Category Archives: Health Care – Access To

First Responder Deaths Demand Response

Ground Zero in Ruins. Courtesy CBS News

Ground Zero in Ruins. Courtesy CBS News

Adan Gonzalez, 69, died of throat cancer in April, 2015. Mr. Gonzalez had been a photographer and a volunteer at the World Trade Center site, working for two years as a photographer documenting the event and serving other volunteers.

Mr. Gonzalez is one of 1,712 First Responders who died due to the Sept. 11 attacks, 412 who died the day of the attacks (wikipedia) and 1,300 who died from medical complications arising from their search and rescue work. Over 40% of the 4,053 people who died in or resulting from the attack, not counting soldiers killed in Afghanistan or Iraq, or who died after returning home were first responders engaged in search and rescue or cleanup operations, a humanitarian mission.

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How to Fix Medicare, Medicaid, and Social Security

FDR in 1933
President Roosevelt created the Social Security Administration in 1935.

Pres. Johnson
President Johnson created Medicare in 1965.

President Obama
President Obama passed the Affordable Care Act in 2010.

People say “Medicare and Social Security are broken. They need to be fixed.” Some say they should be eliminated, or turned into voucher programs. What are the facts? What does “Broken” mean, in the context of Medicare and Social Security?

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Don’t wealthy Americans need emergency rooms, too?

httpv://www.youtube.com/watch?v=9H4u-trTvNk

New York City politics is often about real estate value, and distance is often measured in travel time. A hospital three miles away in suburban or rural Arizona might be reachable, on a flat straight road with no traffic, in  an ambulance with lights and sirens running, in well under three minutes. Not in New York City.

In 2010, in financial trouble after serving the sick and dying for 161 years, a deal was brokered – the details don’t matter – in which the overwhelming majority of the hospital’s grounds would be replaced by luxury housing, plus the fig leaf of an “urgent care center,” which, it was implied, was the functional equivalent of a hospital emergency department. St. Vincent’s did have, while it was in operation, a full-on top tier emergency department, with specialists, operating rooms – like, in fact, a fully accredited emergency department designated as a trauma center in a major American city.  The replacement “urgent care center” – to  be frank, this phrase as used is more deceptive than illustrative – would not, is not, and will not be able to treat gunshot wounds, heart attacks – those patients will have to be transported to the nearing hospital designated, accredited, equipped and trained as a trauma center.

So the people buying this “luxury” housing will be buying housing without one of the characteristic amenities of modern big cities: outstanding hospitals with emergency departments. Unless, of course, they’re lucky in avoiding traffic, or in good enough shape to withstand a long ride in an ambulance. It is not without some shame that we note that New Yorkers, whatever their other virtues, are inured to the signals of emergency vehicles: we don’t rapidly pull over to make way for ambulances, police vehicles, or fire trucks.  Our chronic housing shortage being what it is, people will undoubtedly buy or rent apartments on the former St.Vincent’s site anyway, but we wonder if the lack of a readily available emergency  room will affect prices.  From http://healthcarevote2013.com:

Few healthcare issues are as urgent in New York City as hospital closures.  The Year Of The Healthcare Vote 2013 was created in response to the closure of St. Vincent’s Hospital in 2010.  St. Vincent’s had served New York for 161 years, and will be replaced by luxury condominiums.  Since that time hospitals have been closing at an alarming rate throughout New York City – in particular those that serve working and middle class New Yorkers.

In 2013 New Yorkers will choose a new Mayor, 51 members of City Council, a Comptroller, a Public Advocate and five Borough Presidents.  Access to quality healthcare is a life and death concern for New Yorkers; Healthcare Vote 2013 will bring awareness and accountability to healthcare issues in New York City’s upcoming elections.

Healthcare Vote 2013 will work to advance discussions on all healthcare issues important in our communities and ask candidates to pledge to preserve publicly accessible hospitals and expand public healthcare in the neighborhoods they represent including restoring a hospital to the Lower West Side of Manhattan.

Please get involved.

Percentage of population without health insurance by state, 2009

Percentage of population without health insurance indicated by darker tone

 

 

From Wikipedia’s article, Health Insurance Coverage in the United States.

The shaded  areas indicate percentage  of population without health  insurance coverage, with the darkest shading indicating the highest rates of population without insurance.
 20–27%
  16–20%
  14–16%
  10–14%
  4–10%

Health Care for all Americans

President Obama, 2010

President Obama

President Obama thinks that every American should have access to health care. Judge Henry E. Hudson in Virginia, however, ruled that compelling people to buy health insurance is unconstitutional. (NY Times, New York Magazine, CNN)

President Obama is obviously correct. President Bush and Senator McCain might actually agree. Pres. ush, who appointed Judge Hudson to the Federal District Court, said in Cleveland, Ohio, July, 10, 2007, (1, 2), “People have access to health care in America. After all, you just go to an emergency room.” Sen. McCain repeated this during his 2008 campaign for the Presidency (click here). While this implies a form of universal health care, Pres. Bush and Sen. McCain, miss the nuance that emergency rooms are not primary care facilities (click here). Emergency rooms are designed for EMERGENCIES. They are not equipped to handle primary care (click here).  (This is a ‘nuance’ big enough for an aircraft carrier to sail thru.)

Judge Hudson, however, may have a point. While it’s one thing to mandate that everyone have access to health care, it’s another to mandate that everyone patronize a set of investor owned or privately held enterprises.  It’s like saying that every child must go to school, and must also go to a private school.

But if both Pres. Obama and Judge Hudson are right, is there a common ground?

Let’s look first at the uninsured. Continue reading →

Kaiser Family Foundation: side-by-side comparison of health insurance proposals

The Kaiser Family Foundation has created a web page which permits side-by-side comparisons of every health-care proposal currently on the table, including that by U.S. Senator Bernie Sanders (D-VT via

Brooklyn, New York) and that of the Republican Study Group. I note those because I’m taking a guess that those represent the poles of the debate – but that may not be the case. There are fourteen bills compared, not including President Obama’s proposal as a candidate, which KFF thoughtfully provides.

We are reluctant to reach a conclusion, not having read the bill yet – but concerned that the net effect of the bill may amount to a step backwards. That said, if the bill passes or fails to pass in its current form, we suggest that – among other steps – it may be time to revisit the insurance industry’s exemption(s) from United States antitrust laws.


Representative Rush Holt on Health Care Legislation

In an e-mail to supporters, Rush Holt, D, NJ-12 said,

Rep. Rush Holt, Ph.D.

Rep. Rush Holt, Ph.D.

I just now voted for the Affordable Health Care for America Act. I want you to know about this development and what the bill means for you. This bill would provide secure and stable health coverage regardless of whether you change jobs or are between jobs, ensure Americans will never be denied care if they get sick, and extend coverage to those not well served by the current system.

This is a historic vote and the furthest we have come toward providing affordable and quality health coverage to all Americans. Continue reading →

Puzzling Veterans Administration regulation limits use of safer, cheaper, effective treatment

For some background, see our earlier post, Mindgrowth – affordable, effective biofeedback devices.

The United States military and veterans hospital systems are making effective and widespread use of biofeedback  ((Biofeedback, as defined by the United States National Institutes of Health.))  in treating PTSD ((Post-Traumatic Stress Disorder; see, inter alia, “Traumatic Stress,” by the Harvard Physician Bess van der Kolk. For other examples see Tackling fears, virtually (Times Colonist, October 8, 2009;Stress management program helps soldiers with PTSD Florida Times-Union, 28 Sep 2009))

That biofeedback (sometimes referred to as “neurofeedback”) can be of medical use seems uncontroversial. The desired end-state, of course, is for the patient to beable to reproduce the same effect (e.g., not panicking when exposed to loud noises) under normal circumstances and without the use of the equipment.It’s a process of learning and unlearning, and like any such process, some repetition is in order.

Why, then, would the government use this equipment widely, but have a rule which prohibits prescribing or dispensing the equipment so that patients can take the devices home and practice with them between  office visits. Link to VA Regulation (excerpted in footnote)  ((http://www.va.gov/hac/forbeneficiaries/champva/policymanual/champva/chapter2/1c2s30-5.htm, or http://tinyurl.com/yfyywhd

VI. EXCLUSIONS

A. Biofeedback for hypertension.

B. Biofeedback for the treatment of migraine headaches.

C. Biofeedback therapy provided for the treatment of ordinary muscle tension or for psychosomatic (i.e., psychophysiological or psychological factors affecting a medical condition) conditions (CPT codes 90901, 90875, and 90876). [38 CFR 17.272(a)(71)]

D. Rental or purchase of biofeedback equipment.  [38 CFR 17.272 (a)(70)]

E. Treatment of psychosomatic conditions (i.e., psychophysiological or psychological factors affecting medical condition) and for CPT codes 90875 and 90876.  This exclusion includes individual psychophysiological therapy incorporating biofeedback training.))

We’d welcome learning that we’ve misread the rule, or that there’s a good reason for it – devices powered by two “AA” batteries don’t generally pose much risk.

But if our reading is correct, who benefits from this rule?

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Health Care – Medicare for All

I have a good full-time job. I buy the health insurance my Human Resources Dept tells me to buy. (This is not, by the way, a “free market” as described by Adam Smith, David Ricardo, John Maynard Keynes, Milton Friedman, and other neo-classical economists.) I pay enough that I could be driving a Hummer  about 2,400 miles per month (at current gas prices).

But my coverage is rationed by insurance company beancounters. When I need a doctor, I see one of their docs.  A complete physical is free once a year. It takes about two hours and 30 seconds – two hours waiting and 30 seconds in which the doctor says “You’re breathing. That’s good. You’re blood pressure is high, if it gets higher we’ll put you on meds.”

That’s ok, or what passes for ok. As long as I don’t get sick I’m ok. That’s why my blood pressure is high. I’m worried about getting sick. Or losing my job. Or losing my job and getting sick. In that case I’ll lose my house.

One thing I don’t worry about is that my father. He’s well over 80, and he has good health, and good health care. He’s on Medicare. It’s great. Efficient.  Government run. Not sexy like the Apollo Mission to the moon, but very important. And for the health care that my kids teachers get. They go to public school. The teachers are in the unions. And the health care is good. The kids too get good health care. My kids, my kids friends, even if their parents work but don’t get health care, then, thanks to Presidents Clinton and Obama, and despite the efforts and vetos of President Bush, they get health care.

But one of the things that really gets me, the thing that makes my blood boil – which is why I’ll need blood pressure meds – is that close to 50 Million Americans – one out of six – have no health insurance. And it’s people between the age of 18 and 65. People who work, or would work, if they could find jobs.  This is wrong on many levels. It’s not just that I have friends in that position, and that I was in that situation – working hard, falling backwards, no health insurance – barely able to afford food. According to Paul Krugman, in the New York Times, “many of the protesters who don’t want “Government Run Health Care” are on Medicare.” While that’s almost funny, it’s also very sad.

Health Care Costs and Access, US, Canada

Back in 2006, 45 Million Americans, one out of every six people, had no health insurance. When those one of every six people got exposed to something contagious, they exposed a lot of other people. Given the level of unemployment today, the number of people without health insurance is probably higher. It includes everyone who lost their job and can’t afford or no longer qualifies for COBRA.  According to a report on CNN, produced by Jennifer Pifer-Bixler, published March 4, 2009, at some point during 2007 or 2008, 86.7 Million Americans –One out of Three were without health insurance.

As Peter Barnes put it, in Capitalism 3.0, (ISBN-10: 1-57675-361-1)

Here’s the bottom line.  All Canadians get health care and peace of mind at a per capita cost that’s about 45% lower than ours. Canada lays out less than ten cents of every health care dollar on administration, while we spend nearly thirty cents (and that doesn’t include time and energy patients themselves spend on paperwork.) What’s more, our health care system doesn’t even keep us healthy. Our infant mortality is higher than Canada’s, our life expectancy is lower, and we have proportionally more obesity, cancer, diabetes, and depression. To top it off, forty-five million of us have no health insurance at all.

Health Care By The Numbers, 2005 United States

 Canada
Estimated per capita expenditures (2004; US $) $6,040 $3,326
Percent spent on administration (1999) 26% 10%
Monthly premium for family of four $1045 $88
Male life expectancy (years) 75 77
Female life expectancy (years) 81 84
Infant mortality (per 1,000 births)

6.4 4.7

This is not why Paul Revere rode thru Boston on the 18th of April in ’75. This is not why John Hancock, Sam Adams, John Adams, Richard Stockton, Ben Franklin, Thomas Jefferson, and the rest of the 56 delegates signed the Declaration of Independence (U S History . org , wikipedia).

This is not the America I know and love.

Here’s the article on CNN :

Study: 86.7 million Americans uninsured over last two years

By Jennifer Pifer-Bixler, CNN Senior Medial Producer
March 5, 2009: 1:44 PM ET

NEW YORK (CNN) — One out of three Americans under 65 went without health insurance at some point during 2007 and 2008, according to a report released Wednesday.

The study, commissioned by the consumer health advocacy group Families USA, found 86.7 million Americans were uninsured for at least a portion of those two years.

Among the report’s key findings:

  • Nearly three out of four of those uninsured Americans were without health insurance for at least six months.
  • Almost two-thirds of them were uninsured for nine months or more.
  • Four out of five of the uninsured were in working families.
  • People without health insurance are less likely to have a usual doctor and often go without screenings or preventative care.

“The huge number of people without health coverage is worse than an epidemic,” Ron Pollack, executive director of Families USA, said in a news release. “Inaction on health care reform in 2009 cannot be an option for the tens of millions of people who lack or lose health coverage each year. … The cost of doing nothing is too high.”

Mindgrowth: biofeedback devices for pain management and other uses

Mindgrowth, a U.S.-Canadian company – distributes biofeedback equipment  – with MindGrowth's GSR deviceand without tracking software – used for, among other things, pain management/reduction, treating PTSD, panic disorders, and other uses.The GSR2 (pictured below) is designed and manufactured in North America by Thought Technology, the largest manufacturer of biofeedback products in the world. There are more than 550,000 of the GSR2 in use worldwide, including the United States Veterans’ Administration medical system.

Biofeedback is no longer “experimental” – there’s no question that it works, not only for medical uses, but also in enhancing athletic performance and cognitive function. It has a substantial drawback in the context of the United States health system: once purchased, and used/learned, some people have lasting effects and never touch the equipment again – others need to return to the biofeedback equipment to “relearn” the original “lesson.” To keep this example simple – think of someone trying to unlearn a fear response to a particular stimulus – loud noises, for example.

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