood once did, including contraception, cancer screenings and STI tests, to the same kind of patients, low-income women who rely on the public safety net for their healthcare.
In fact, just before the Planned Parenthood clinic shut down, the two providers made a plan to minimize the fallout. Planned Parenthood sent nearly 5,000 patient medical records – up to 1,000 belonging to active patients – directly to MCHS.
But to Austin’s dismay, only about 100 former Planned Parenthood patients ever showed up at his door.
“We are seeing a subsequent rise in STDs and a subsequent rise in unplanned pregnancies,” Austin said. He believes they could be linked. “And I’m sitting here going, ‘See? I told you so. This is what happens.’”
In the weeks ahead, members of Congress will replicate Midland’s experiment on a grand scale by defunding Planned Parenthood across the country. They will do so in the form of a budget that blocks Planned Parenthood from accepting Medicaid, the government-funded insurance for low-income individuals.
It’s a move Republicans have long framed as a rebuke of Planned Parenthood’s role in providing abortions – even though Medicaid is prohibited from covering abortions by law, and only half of Planned Parenthood clinics even offer the procedure.
What Medicaid does do is allow Planned Parenthood to provide contraception, cancer screenings and STI tests to 1.5 million patients in the public safety net at some 650 health centers for no cost. About two-fifths of the organization’s $ 1.3 billion annual budget derives from public funding. Without the reimbursements Medicaid provides, a spokeswoman for the Planned Parenthood said, an unknown number of those centers will have to close.
House Speaker Paul Ryan of Wisconsin recently predicted that federally funded health centers – like the one in Midland – could pick up where Planned Parenthood left off. “They’re in virtually every community,” he said at a recent town hall, “providing the same kinds of services.”
But public health officials such as Austin, who work in states where Planned Parenthood’s presence is already in decline, are sounding the alarm. They say the loss of Planned Parenthood would imperil the health of thousands of women who already face high barriers for care.
And some of the strongest voices in opposition come from Ryan’s own backyard.
“They’ve never replaced the services of Planned Parenthood,” said Gail Scott, director of health in Jefferson County, Wisconsin. Her county, which lost the Johnson Creek Planned Parenthood in 2013, bumps up against Ryan’s congressional district. “I’m not pro-abortion or anything,” she said. “But I can tell you nothing ever replaced those services for uninsured people.”
The clinics in Johnson Creek closed because lawmakers in Wisconsin, as in Texas, approved a series of family planning cuts targeted directly at Planned Parenthood. Today, Scott said, when the Jefferson County health department gets calls from low-income women looking for a place to obtain contraception, staff recommend they travel to another county – where there’s still a Planned Parenthood.
Chippewa County, Wisconsin, also lost its Planned Parenthood clinic. Jean Durch, the county health director at the time who is now retired, recalled that after the closure, there was no place in Chippewa for women to receive STI tests, even though her department sought the funding to make it happen.
“We never were able, before I retired, to pick up the full complement of services” of Planned Parenthood, she said.
And Shawano County, Wisconsin, which is experiencing a flare-up in gonorrhea and which the state government recently designated a hot-spot for new chlamydia infections, is still feeling the pressure. After the Planned Parenthood there closed, former patients faced significant waiting lists to see a doctor at local community health clinics. The health department didn’t know where to send women for certain services.
“The clinic that closed in Shawano served the whole county,” said Jaime Bodden, the Shawano County health director. Not just women on Medicaid, she said, but women with stingy insurance and women with no insurance at all. Now, the county health department is virtually on its own as it combats the region’s rising STI rates.
“It’s something that we still often talk about,” she said. “We say, ‘Wouldn’t it be nice to have Planned Parenthood in town?’”
‘A national healthcare disaster’
Planned Parenthood officials say Wisconsin would continue to be hard-hit if Congress went through with its plans for defunding. A disproportionate number of its patients there are Medicaid beneficiaries and women of color – groups of people who already face barriers to accessing care.
Already, some of their patients are worried about gaps in their health care if Planned Parenthood were to disappear.
“I have to get that care,” said Courtney Kessler, 22, of Madison, Wisconsin, who has a family history of ovarian cancer and has gone to Planned Parenthood for cancer screenings and contraception for seven years. She is on a public safety net program that covers the costs. “I don’t know where else I would go. I would have to spend time finding somewhere else to go, and worry about, can I afford it? And worry about, am I getting the same quality of care I get with Planned Parenthood? It’s only making it more difficult for people already having struggles.”
Planned Parenthood operates 22 locations in 15 Wisconsin counties, with just two providing abortion services. A new survey conducted by Health Management Associates, a healthcare consulting firm, and paid for by Planned Parenthood, concluded that in seven of those counties there are no viable alternatives to Planned Parenthood for family planning services. In four other counties, there is only one viable alternative. Two counties that would have no alternative if Planned Parenthood were to close – Racine and Walworth – comprise part of speaker Ryan’s district.
The notion that overnight they can serve two million more people who need reproductive health services is absurd
The survey also concluded that many alternatives offer limited hours and do not stock all the most effective contraceptives – making it questionable that they are truly alternatives to Planned Parenthood.
Raegan McDonald-Mosley, Planned Parenthood’s chief medical officer, said this pattern holds across the country. In 332 of the 491 counties where it had locations in 2010, the latest year numbers were available, Planned Parenthood served at least half of the women obtaining contraception through the public safety net. In 103 of those counties, Planned Parenthood was the only safety net provider for family planning.
“We play a hugely important role in family planning safety net around the country,” said McDonald-Mosley. If those clinics were no longer options for many women, “It would truly be a national healthcare disaster.”
A woman has her blood pressure checked at a women’s clinic in San Juan, Texas. Photograph: Delcia Lopez/Reuters
Proponents of defunding Planned Parenthood have circulated their own surveys. In 2015, lawmakers and anti-abortion activists distributed maps and lists claiming there were thousands of government-funded health clinics able to take on Planned Parenthood patients. Several news outlets revealed that these lists included dentists, jails and food banks.
Still, many of the dots on such maps represent clinics that really do offer the same services as Planned Parenthood. The question is, can they take on potentially millions of new patients?
Many public health advocates are skeptical.
“Planned Parenthood treats about 2 million women on Medicaid and community health clinics in total serve about 25 million – everybody from infants to 90-year-olds,” said Sara Rosenbaum, a professor of health policy at George Washington University who has worked in the field of community health for several decades.
“They have wait lists for the people they’re serving today, much less having to absorb all of Planned Parenthood’s patients as well,” she continued. “The notion they can suddenly ramp up their capacity to absorb all of the services Planned Parenthood can offer, the notion that overnight they can serve two million more people who need reproductive health services is absurd. It displays, to my mind, an astounding ignorance of how the health system works.”
‘Texas illuminates what may happen’
Planned Parenthood hasn’t produced an estimate of how many of its clinics might close, and where if the group were defunded.
In Texas, though, a nascent body of research suggests that excluding Planned Parenthood from the safety net has negative consequences even when the cuts don’t force clinics to shut their doors.
These studies have measured what happens not when Planned Parenthood clinics closed, but when women enrolled in Texas’ Medicaid-like program can no longer use their insurance at Planned Parenthood. One study, from the Texas Policy Evaluation Project of the University of Texas-Austin, followed women in Midland (before the clinic shut down) and Houston who relied on Planned Parenthood for Depo Provera, an injectable contraceptive. They found that 20% of women who wanted to stay on Depo-Provera missed their next dose.
These women faced a small but real increase in their odds of getting pregnant. About 25% became pregnant – versus just 8% of the women who didn’t miss their next dose.
The other four out of five women in the survey who wanted another dose, got one. But it wasn’t always free, and it wasn’t always straightforward. Forty-three percent of these women reported that it cost them time or money to find a new provider. In Midland, because other providers were scarce, 65% of the women surveyed kept going to Planned Parenthood, even though it now meant paying out of pocket.
Republicans trade blows with Planned Parenthood president Cecile Richards, in a congressional hearing in September 2015.
Defunding Planned Parenthood, in other words, didn’t necessarily stop women from relying on Planned Parenthood for health care – it just forced them to replace the state’s money with their own.
“These results should be cautionary to states considering similar measures,” the study warned. “They contradict the claim that Planned Parenthood could be removed from a statewide program with little or no consequence.”
Another study found that after Texas kicked Planned Parenthood out of the Women’s Health Program, there were drops of more than 30% in reimbursement claims for some of the most effective methods of contraceptives (although not birth control pills). The drops were only observed in counties where women had previously used local Planned Parenthood affiliates. That study also measured a small but real uptick in births by women on Medicaid, although there are other explanations besides the loss of Planned Parenthood.
“Texas’s experience illuminates what may happen on a larger scale,” said Joe Potter, a UT Austin researcher. “Each person involved in the program had to go find a new provider. And whether or not the new providers have the training, experience, and bureaucratic set up so women can get care promptly is a big question mark.”
Austin, who runs the clinic in Midland, says the problem isn’t just that local health clinics might not have the capacity. In fact, he was one of few public health officials interviewed who felt that federally funded healthcare clinics really could provide for Planned Parenthood’s patients – eventually.
“Logistically, yes, it can happen,” he said. “But it can’t happen for free or overnight. In Dallas or Austin, you could be talking about 10,000 people being displaced into the community health system. I’m sure [local clinics] would do their best, but it would take a ramp-up to do it.”
A Texas health department survey of the state indicates that the capacity to absorb Planned Parenthood patients might exist. But the problem, as Austin’s experience attests, is getting all of the same patients that Planned Parenthood once served through the door. Clinics like his also have an extremely limited ability to advertise their existence. Women know what Planned Parenthood is and the services it offers. And MCHS doesn’t employ the same medical professionals as Planned Parenthood – people that patients have trusted for years with personal and sometimes embarrassing issues.
All these could be reasons why hundreds of Planned Parenthood patients, unless they moved or found other care, never transferred to Austin’s clinic.
Recently, MCHS moved most of the 5,000 records it inherited from Planned Parenthood into storage.
“It broke my heart,” Austin said. “Here’s 5,000 people who have basically been thrown out on the street. What happened to them? I can only account for about a hundred of them. What happened to the rest?”
