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The War on Women, by Sarah Wolfe

Mar 04, 2012
Is anyone not familiar with Rush Limbaugh’s comments following Rep. Darryl Issa’s refusal to allow a third-year, Georgetown law student to testify before his committee about insurance coverage for contraceptives? Limbaugh decided to conflate her testimony (which she presented, but not to the whole Congress) with “loose” sexual mores. Interesting that someone married four times feels he can play the “morality card.”

In any event, Limbaugh wasted no time in calling the law student, Sandra Fluke, a slut and a prostitute. Predictably, people on the left or in the center denounced his breath-taking misogyny, while those who hope to trounce Obama in November either seconded Limbaugh’s remarks (Pat O’Reilly, for instance) or made tiny bleating sounds they hoped would be interpreted as criticism by the angry women whose votes they want. The only Republican who used strong language was Scott Brown and he’s running against Elizabeth Warren. His handlers told him what to say.

Let’s shove aside the extraneous: the manufactured kerfuffle over contraception, the manufactured kerfuffle over religious rights (hard to be Catholic? Try establishing a voice as an atheist in this theocracy), and the warp speed employed by Republicans to attack the president for telephoning Fluke.

The situation (Rep. Issa’s turning Fluke away, saying her testimony wasn’t significant; who cares what women think about contraception?) elegantly reflects the way in which the powerful (men) cut the powerless (we know who we are) off at the knees, leaving us voiceless and ashamed. By refusing to allow Fluke to speak they did what men have done for centuries: marginalized us, shut us up, ignored our concerns, slammed the door in our faces and said, “Get outta here.”

And then, as though that weren’t enough, they trivialized Fluke (and, by extension, women in general) by equating her thoughtful analysis of why contraception should be covered by employers with the desire to have endless amounts of sex. That contraception is necessary even if you have sex one time, that the need for it is a public health issue, that the vast majority of women of child-bearing age use contraceptives, that abstaining women also take birth control pills was all thrown by the wayside. In essence, both men and their supporters were saying that women have no right to talk about sex in public, that the expression of a need for contraception by an unmarried woman is shameful and shouldn’t be allowed. Yea, even unto the 21st century doth this continue!

Every few years, civilized people who had begun to believe that things had gotten better are shocked when troglodytes trot out the same, tired sexist and racist beliefs. It’s depressing. Still, this time there was an uproar. And though we figure that Rush will never be thrown off the radio so long as he provokes and has listeners, we can’t but feel that he will be a trifle less careless, a bit more self-conscious about what he says. And for someone as reckless as he is, I imagine that’s a burden. In addition, it must have been inconvenient and time-consuming for his employer to have to deal with angry advertisers pulling their spots. In this mixed-up world, we have to draw consolation from small things.

tags: Health

Health Care Vermont, Part 1

Dec 05, 2010
Vermont’s legislature is considering a plan to implement health care for all its citizens. If successful, it will be a single-payer, government-administered, cradle-to-grave plan that will eliminate the profit and overhead costs of private insurance plans. It will not be easy to implement, even without the millions of dollars the health care industry will pour into defeating it. However, it is important that we succeed here and show the way to the rest of the nation.

To that end, I want to make a few suggestions regarding the direction we should go in crafting this plan.

The point of insurance is to share risk among the insured population, and to protect each of us from ruinous expenses. A car accident, a home destroyed by fire, or the onset of a serious disease can spell financial disaster for a family. Car insurance has long been issued on a no-fault basis, largely to spare society from protracted and expensive legal procedures. However, premiums are still calibrated in accordance with the perceived risk level of the drivers. Sixteen-year-old boys pay more, as do older drivers with poor records. If you set fire to your own house for the insurance, you have committed arson and you will have a hard time collecting.

In the realm of health care, the issue of fault also needs to be addressed. Some people will burden the system more than others for reasons relating to their lifestyle choices. The system should encourage a healthy lifestyle, and when it is burdened with procedures that are the result of unhealthy lifestyles, the patients involved must bear a greater share of the cost. How this is to be adjudicated or implemented is subject to debate. But it is clear to me that an acknowledgement, assignment, and assessment of fault should be part of a universal health care plan.

We all know that health care costs have been skyrocketing throughout most of our lifetimes, and now expend over 17 percent of our GDP—twice that of most other industrialized countries—and they are estimated to nearly double by 2019.1 This is not entirely the fault of greedy private insurance companies. Many diagnostic procedures require expensive new devices. The population is increasing and aging. The American diet is disastrous—childhood obesity, for instance, has tripled in the last thirty years and is now considered of epidemic proportions.2

If we are to craft a do-able universal health care plan, we must make prevention our first priority and we must calibrate coverage in a way that takes that priority into practical consideration.

In my next posting, I will discuss the issues of so-called health care rationing and the incendiary issue of end-of-life care.
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1 National Health Expenditures Top 17% GDP
2 Overweight Trends Among Children and Adolescents
tags: Health

The Coming Constitutional Crisis

Jan 02, 2010
Vermont is at it again.

Hard on the heels of becoming the first state to enact a statute allowing homosexual unions, we are now mounting a credible campaign to bring single-payer, government-administered health care to all our citizens. Bills have been introduced in both houses of the legislature (H.100 in the House1 and S.88 in the Senate2). With coordination from the Vermont Workers’ Center (VWC)3, the grassroots are gathering to demand passage of the bill (the House and Senate versions are essentially the same, unlike the games-playing variations between versions in D.C.).

Should Vermont pull off this cheeky maneuver, and the feds pass a health care proposal requiring every citizen to purchase, either directly or through their employer, health care coverage from private insurers in perpetuity, we can anticipate a Constitutional crisis of dramatic proportions. The graybeards of the Supreme Court will find their strict constructionist, states-rights positions sorely tried as they are called upon to prop up the corporate hegemony which Vermont’s action will have threatened.

The feds, of course, will believe themselves to have any number of prerogatives available to them for purposes of slapping down the upstarts; however, I would not sell Vermonters short in their readiness to dig in their heels. We have not sacrified disproportionately high numbers of our men and women to our nation’s conflicts because we’re pussies4,5. And the last time the nation fumbled the Vermont ball, in 1777, we declared our independence for 14 years6. Those who forget history may be condemned to see it repeated.

On January 6, VWC and supporters of the legislation will meet at noon at the Statehouse in Montpelier to present thousands of postcards in support of single-payer health care to legislators on the opening day of the new session. There is still time to sign these postcards online7. Then, on January 12, from 6-8pm, hearings on H.100 and S.88 will begin.

Should the legislation pass, the two houses have veto-proof majorities which have already overridden two vetoes (unprecedented!) by our lame-duck Republican governor. Can you say “hat trick“?

What fun! Happy New Year.
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1 H.100: An Act Relating to Health Care Financing and Unviersal Access to Health Care in Vermont
2 S.88: An Act Relating to Health Care Financing and Universal Access to Health Care in Vermont
3 Vermont Workers’ Center
4 Effects of the World Wars on Vermont
5 CARSEY STUDY: War Death Rate Higher Among Soldiers from Rural Areas
6 Vermont (Wikipedia)
7 Healthcare Is A Human Right Postcard
tags: Health

Nation of Sheep

Dec 24, 2009
It would have taken but one brave senator to scuttle a health care “reform” bill that, as Howard Dean and others have concluded, will do more harm than good. Besides delivering us all for perpetuity into the kindly hands of the health insurance industry—or face a fine for trying to opt out—it will still, apparently, leave at least 17 million Americans uninsured. It purports to close two loopholes—pre-existing conditions and dropped coverage—that insurance companies have heretofore enjoyed in denying coverage. We shall see to what extent those loopholes really are closed.

One brave senator might have sent—may still send—a resounding message through the corridors of power in Washington, D.C., that the people will not be held hostage to the corporatocracy. I thought that that senator may have been from my own state of Vermont; however, Bernie Sanders voted for the Senate bill along with the other 58 democrats and one other “independent”—Joe Lieberman. He explains himself in a great interview on MSNBC’s Morning Joe show1, where he claims that the provision of a $10 billion program to institute community health centers partly persuaded him to support the bill. We all know what a drop in the bucket $10 billion is, and I was disappointed to hear him grasp on to this straw as a reason to keep from withholding his support.

The most telling comment in the interview comes about halfway through (4:30), when Sanders states outright a truth that should have us all in the streets howling for blood: “Big money interests control the United States Congress.” Others have said the same thing recently. And if that is not a sufficiently sad and infuriating fact to bring the American people to their feet in an outpouring of activism and protest, then what is?

In his just-published novel, Ralph Nader has concluded that a popular social movement is now impossible to mount and that “Only the Super-Rich Can Save Us!” His utopian novel has the likes of Warren Buffet and George Soros joining forces to wrest our nation from runaway capitalism and restore it to the people. After Nader’s dismal showing in a third run for president in 2008, it is not surprising to see one of America’s true heroes reaching for a desperate solution. Fiction is fiction, however, and a far likelier scenario for the future may be a cheery comment Kurt Vonnegut made a few years before his death: “Things are going to get worse and worse, and they’re never going to get better again.”
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1 Sanders’ Honest Assessment of the Health Reform Bill—MSNBC’s Morning Joe
2 Only the Super-Rich Can Save Us!
tags: Health

Unhealthy Care

Nov 10, 2009
If you have not read Naomi Klein’s The Shock Doctrine: The Rise of Disaster Capitalism, then waste no time, click on this link, and buy it now, or run out to your local library for a copy.

Read but a small portion of it and you will understand why our elected representatives could pass a health care “reform” bill last weekend that 1) requires every man, woman, and child in our country to purchase coverage from a corporate health insurance provider for the rest of our lives; 2) does not allow states to craft their own public, single-payer option; 3) protects patents for many of the most important drugs of the future from ever expiring and allowing the manufacture and sale of less expensive generics; and 4) denies coverage for vital and legal medical procedures to the population which needs them most.

We can only hope that the Senate introduces sufficient additional horrors into this bill to assure its failure. In other words, the best health care reform we can hope for now is no health care reform. Because this is not reform. This is Disaster Capitalism at its worst, a huge windfall for the corporatocracy, paid for by the poor and the middle class, yet again.

Klein’s book lays out the pattern and policy of torture—physical, social, and economic—pursued by the corporatocracy, and abetted by their minions in the government, since the end of World War II. The goal: to enrich the few at the expense of the many. And it has been working like a charm, in case you hadn’t noticed. Her book, thoroughly supported with references, is an eye opener of extraordinary proportions. No one who reads it will ever feel the same about our country. And having turned its last page and set it down, you will be forced with a choice: hope or despair.

I still believe there is hope. However, it must manifest itself soon in real action by the American people to reclaim our national ideals. If we aren’t up to the task, more than this nation will suffer the consequences. Our species will self-destruct, and those surviving will not miss us.
tags: Health

NPP Plank 3: Health Care

Jun 28, 2009

No sensible decision can be made any longer without taking into account not only the world as it is, but the world as it will be.
—Isaac Asimov, scientist and writer (1920-1992)
The current, very heated debate surrounding health care reform is being conducted entirely within the context of the status quo, whereas medicine and health care will experience revolutionary change this century, rendering the status quo unrecognizable, probably within a generation.

In the first place, many diseases will be eradicated, possibly including such big-league killers as cancer and heart disease. We will learn to prevent many of these maladies, some as early as in the womb. Others will be cured by new pharmaceuticals and surgical procedures. In the second place, it is not unreasonable to predict a doubling of longevity among industrialized populations by 2100.1

We are well on the road to these changes today, and they will transform our attitude toward health care, as medical procedures proliferate and many of us hang around a good deal longer making use of them.

Combine this slightly futuristic picture with the status quo in America: 47 million Americans, nearly one in six, were uninsured before disaster struck our economy in 20082 and many millions more were underinsured. More to the point, medical care is consuming ever-greater proportions of our gross domestic product, up from around five percent in 1960 to over 17 percent today.3 Given the assertions made in the second paragraph, that proportion is only likely to increase, and any health care reform must, of necessity, be geared to slowing the pace of this growth.

Health care reform must, therefore, address the world to come, not the one which is quickly passing away. With that in mind, the Health Care plank of the “New Political Party (NPP)” supports the following:
  • Free, universal, government-managed basic health care to be provided to all U.S. persons (citizens and permanent residents) from prenatal care to death.
  • “Basic health care” will include primary-care physician examinations with an emphasis on preventive and family planning medical services; physician and hospital treatment of all injuries and illnesses; dental care; mental health care; the provision of medicines and drugs; and long-term nursing and/or home health care. Assisted suicide services will be funded in all states where they have been legalized.
  • Organ donations will be required from all decedents until such time as the manufacture of artificial organs is perfected.
  • Individuals who persist in unhealthy lifestyles (tobacco smokers, the obese, etc.) or refuse to participate in reasonable and proven preventive health care measures (vaccinations, colonoscopies, etc.) will be taxed a surcharge to compensate for their added burden to the system.
  • Elective and cosmetic surgeries and other medical procedures considered by the people to be beyond the scope of basic health care will be the responsibility of the individuals seeking them.
  • A significant portion of the remuneration for physicians and other care providers will be based upon their effectiveness in delivering preventive health care and in treating illnesses and injuries with efficiency, effectiveness, and economy.
  • The pharmaceutical industry will be nationalized, removing it from the for-profit sector.
  • The government will fund medical malpractice insurance, government attorneys will defend these cases, higher standards of proof will be required for demonstrating malpractice, and ceilings will be placed on awards.
  • The system will be funded by federal income tax revenues and will not be allowed to run on a deficit basis for more than one year.
Businesses will be relieved of the necessity to provide health insurance to their employees, providing an enormous boost in competitiveness domestically and internationally. The 50 percent of bankruptcy filings now at least partly due to devastating health care expenses4 will disappear. A portion of the finance industry which has been responsible for the collapse of the world economy—the medical insurance industry—will be eradicated.

Nothing has been said here about rationing health care services, limiting choice of physicians or hospitals, or any of the other draconian measures with which opponents of a national health care system would frighten us. The measures above which may seem controversial—required organ donations, the nationalization of a major industry, the placement of restrictions on malpractice claims, and penalizing the intentional pursuit of ill health—are the prices a free people pay to enter into a cooperative agreement to insure high-quality health care at a reasonable cost.

Anyone wishing to opt out of this arrangement will be free to do so and will receive a tax credit. They are thereafter on their own, so perhaps there is room for a small continuing health insurance industry after all. Do I hear any takers?
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1 Aubrey de Grey says we can avoid aging (Video), from TED Talks, Jul 2005, accessed Jun 27, 2009.
2 Census Bureau: Number of U.S. Uninsured Rises to 47 Million Americans are Uninsured [sic]: Almost 5 Percent Increase Since 2005. From Medscape.com, Jan 8, 2008, accessed Jun 27, 2009.
3 Remember the HMO Revolution, by Robin Hanson, from overcomingbias.com, Jun 10, 2009, accessed Jun 27, 2009.
4 Health Insurance Costs, from the National Coalition on Health Care, 2009, accessed Jun 27, 2009.
tags: Health

Dawn of a New Day

Apr 01, 2009
We took the day off yesterday (Friday, March 27) and we’re glad we did. We were home to receive a phone call from James Carmichael, an aid to Rahm Emanuel in the White House. Back in the heady days of the interregnum we had had the audacity to hope for a position in the new Obama White House and had applied for same on the Change.gov web site. Now they were finally getting back to us, and with an offer we are still finding it difficult to believe.

The Initiative for an Equitable Society will be a new cabinet-level department Obama will announce this week, if he hasn’t already. We were offered the position of Research Manager in the office, where we would oversee fact-gathering for upper management tasked, initially, with three assignments:

  1. Together with representatives of both houses of Congress, draft legislation establishing a national minimum wage at a level sufficient to support a family of four, proportionally weighted to the varying requirements among the states.
  2. Together with the Department of Education, identify effective national education innovators in preK-16 and gather them into a Presidential Commission tasked with preparing a blueprint, within 12 months, for reforming the American educational system. The administration guarantees funding will be available as well as their full support in generating any legislation which may be required.
  3. Together with the Department of Health and Human Services and the new Health Czar, evaluate existing universal, single-payer health care systems around the world, taking from each the features which work to the satisfaction of the populaces involved, and, within 12 months, craft a plan for such a system in the U.S.
Naturally, we accepted with alacrity and are off to D.C. later this month.

And if you believe all that, we have a lovely bridge in New York City we are prepared to part with at a very reasonable price.
tags: Health

Ruining Your Health

Mar 18, 2009
Health insurance is so expensive that 46 million Americans (15 percent of us) can’t afford it. The government provides it at a deep discount for many millions of others who are elderly, disabled, or veterans.

Health insurance expends huge amounts on administrative costs and profit-taking, far more than the government does in managing Medicare and Medicaid.

Health insurance costs as much as it does because the companies that offer it spend large amounts of money trying to avoid covering people likely to need coverage and fighting to avoid paying for the services required by those who have it.

Health insurance is history in the rest of the industrialized world, where single-payer universal health coverage has been happily in place for as long as 60 years.

So of course the change artists in our current administration are backing a very clever idea for providing universal health care: require everyone to have health insurance.

Obama’s recent health care conference was not even going to include a single voice for single-payer, until the outcry was so loud that Representative Conyers was invited. Still, you will find little or no mention of this rational solution in the news media. The blackout is all but complete (except on Democracy Now, of course1).

The element in Obama’s plan most likely to provide real relief for Americans—the devising of a national health insurance provider to compete with private insurers—is almost certain to go down in defeat, despite the fact that over 70 percent of Americans favor it2,3. And we will be left with a system that costs employers more, that costs the insured more, that continues a vastly inefficient and inequitable system, and that will leave more, not fewer, Americans uninsured.
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1 As Obama Hosts Summit on Healthcare, Marginalized Advocates Ask Why Single Payer Is Ignored, from Democracy Now, Mar 6, 2009. All notes accessed Mar 12, 2009.
2 Poll Excludes Single-Payer Healthcare; Respondents Implicitly Endorse It Anyway, by Jerry Policoff, from OpEd News, Mar 12, 2009
3 Poll: 73% of Voters Think Health Care Reform Must Include Choice of a Public Health Insurance Plan, by Robert Creamer, from the Huffington Post, Mar 10, 2009
tags: Health

It’s a Crying Shame

Feb 19, 2009
Four children die in the U.S. every day as a result of child abuse, and three of them are under the age of four. A report of child abuse is made every 10 seconds during which three other occurrences go unreported. Of the reported rapes of children under 12, 90 percent of them knew the perpetrators. Child abuse happens across the entire socioeconomic spectrum.1

A study by Ronald J. Prinz, et al., of the University of South Carolina, the University of Brisbane, and Georgia State University, promises that help is on the way. Their report, Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial determined, not surprisingly, that when counties offer family service providers instruction in carefully crafted parenting procedures, those counties do significantly better in reducing child abuse than those counties where a business-as-usual approach is maintained.

Hard times spell even harder times for the powerless, and children are an all-too-ready target for a parent or guardian’s anger, frustration, and despair. With the economic meltdown, millions suddenly unemployed, and a frozen credit market, hard times are about to hit our children even harder. County workers, take note. This study can help protect our most precious asset.
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1 National Child Abuse Statistics, from ChildHelp, Prevention and Treatment of Child Abuse, accessed February 15, 2009
tags: Health

As California Goes...

Jan 24, 2009
They’re not the worst—they’re just the first!

You can view the possible future of our nation by examining the present in California, the traditional trendsetter for the rest of us. Children NOW, “a national organization for people who care about children and want to ensure that they are the top public policy priority,” did just that recently. Their January 6, 2009, press release, “Investing in Children Key to Righting California Economy,” reveals their findings, and they are not pretty:

  • A million California children are without health insurance. Every time one of them visits a hospital for a preventable ailment, it costs California $7,000, whereas it would cost only 17 percent of that ($1,200) to provide health coverage for each uninsured child.
  • One in five (109,011) high school students in California dropped out in 2007.
  • Sixteen percent of California adolescents are obese, costing Californians $7.7 billion annually.
  • Fewer than half (48 percent) of California’s 3- and 4-year-olds attend any sort of preschool.
  • Meanwhile, the state faces a growing shortage of college-educated workers, according to the Public Policy Institute of California. This means that the income gap between in-demand college grads and the excessive numbers of workers with a high school education or less will continue to grow. In 1980, that difference was 39 percent; in 2006, it was 86 percent.
Coming Soon to a State Near You! A population explosion of uninsured, uneducated, unfit, unemployable, and very unhappy young people. Be Prepared!
tags: Health

The High Cost of Medicare

Jan 04, 2009
And you thought it was free! Well, don’t feel bad—so did we.

In point of fact, it is likely your Medicare-based health coverage, in the absence of the passage of a universal health care plan similar to the bill currently before the House (H.R. 676), will cost you close to the amount you will be receiving from your Social Security benefits.

Medicare is divided into three parts:

Part A is for hospital insurance. It covers hospitalizations, skilled nursing facilities (a nursing home), and some home health care. Part A will be without cost for most Medicare beneficiaries (those with 40 or more quarters—ten years—of Medicare-covered employment, or a spouse with same), unless you actually need to use the service, in which case you will have to pay a $1,068 deductible for a hospital stay of 1-60 days. If you need to stay in a hospital longer than that, well, don’t ask. Additionally, without those 40 quarters of employment, your out-of-pocket cost for Part A (before the deductible) can be as high as $5,316 per year.1

Part B is for medical insurance. This covers physician services, outpatient hospital services, certain home health services, and durable medical equipment. In 2009, this will cost all Medicare beneficiaries $1,156.80. Again, if you actually need to see a doctor during this time, you will have a $135.00 deductible and, after that is expended, you will be liable for 20 percent of the cost of any additional Medicare-approved services.

Typically, according to a knowledgeable friend of ours with long experience in the health field, people purchase supplemental insurance to cover the Part A deductible and Part B deductible and 20 percent co-pay, at a cost of $3,000 to $4,000 per year.

Then comes Part D, the unkindest cut of all. Part D is for medications, and one has to go shopping for plans from various providers for Part D—back into the kindly hands of private insurance companies.2 In our sparsely populated, rural Vermont area, there are 47 contenders in the “Prescription Drug Plan” category and 9 in the “Medicare Health Plan Category” (we have yet to determine the difference). The 56 plans all have different combinations of monthly premiums, annual deductibles, and co-pays (what they call Drug Cost Sharing). Monthly premiums range from nothing to $111.40; annual deductibles from nothing to $295; and co-pays appear to be about 25 to 33 percent of the cost of the medications. But wait! The complication doesn’t end there. We mustn’t forget “The Gap.”

The costs above only pertain to the first $2,700 in medications you receive during a calendar year. Once you have reached that limit, you fall into the Gap and are responsible for the entire cost of the next $4,350 of your medications in that year, during which time you must continue to pay the monthly premium!

As with Parts A and B, there are numerous insurance companies eager to sell you policies to supplement possible expenses beyond the basic plan you select, although co-pays will probably still be required.

So there it is. The free government-sponsored Medicare you have been paying into during your working life, the benefits of which you have been looking forward to reaping upon a well-earned retirement, is going to cost you your Social Security check, deluge you in paperwork, torment you with multiple plans to select from (with a hefty penalty for dilly-dallying3), and altogether threaten to turn your golden years into dross.

Read H.R. 676 (linked above). It only takes a few minutes. It promises a universal health care system properly funded and administered for the benefit of the people rather than the corporations or the bureaucrats. If your representative is a co-sponsor (find out here), write them and tell them you are grateful for their support of this initiative. If they aren’t, write them and encourage them to get on board.

Single-payer, universal health care is a cherished right throughout the civilized world—except in the U.S. Bring it home in 2009!
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1 Medicare: The Official U.S. Government Site for People with Medicare (accessed, as all footnotes in this entry, January 1, 2009)
2 Medicare Prescription Drug Plan Finder
3 The New Medicare Part D and Its Penalties
tags: Health

Hunting for Health

Dec 25, 2008
As if our health care system weren’t in enough of a shambles, look out now for a sharp increase in “health tourism,” the international hunt for the best, most affordable health care. Traffic to Southeast Asia in pursuit of medical procedures is expected to grow 20 percent a year, to become a $4 billion industry by 2012.

Deloitte Consulting has concentrated its study on Southeast Asia, though doubtless many of their findings pertain to the entire globe. Medical Tourism: The Asian Chapter (.pdf, 413Kb) reports that medical procedures in SE Asia often cost only 20 to 30 percent of what they cost in the U.S. (including transportation and accommodation), and countries such as Singapore, Thailand, India, and Malaysia are busily acquiring state-of-the-art medical equipment and facilities in order to present a credible face to the world as an alternative source of medical care.

Heart bypass surgery costs $80,000 to $130,000 in the U.S. and only $6,700 to $9,300 in India. If you were a candidate for such a procedure, among the 100 million un- or underinsured Americans, relatively sure you would receive excellent treatment in a modern facility, perhaps even operated on by a U.S. physician, what would you do?

We know we pay twice as much in this country for medical care that is of significantly less quality than that of the rest of the civilized world. (See our various posting on health care.) If our entire medical industry is not to be threatened with imploding through domestic and international pressures, the Obama administration must confront its weaknesses. When it does, we are confident that the need for universal, single-payer, federally managed health care will carry the day.
tags: Health

Table of Contents

Health Care in Hard Times

Dec 15, 2008
Sixty-one percent of the nonelderly employed receive their health insurance through an employer. It is estimated that for every one point increase in the unemployment rate, 1.1 million adults will lose their health insurance coverage.1 With accelerating layoffs, many of us are now contemplating the awful eventuality of simultaneously losing our jobs and our health insurance. When that happens, options are limited to COBRA, Medicaid/SCHIP, and private insurance.

The Kaiser Family Foundation, through its Commission on Medicaid and the Uninsured, has produced a report entitled Health Coverage in a Period of Rising Unemployment (.pdf, 288Kb), by Karen Schwartz. It is a guide to the pluses and minuses of those three options and, unfortunately, one that you may wish to bookmark for future reference. Our conclusions:

  • COBRA is no bargain, even if you are lucky enough to qualify for it;
  • If you have to go with a private insurance carrier, make sure you are a 20-year-old nonsmoking male who jogs five miles a day;
  • Medicaid may be available for dependent children (through SCHIP), less available for their parents, and almost certainly not available for childless adults;
  • Not being insured while unemployed can hurt your coverage once you go back to work.
The provision of health care in this country is not only expensive, less effective relative to other civilized countries, and impenetrably complicated, it is also cruel, with the full force of its shortcomings affecting those least able to withstand them—the poor, the unemployed, and the elderly.

Universal. Single-payer. Federally managed. Now.
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1 Health Coverage in a Period of Rising Unemployment, from the Kaiser Commission on Medicaid and the Uninsured, undated, accessed December 9, 2008
tags: Health

Sick to Think of It

Nov 30, 2008
Our employer-based health insurance (in healthy New Hampshire) has gone up over 40 percent in three years, roughly four times the increase in the Consumer Price Index.1 At that cost—about twice what the rest of the civilized world pays—we receive medical care that is significantly, demonstrably, shamefully inferior.2 We rank 26th in child mortality. Our maternal death rate is also high, and rising.3 We lag behind 16 other countries in longevity.4 America’s poor health, and poorer health care, cost us billions in lost productivity every year.

The wealthiest nation in the world—until recently, at any rate—owes itself an obligation to remove health care from the rough-and-tumble of the marketplace, where supply and demand and the profit motive reign supreme, at the expense of high-quality care. There are enough national health care systems in the world now that we can study them all and pick and choose the best features of each in crafting our own. To maintain the status quo, even with a tweak here and a tuck there, is indefensible, given the cost and the inferior product our health care system provides.

Barack Obama never mentioned single-payer, federally managed health care in his campaign. We hope it was because he knew it would lose him much-needed dollars from the insurance industry and, possibly, a few thousand votes. But single-payer, federally managed health care is the only sensible solution, it is what the people want, and it will be a defining test of Obama’s presidency for him to move Congress toward this long overdue goal in his first term.

The New America Foundation has given us a grim glance at the future in their report, The Cost of Doing Nothing. If you think things are bad today, wait a very few years, less than a decade, when half of us will be spending 45 to 60 percent of our income just for health insurance and related deductibles. It makes you sick to think of it.

The 21st century will witness a revolution in medical care. For the sake of equity and economy, for the sake of sanity and American productivity, we must stop funding it with a 19th century model.
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1 Consumer Price Index, from the Bureau of Labor Statistics, U.S. Department of Labor (Accessed November 25, 2008)
2 Click here to display the health-related items on All Together Now, for this and other pertinent statistics.
3 Maternal Mortality Rate in U.S. Highest in Decades, Experts Say, from Medical News Today, August 29, 2007 (Accessed November 25, 2008)
4 Infant Mortality and Life Expectancy for Selected Countries, 2007, from Infoplease (Accessed November 25, 2008)
tags: Health

What's Logic Got to Do With It?

Nov 22, 2008
Post hoc ergo propter hoc is a logical fallacy that says, “Since that event followed this one, that event must have been caused by this one.”1 The usually level-headed Rand Corporation has fallen into this common error in its latest study on teenage pregnancy, which, in their news release, claims it is the “First to Link Viewing of Sexual Content on Television to Subsequent Teen Pregnancy.” This is not to say that watching a lot of sex on television does not lead to a tendency to become pregnant. However, it is just as logical to conclude that a tendency to become pregnant leads to watching a lot of sex on television.

We don’t personally know the current state of sexuality on television, being blissfully unencumbered by that annoyance; however, we are pretty sure it can’t hold a candle to the current state of sexuality on the Internet. There, if you can Google it, you can find it, in full-screen video. And we are sure it is having a far more profound effect on teen sexual activity than watching Tony Soprano climb on top of some pneumatic extra on HBO.

Among more certifiable truths regarding teen sexuality are these: Teen births declined precipitously from 60 births per 1,000 teens age 15 to 19 in 1991 to 40 in 2005. There was a slight increase in 2006.2 The abortion rate has also enjoyed significant declines since 1990, as we noted in No Sex, Please, We’re Abstaining. We expect when the new administration scuttles the ridiculous “abstinence only” sex education requirements associated with federal support of various family planning programs here and abroad that the abortion rate will be reduced even more dramatically.

The fact of the matter may just be that all this sex we are awash in is doing us more good than harm! A recent study published in the Journal of Youth and Adolescence3 finds that “teens who have sex at an early age may be less inclined to exhibit delinquent behavior in early adulthood than their peers who waited until they were older to have sex.”4 Sex may even help these teens in developing better social relationships in early adulthood.

I whispered, “I am too young,”
And then, “I am old enough”;
Wherefore I threw a penny
To find out if I might love.
“Go and love, go and love, young man,
If the lady be young and fair.”
Ah, penny, brown penny, brown penny,
I am looped in the loops of her hair.

O love is the crooked thing,
There is nobody wise enough
To find out all that is in it,
For he would be thinking of love
Till the stars had run away
And the shadows eaten the moon.
Ah, penny, brown penny, brown penny,
One cannot begin it too soon.5

____________________
1 Post hoc ergo proper hoc, from Wikipedia (Accessed November 16, 2008)
2 Teenage Birth Rate Rises for First Time Since ’91, by Gardiner Harris, from the New York Times, December 6, 2007 (Accessed November 16, 2008)
3 Rethinking Timing of First Sex and Delinquency, by K. Paige Harden, et al., from Journal of Youth and Adolescence, volume 37, number 4, April 2008, pp. 373-385 (Accessed November 16, 2008)
4 Early Teen Sex May Not Be A Path To Delinquency, Study Shows, from ScienceDaily, November 14, 2007 (Accessed November 16, 2008)
5 Brown Penny, by William Butler Yeats (Accessed November 16, 2008)
tags: Health

Ailing America

Oct 20, 2008
A couple of health-care-related reports came to our notice this week, different but not entirely unrelated.

From the New America Foundation comes a report warning against implementing an insurance plan favored by some members of Congress and by John McCain. Across State Lines Explained: Why Selling Health Insurance Across State Lines is Not the Answer warns that the worst part of this plan is that insurance companies would only have to abide by the laws of the state in which they were headquartered, and not the laws of the states in which they were selling their insurance. Yes, that’s right: More veiled deregulation.

According to the report, insurers selling across state lines would have an easier time cherry-picking healthy customers to insure and charging higher premiums to the elderly or less-healthy populations—or refusing to insure them at all—resulting ultimately in increasing even more the 90+ million people currently un- or underinsured.

Americans have been speaking up for years for single-payer, Medicare-type health care.1,2 Neither of the main presidential candidates has come out for such a plan, beholden as they both are to the insurance companies. Meanwhile, health care premiums have doubled during the Bush 2 administration.3 It is time to support those politicians, and only those, who do favor what the American people want.

The other report may fall into the “Well, duh!” category. America’s Health Starts with Healthy Children comes to us from the Robert Wood Johnson Foundation. The report, which examined children’s health in association with parental economic and educational factors, concludes, “Across the country and within every state, there are substantial shortfalls in the health of children based on their family’s income and education....”

In addition to having a general infant mortality rate worse than 41 other countries (including the Czech Republic, South Korea, and Cuba),4 the report finds that a greater proportion of children from poorer families enjoy less than optimal health than those from higher-income families. The gap is as wide as 44 percent to 7 percent in Texas, down to 13 percent versus 6.4 percent in New Hampshire.

Child obesity, neglecting to teach our children math and science skills, inequitable health care across economic lines, huge and growing income inequities, governmental inattention to the will of the people: these things must stop.

We must address the three pillars upon which our civilization and our collective well-being depend—income, health, and education—and we must end their inequitable distribution. The American people know how to do it, and are willing to make the necessary sacrifices. It is our one-party political establishment, and the hammerlock hold the corporations have over it, that are impeding change.
____________________
1 Growing Health Care Concerns Fuel Cautious Support for Change (.pdf), an ABCNews/Washington Post Poll, October 13, 2003 (Accessed October 17, 2008)
2 Single-Payer Health Care, from Wikipedia (Accessed October 17, 2004)
3 Employer Health Benefits 2008 Annual Survey, from the Kaiser Family Foundation (Accessed October 17, 2008)
4 Rank Order - Infant Mortality Rate, from the CIA World Factbook, October 9, 2008 (Accessed October 17, 2008)
tags: Health

Pro and Con

Oct 18, 2008
We’re pro-choice and anti-abortion. Abortion is a horrible experience for any woman to undergo; horrible for her mate, who is forced to be a hopelessly frustrated non-participant on the sidelines; horrible for families and friends. That it often is performed in consequence of a rape or an incestuous attack only makes it more horrible.

Happily, the numbers of abortions have been declining in America for the past generation, from a high of 1,429,247 in 1990 (that is 344 abortions for every 1,000 live births) to 839,226 in 2004 (or 238 for every 1,000 live births).1 That is still a hefty number—almost one abortion for every four live births. Too much suffering all around.

Most abortions in 2004 (33 percent) were performed on women in the 20- to 24-year age group. Sadly, 17 percent were performed on younger women and girls, most of whom had presumably not reached the age of independence. Over 4,300 abortions were performed on girls younger than 15. To speak of the decline of the family is almost to speak a cliche these days. And yet the numbers don’t lie. About half of all first marriages end in divorce, and the number goes up precipitously for second and third marriages.2 The percentage of single-parent households with children increased from 19.5 percent in 1980 to 28.3 percent in 2005. Drug law violations among delinquents have almost tripled between 1990 and 2004 and offenses against the public have more than doubled.3 Reported cases of child abuse (the tip of the iceberg if there ever was one) went up 30 percent between 1990 and 2005.4

So it was with some degree of anticipatory joy that the following press release caught our eye: The Effect of Parental Involvement Laws on the Incidence of Abortion Among Minors. “What!,” we exclaimed, ”There are laws now requiring parents to get involved with their children? What a great idea!”

Alas, no. The study, written by Michael J. New and published by the Family Research Council is merely another screed against abortion, this one posing as a scientific study. The “involvement“ is simply the levels of parental notification or consent required by various states when a child discovers herself to be pregnant, and the study purports to show how the more stringent the level of involvement is (on a scale from mere notification to two-parent consent), the lower the rate of abortion. Well, perhaps, but are we the only ones who find the following extract, with its multiple assaults upon a frightened, frantic fifteen- or sixteen-year old reduced to sciencespeak, overwhelmingly sad?

The regression results indicate that a number of different types of laws result in reductions in the minor abortion rate. Informed consent laws which provide women seeking abortion with information about public and private sources of support, health risks involved with an abortion, and fetal development reduce the minor abortion rate by 3.8 percent. This finding is statistically significant. The regression model finds that public funding restrictions reduce the minor abortion rate by 7.8 percent. This finding is also statistically significant. Finally, partial birth abortion bans have little effect on the minor abortion rate, a finding that is consistent with much of the academic and policy literature that has analyzed the effects of partial birth abortion laws.

Of more interest, however, are the effects of the parental involvement laws. The regression results indicate that the passage of a parental involvement law reduces the minor abortion rate by 13.6 percent....
Harangue them, impoverish them, outlaw them if they wait too long, and if that doesn’t do the trick, rat them out to Mom and Dad. But for goodness sakes, don’t teach them how to take care of themselves in the first place, don’t let them hear about, let alone acquire, condoms or birth control information, despite the fact that we had sex and 75 percent of them are going to have sex before they’re 21, and we know it.5

That one in five pregnancies is considered so unacceptable to the prospective mother that they end in the horror of abortion, that the majority of Americans—men, women, Democrats, Republicans—support abortion rights,6 that no country or culture or legal system has ever granted the fetus the status of a human being, that we live in a world of disappearing resources and exploding populations: None of this matters to the small minority of hysteriarchs infected with the idee fixe that a zygote is imbued with a soul, and are prepared to commit murder and mayhem to enforce their delusions on a healthier, smarter, and vastly more compassionate public.

Obama has said, “we can certainly agree that we should be doing everything we can to avoid unwanted pregnancies that might even lead somebody to consider having an abortion.” We are afraid the fanatics cannot agree to that; however, that is the goal: No unwanted pregnancies. We are on our way, down over 600,000 a year since 1990.

It can be done.
____________________
1 Reproductive Health: Data and Statistics (Abortion) from the Centers for Disease Control (Accesssed October 15, 2008)
2 Single-Parent Households: 1980 to 2005, from the U.S. Census Bureau (Accessed October 15, 2008)
3 Delinquency Cases Disposed by Juvenile Courts by Reason for Referral: 1990 to 2004, op. cit. (Accessed October 15, 2008)
4 Child Abuse and Neglect Cases Substantiated and Indicated— Victim Characteristics: 1990 to 2005, op. cit. (Accessed October 15, 2008)
5 No Sex, Please, We’re Abstaining, from All Together Now, October 5, 2008
6 Abortion in the United States: Public Opinion, from Wikipedia (Accessed October 15, 2008)
tags: Health

To Be or Not To Be1

Oct 12, 2008
Unwilling, we enter this world. Often even more unwilling, we leave it. Yet in 2005, 32,637 Americans left quite willingly,2 whether because they were in terrible physical or psychic pain or because they shared the sentiment of actor George Sanders, who at 65 left a suicide note that read, “Dear World, I am leaving because I am bored. I feel I have lived long enough. I am leaving you with your worries in this sweet cesspool. Good luck.”

Death is the great mystery, the “undiscover’d country from whose bourn no traveller returns,”3 the universal fate of all living things: “born but to die.”4 No wonder it breeds such hopes of heaven and of reincarnation. No wonder religions deny its existence so vehemently one might think it is religion’s sole raison d’être to do so.

How willingly, thoughtlessly, copiously we send others to their deaths! And how assiduously we continue to inhibit ourselves from pursuing the bare bodkin when life becomes too terrible or too boring to endure. Suicide, once a felony throughout the U.S., is no longer a crime in any state. However, only in Oregon has suicide been promoted to a right, with assisted suicide legalized. And even there, the right to choose to end one’s life is hedged in by a long list of conditions and procedures.

The Canadian Library of Parliament has released a report, Euthanasia and Assisted Suicide: International Experiences, by Marlisa Tiedemann and Dominque Valiquet. A number of European countries allow euthanasia and assisted suicide. In each country, a great struggle over the legislation occurred between what we may call the Pro-Life and the Pro-Choice contingents. And in every case where the legislation was successful, conditions similar to those in Oregon are required for the act to be legal.

And why should that be so? Why should we not be freely and unconditionally able to choose a painless and peaceful leavetaking, having no choice in our coming hither, and our end so certain? “To cease upon the midnight with no pain:”5 a consummation, I would think, devoutly to be wished, and one which most people wish for. And yet we continue to deny it to ourselves. But we’re getting there. Oregon and a few nations have begun the journey toward death on demand.

It strikes us that if the term “human rights” has any meaning at all, this right must surely be among them.
____________________
1 Our illustration is The Death of Socrates, by Jacques-Louis David. Click this link to view larger versions of the painting.
2 Suicide Statistics at Suicide.org (Accessed October 8, 2008)
3 Hamlet, by William Shakespeare, Act 3, Scene 1, lines 87-88.
4 Essay on Man, by Alexander Pope, line 10
5 Ode to a Nightingale, by John Keats, line 56
tags: Health

No Sex, Please, We're Abstaining

Oct 05, 2008
We wonder whether these Sarah Palin types who support abstinence-only sex education1 are serious, or are only being spoilsports. We could not find statistics on how many Americans favor abstinence-only sex education (which consists, essentially, of delivering three words, “Just say no!” in a frantic, hushed tone). We did find that over the past 20 years polls have consistently shown that 35 percent of adults say premarital sex is always or almost always wrong,2 so we can presume they are the ones whose voices are drowning out the rest of us these days.

More enlightening—and infinitely more entertaining—were the reliable statistics we found confirming that “almost all Americans have sex before marrying.”3 We are talking, like, 97 percent here. Essentially everyone.

When numbers like that come up against an “official” federal government policy of abstinence-only sex education,4 it is no wonder teens in the U.S. suffer from the highest birth rate and one of the highest rates of sexually transmitted diseases (STDs) in the industrialized world.5

So here is a message to the roughly one-third of Americans who have had sex before marriage and apparently had such a horrible time of it they want to spare their children the experience:

Fuhgeddaboudit.

Abstinence-only sex education doesn’t work. So says an article by Douglas B. Kirby, entitled The Impact of Abstinence and Comprehensive STD/HIV Education Programs on Adolescent Sexual Behavior, from the September 2008 issue of Sexual Research and Sexual Policy. The article concludes, “abstinence programs have little evidence to warrant their widespread replication....”

So let’s cut out the abstinence nonsense. If 97 percent of us are gonna do it—and 75 percent of us are gonna do it before we’re 216—let’s do it right—with understanding, with care, with as few unwanted pregnancies as possible, and with no STDs.

And the only way we’ll learn to do it that way is if we’re taught to do it that way.

Update: An article in the January 2009 journal Pediatrics reports that “The sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are less likely to protect themselves from pregnancy and disease before marriage... Clinicians should provide birth control information to all adolescents, especially virginity pledgers.”
____________________
1 Palin on Abortion: I’d Oppose Even If My Own Daughter Was Raped, by Sam Stein, from the Huffington Post, September 1, 2008 (Accessed September 30, 2008)
2 Trends in Premarital Sex in the United States, 1954-2003 (.pdf), by Lawrence B. Finer, PhD, from Public Health Reports, volume 122, Jan-Feb 2007, pg. 74 (Accessed September 30, 2008)
3 Op. cit., pg. 73
4 Abstinence-only Education, from the Union of Concerned Scientists, undated (Accessed September 30, 2008)
5 Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact, by Debra Hauser, from Advocates for Youth, undated (Accessed September 30, 2008)
6 Finer, op. cit., pg. 73
tags: Health

Let Us Now Praise ... Paul Farmer

Aug 31, 2008
You can read about him on Wikipedia, but you’d do better to pick up a copy of Tracy Kidder’s book, Mountains Beyond Mountains.

Forty-nine-year-old Paul Farmer is the co-founder, and moving spirit behind Partners in Health (PIH), a worldwide movement dedicated to providing health care for the poor. From hands-on labor as a physician in Haiti, providing care to the poorest citizens of the poorest country in the western hemisphere, Dr. Farmer developed a model for effectively providing care to the poor around the world. PIH now works in Haiti, Peru, Russia, the U.S., Rwanda, Lesotho, Malawi, Mexico, and Guatemala.

Their vision statement is quite remarkable all by itself:

At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone. When a person in Peru, or Siberia, or rural Haiti falls ill, PIH uses all of the means at our disposal to make them well—from pressuring drug manufacturers, to lobbying policy makers, to providing medical care and social services. Whatever it takes. Just as we would do if a member of our own family—or we ourselves—were ill.
From one man living in the mountains of Haiti and bringing aid to sufferers who would otherwise die unnoticed and unmourned, PIH has grown into a $50 million miracle that is showing the world how to deliver world-class health care to its most abject and needy citizens. They do it by working together, forging partnerships with local community health workers, nurses, doctors, administrators, sister organizations, NGOs, local and national governments, and funders.

For his instinctive compassion for his fellow human beings, for the bravery and generosity which has led him to dedicate his life to the neediest, for the brilliance with which he has built a global enterprise and peopled it with individuals as committed, capable, and dedicated as he is, we award Paul Farmer our third “Golden A” for Achievement.
tags: Health

Read the History of Partners In Health

Having It Both Ways

Aug 30, 2008
Two reports came across our desk on the same day last week, regarding the Medicare Part D drug benefit program, about to enter its fifth year.

One was from the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), entitled, Lower Medicare Part D Costs Than Expected in 2009. (We guess that’s not ungrammatical, but we know there’s something wrong with that acronym.)

The other was from the Kaiser Family Foundation and is linked below. Their report is entitled, “New Study Examines Impact of ‘Doughnut Hole’ on People Enrolled in Medicare Drug Plans in 2007.”

They must have named the Medicare Part D Drug Plan after the Marquis de Sade. It is the most sadistic imposition of bureaucracy, anxiety, and expense on an aging and ailing population that anyone could possibly come up with.

The first report is, predictably, all pie in the sky. It claims Part D beneficiary satisfaction “remains high” without getting specific, and notes that the basic monthly premium for 2009 will be about $28, a full $14 less than expected at the enactment of the program in 2003.

Segue to the Kaiser report. Here we find that beyond that reasonable monthly premium, Part D also calls for a $275 deductible and, thereafter, a 25 percent co-pay up to the first $2,510 in annual drug costs. Reach that plateau and the fun really begins. Now you’ve arrived at the dreaded Doughnut Hole, a sort of reverse eye of the hurricane, where all is not quiet and where you are on your own for your full prescription drug costs for the next $3,216.

The purpose of the Kaiser report, which was produced in collaboration with Georgetown University and NORC (an apparently orphaned acronym) at the University of Chicago, is to report on the extent and impact of the Doughnut Hole catastrophe in 2007. Then, 26 percent of non-low-income enrollees (low-income people have some protections built in) reached the coverage gap, and 15 percent of them simply stopped taking their medicine. Those who continued saw their monthly out-of-pocket drug expenses soar from $104 (no, not $28) to $196.

So here is what is awaiting us all in our twilight years: A bewildering shopping expedition—with a hefty penalty for dragging our feet—to decide on a plan from a multitude of apples and oranges from which to choose. And thereafter one in four of us can look forward to running out of coverage and paying the full freight on our drugs for, on average, the last third of the year.

Meanwhile, up in the clouds, the Marquis chuckles.
tags: Health

Read the Kaiser Summary and Download the Report

Water, Water, Anywhere?

Aug 28, 2008
If I were King of the Forest, the first thing I would do is to make sure everyone had a clean drink of water when they wanted one. After water comes enough to eat and after that comes an education sufficient to provide each of us with the tools and the maturity to be all that we want to be.

But first comes water, a top priority for just about all life on the planet. And the fact that 2.5 billion people—almost half the population—do not have access to clean water is a disgrace to our species. Over a sixth of the world’s population still defecate in the open—the riskiest sanitation practice of all.

A million and a half children die every year from diarrhoeal diseases, directly attributable to a lack of access to clean water and proper sanitation.

In this International Year of Sanitation, two reports on the state of the world’s water make stark reading.

Progress on Drinking Water and Sanitation: Special Focus on Sanitation (zipped .pdf)
This report, a joint effort of UNICEF and the World Health Organization (WHO), details global progress towards the Millennium Development Goal (MDG) for drinking water and sanitation. Only 62 percent of the world’s population have access to a level of sanitation that ensures hygienic separation of human excreta from human contact. It looks now like we will miss the MDG sanitation goal for 2015 by over 700 million people.
Climate Change and Water (.pdf)
The Intergovernmental Panel on Climate Change, which brought us the painstakingly scientific assessment reports on global warming, produced this report on the relationship between climate change and freshwater resources. In brief, as we continue to drag our feet on mitigation of the former, our freshwater resources will continue to deterioriate, often in unpredictable ways. Precipitation is growing in higher latitudes and shrinking in areas surrounding the equator. In the former, heavier rainfalls will increase flooding and, in the latter, droughts will become more common. As the climate warms, glaciers melt, raising sea levels, and there is less seasonal runoff from shrinking snow caps at high elevations, threatening the fresh water supply for the more than one-sixth of the world population who live there. A disrupted global water system will impact many other areas, including energy, health, food security, and nature conservation. Water disputes, internal and international, which are already common, could easily turn into wars.
Water is the “stuff” of life. “River” and “Rivalry” share the same root, and geography teaches us that freedom and its most cherished attributes flourish best where clean water is plentiful.1

Water: First. Water: Clean. Water: Now.
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1Water dispute, in Wikipedia (Accessed August 23, 2008)
tags: Health

Read WHO’s Press Release on Its Report

Not Another Piece About Health Care!

Aug 25, 2008

Insanity: Doing the same thing over and over again and expecting different results. [Albert Einstein (attributed)]
Between 1988 and 2006, many states tried doing the same thing over and over again, with each of them consistently coming up with the same disappointing result. They were making the admirable attempt to insure that all of their citizens received adequate medical care when they needed it.

In a paper in a recent issue of the International Journal of Health Services entitled, “State Health Reform Flatlines,” the authors Steffie Woolhandler, Benjamin Day, and David U. Himmelstein relate the remarkably similar tales of seven states that thought they were instituting universal health care. In every case, the number of uninsured increased throughout the life of their plans. The paper was recently featured on the web site of Physicians for a National Health Plan (PNHP), an organization of physicians in favor of single-payer national health insurance.

Why the dismal results? The authors conclude that a combination of rising, uncontainable costs, and the flagging determination of legislators doomed the plans to failure. Their final word:
We remain convinced that more radical reforms can simultaneously expand coverage and control costs. A shift from our complex and fragmented payment system to a simple single-payer approach could save about 14.3 percent of total health spending—equivalent to $323 billion in 2007—on reimbursement-driven bureaucracy. Such administrative savings are unattainable with lesser reforms. A nonprofit national health insurance system could also curtail wasteful over-investment in medical technology (e.g., the proliferation of new cardiac care hospitals located near existing ones) and attenuate incentives for unnecessary and even harmful care.
What keeps our presidential candidates from taking the position that a solid majority of Americans and a growing number of physicians now favor?1 What keeps our nation from investigating a system the rest of the civilized world has had in place now, in some instances, for well over a generation? Why are our per capita costs for health care per year twice what other countries are spending? Why are over 47 million Americans still uninsured, with the numbers growing rapidly every year?

We know why, of course. For the same reason the middle class is disappearing, suffering a net loss in income over the Bush 2 years while the richest one percent have become as wealthy as medieval royalty.2 For the same reason we are in Iraq, where billions are being made by the few, while brave, if ignorant, Americans are being slaughtered every day. For the same reason famine has come knocking on the doors of over a billion of our fellow humans.

A great reckoning is at hand. We cannot persist in the same patterns and expect anything other than to continue on the downward path we tread. To expect anything different is, well, insanity.
____________________
1Sentiment shifts as primary season approaches, by The Associated Press, undated story on Yahoo News (Accessed August 20, 2008)
2Middle-Class Life Under Bush: Less Affordable and Less Secure (Accessed August 20, 2008)
tags: Health

Read the Press Release and Download the Paper

Feelin’ Poorly

Aug 13, 2008
The Commonwealth Fund, “a private foundation that aims to promote a high performing health care system,” supports independent research on health care issues. They produce a biannual National Scorecard on U.S. health care, scoring our system on 37 indicators of performance that are summarized within six criteria: Healthy Lives, Quality, Access, Efficiency, Equity, and Overall Score. In 2006, our health care system scored a dismal Overall Score of 67 out of a possible 100 “when comparing national averages with benchmarks of best performance achieved internationally and within the United States.”

In 2008, we dropped two points.

Most worrisome was the nine-point drop (from 67 to 58) for access to health care, as 35 percent of adults aged 19 to 64 who were un- or underinsured in 2006 grew to 42 percent in 2008. At that rate, half our population, which pays twice what the rest of the industrialized world pays for demonstrably inferior medical care, will be without adequate access to inadequate care by the end of the decade.

“Why Not the Best?: Results from the National Scorecard on U.S. Health System Performance, 2008” asks a very good question. The answer is a simple one known to us all. We don’t have the best—or anything like the best— because in America health care is a business, and that means it is profit based, and that means it must be provided at the lowest possible expense and at the highest price it can command. And thus we get a meager product at a premium price. And until we take it out of the realm of business, it will continue to deliver less and less for more and more.

Some staggering numbers from the National Coalition of Health Care.1

  • We spend on health care 4.3 times what we spend on national defense (and we spend almost as much on national defense as all other countries of the world combined2).
  • In 2005, we spent 16 percent of our gross domestic product on health care, a number expected to go up to 20 percent by 2016. That’s one dollar out of every five, with, today, 47 million people uninsured. Meanwhile, Canada spent 9.7 percent of its GDP on health care, and insured every man, woman, and child in the country.
  • Since 2000, employment-based health insurance premiums have increased 100 percent, compared to cumulative inflation of 24 percent and cumulative wage growth of 21 percent. Notice we’ve lost three percent of our wages to inflation and a large chunk to skyrocketing co-pays and deductibles.
  • Every 30 seconds in the U.S., someone files for bankruptcy in the aftermath of a serious medical problem.
It’s not healthy. And it can’t go on like this.
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1See the NCHC site for sources. (Accessed August 4, 2008)
2Global Issues (Accessed August 4, 2008)
tags: Health

Read the Overview and Download the Report

All for One

Aug 06, 2008
In an admirable example of “All Together Now,” 24 laboratories across the province of Ontario will band together to seek out the next generation of cancer-fighting therapies and deliver them quickly to patients.

“The problem (of cancer) is vast,” said Dr. Robert Rottapel, the program’s director. “If we work together, our efforts will certainly have a bigger punch. We’ll get there faster.” From the article:

The researchers plan to screen the entire cancer genome to identify specific genes, proteins or genetic networks that are important for tumour growth or carcinogenesis, the process by which normal cells turn into cancer cells. They will then develop drugs that target these specific molecular and cellular changes and will therefore only destroy the cancer while protecting the surrounding normal tissue.

tags: Health

Read the Article (free registration may be required)

Drugs on the Market

Jul 25, 2008
An interesting concatenation of reports came across my radar on the same day recently:

The pharmaceutical lobby (the largest in a crowded field) spent $168 million dollars lobbying Congress in 2007, 32 percent more than in 2006. This increase was probably owing to the Democratic takeover of Congress, and the subsequent hearings chaired by the new guys on drug issues. (I wonder sometimes whether those hearings aren’t intended to prime the pump for lobbying and campaign expenditures rather than to develop real reforms. More than $6.8 million of the $14.4 million the industry contributed to campaigns in 2006 went to members of the three committees that “regulate” the industry, according to the article.) There are several more eyebrow-raising facts about the questionable relationships among the drug companies, Congress, and the FDA (such as the fact that drug companies fund over a quarter of the FDA's budget), but I'll leave you to read about them in the article (link below).

Meanwhile, we in the U.S. spent $286.5 billion last year for prescription drugs, marching to the beat of a 20-fold increase in direct-to-consumer advertising over the past decade. That figure amounted to $29.9 billion in 2005, according to a paper in the New England Journal of Medicine.1

Chump change, when you look at the flipside: the trade in what our paternalistic government has deemed “illicit” drugs. No one knows the global proceeds from illegal drugs, with estimates ranging from $100 billion to a whopping $1 trillion. The U.S. will spend $14 billion dollars in FY 2008 (and more every year after that) in the losing battle to keep drugs out of the U.S. We spent almost $400 million on crop eradication in Colombia and Afghanistan alone in 2006. I leave it to you to decide whether it was $400 million well spent.

The CRS report, which is available here at OpenCRS, a project of the Center for Democracy and Technology, describes in detail the methods used by the U.S. to stop the drug trade in the U.S. The libertarian in me wonders why we don’t just legalize them all, and devote a tiny fraction of what we are spending to keep them out of the country to treat those individuals who succumb to an addiction. That tiny fraction could easily be made up by taxing the drugs the way we tax the legal killers, alcohol and tobacco. At the very least, marijuana should be legalized and taxed, and that alone could underwrite our continuing unsuccessful efforts to control debilitating substances such as heroin. The liquor lobby has been stunningly successful in associating marijuana with these dangerous substances; however, the research is clear that alcohol (and tobacco) are far more addictive and costly to our economy and to our people than is marijuana.2
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1A Decade of Direct-to-Consumer Advertising of Prescription Drugs,” by Julie M. Donohue, Ph.D., et al., volume 357, number 7, pp. 673-681 (Accessed July 20, 2008)
2Health Education: Marijuana at Brown University (Accessed July 20, 2008)
tags: Health

Read “Pushing Prescriptions”

Nor Any Drop to Drink

Jul 13, 2008
Millions of people die every year from preventable causes related to unsafe drinking water, inadequate sanitation, and insufficient hygiene. Most of them are children under five. They die by contracting diarrhoea (1.5 million deaths each year), through malnutrition (860,000 deaths), and a variety of others ailments and afflictions such as intestinal infections. It is estimated that improving water, sanitation, and hygiene has the potential to prevent at least 9.1% of the disease burden of the world.

This report, from the World Health Organization, entitled “Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health,” contains an especially interesting section on the benefit-cost ratio—how much benefit the world will realize from how much cost. Providing universal access to improved water and improved sanitation and water disinfected at the point of use by 2015 would result in annual benefits of over $344 billion, at a benefit-cost ratio of 12 to 1. One trillion dollars every three years for one-twelfth the cost—now that's a benefit. What are we waiting for?
tags: Health

Read the Abstract and Download the Report

The Doctor Is Out

Jul 12, 2008
In 2007, more than 20% of Americans reported not getting or delaying needed medical care in the previous 12 months—up from 14% in 2003. The report is from the Center for Studying Health System Change, and is entitled “Falling Behind: Americans' Access to Medical Care Deterioriates, 2003-2007,” Though as usual the worst-served in the U.S. population were the low-income children, one surprising finding was that “insured people experienced a greater percentage increase in unmet medical needs compared with uninsured people—a 62 percent increase for the insured vs. a 33 percent increase for the uninsured.”

We spend per capita twice as much ($7,129) on health care in the U.S. than any other industrialized nation.1 And yet we are becoming more and more anxious about our health care as each year passes. Almost 50 million people—one-sixth of the population—is without coverage at all, and the rest of us are finding ourselves increasingly at the end of long waiting lists for specialist-based or even primary care.

Single-payer, government-managed health care is the only system that promises to deliver a reasonable degree of economy and efficiency to a system run wild. However, neither leading presidential candidate has come out for it, because, once again, it would involve going up against the very corporations that put them where they are—in their candidacies for the presidency. Though a majority of the public wants it, and many, if not most, doctors would welcome a system that wasn't burying them in administrivia, the corporatocracy will not allow it. How bad do things have to get? How high do our co-pays have to go? I guess we'll be able to watch and see, because there's no white knight on the horizon (except Nader, of course) willing to do battle with the medical establishment.
____________________
1Physicians for a National Health Program, http://www.pnhp.org/, accessed July 5, 2008.
tags: Health

Read the Press Release and the Report

The Matter of the Meat

Jul 09, 2008
Animal agriculture—the raising of animals for human consumption—has experienced “warp speed” growth over the last 50 years. From a former paradigm of small family farms with a few animals housed in traditional barns and stables, we've morphed to a system of “industrial farm animal production (IFAP)” where thousands of animals are warehoused in factorylike structures, force fed, heavily medicated, and rushed to market after a life that can only be characterized, in the words of Thomas Hobbes, as “poor, nasty, brutish, and short.”

As Daniel Quinn has persuasively argued in Ishmael and other books, our problems began 10,000 years ago when we stopped hunting and gathering and settled down to planting. That ingenious move on the part of the species enabled rapid population growth, and subsequent improvements in agriculture encouraged additional population growth which brought additional improvements which brought additional growth, until we're so overpopulated we're running out of space to plant all those improved agricultural products. Enter the industrial farm animal production, and the unintended and dire consequences set forth in the report from the Pew Charitable Trusts Commission on Farm Animal Production, “Putting Meat on the Table: Industrial Farm Animal Production in America.”

As usual, we are only getting around to counting the costs of “progress” after we've begun paying them. The lengthy (124 pp.) and comprehensive Pew report covers just what those costs consist of, in terms of threats to our health; the impact on our poor, bedraggled environment; and the horrific consequences visited upon our fellow creatures in the cause of maximizing profits at both ends of the supply and demand chain. It summarizes a vast literature of research and the news it delivers is not good news. However, its recommendations to fix the system are as reasonable as they are thorough.

What I can do. What you can do.
First of all, we must elect representatives who will implement, through the passage of new laws, the recommendations set forth in the report. In the meanwhile, however, we can vote with our feet (and our mouths) by refraining from purchasing and eating animals and animal products which have not been produced in a humane manner. I believe only reputable third-party certification organizations may be trusted to provide standards that assure the humane treatment of farm animals. Thankfully, there are a number of them identified in the Pew report. (If you know of others, please tell me about them and I will add them to this list.) In future, I intend to require my retail providers (groceries and restaurants) to subscribe to one or more of these standards-defining and labeling bodies and will refrain from purchasing and consuming their products until they do so.

Certified Humane Raised and Handled
An International Standards Organization (ISO) certified third-party labeling program which provides detailed standards for egg-laying hens, broilers, turkeys, beef, dairy, sheep, and swine.
American Humane Certified farm animal program (formerly Free Farmed)
A third-party domestic labeling program that traces its roots to the formation in 1877 of the American Humane Association. It provides standards for egg-laying hens, broilers, turkeys, beef, dairy, sheep, and swine.
United Egg Producers' UEP Certified Program
A third-party auditing and labeling program for caged layers.
It is interesting to note that on the Pew list of major US Animal Welfare Standards, where the three organizations noted above were found, all the entities that have been approved by a consortium of grocers and restaurants for the development of retail auditing programs are those whose standards are characterized as “guidelines” or “voluntary.” None of the third-party certifying organizations noted above is among that list.
tags: Health

Read the Press Release and Download the Report

Let Us Now Praise ... Greg Mortenson

Jun 30, 2008
If we could live our life over again, we'd want to be Greg Mortenson.

If you haven't read Three Cups of Tea, by Greg and David Oliver Relin, then run, don't walk, to your nearest neighborhood book store or library and get it, read it, and pass it on to a friend. Then set out your penny jar at the office and get cracking. Greg Mortenson is the power, the inspiration, the miracle behind the Central Asia Institute (CAI), and he has devoted his life to bringing education to rural Pakistan and Afghanistan. He has built dozens of schools, provided scholarships for advanced education beyond the primary grades, trained and employed scores of teachers, provided health care training and services, and developed projects to bring clean water to remote communities.

Starting out on a shoestring, living in his car, handwriting over 500 letters of appeal to potential donors for his first school, Mortenson in a mere 15 years has accomplished more to bring us together and to advance world peace than anyone else we know of. CAI's Mission Statement should be a mission statement for all of us: “To promote and support community-based education, especially for girls, in remote regions of Pakistan and Afghanistan.” And it can be. Go online, learn more about CAI, read that book, then give, to a cause that is quietly reforming one corner of the world, and showing us how to do it planetwide.

Though he is overdue the Nobel Peace Prize, all we can do here is award Greg Mortenson All Together Now's first “Golden A” for Achievement. In his compassion, his farsightedness, and his industry, we see the future of our species, if our species is to have a future at all.
tags: Health

Read the History of CAI

Off the Charts

Jun 28, 2008
About 20 years ago, we spent a long Martin Luther King holiday weekend in a Manhattan hospital, while a parade of specialists visited our bedside and tried to figure out why we had inverted T cells, chills, muscle strain, and chronic fatigue. A cardiologist finally figured it out, although we’re not sure why, since the solution was outside his purview. A recent bad cold had wiped out our thyroid gland. We’ve been taking synthroid ever since.

Once the solution was found, the symptoms made sense to everyone. At this point in time, we already had a few years’ experience with microcomputers, and we wondered why someone had not just typed our symptoms into a program when we were first admitted. Our affliction would have popped right up, possibly in a short list of suspects, saving thousands of dollars and no little anxiety on the part of our wife-to-be and ourself. We was told that no such program existed and that if it did doctors probably wouldn’t use it for fear of losing their god-given monopoly on making diagnoses.

Fast forward to 2008, and a special article published on June 18 in the New England Journal of Medicine, “Electronic Health Records in Ambulatory Care—A National Survey of Physicians.” This is the first large-scale survey of the use of automated record systems in physicians’ offices. Among the article’s findings:

  • Only four percent of physicians have “an extensive, fully functional electronic-records system.”
  • Thirteen percent more have a “basic” system.
  • “Physicians who use electronic health records believe such systems improve the quality of care.”
Well, duh!

The study further found that the most commonly cited barrier to adoption of these systems was their cost. Perhaps. But we wouldn’t be surprised if there were another powerful reason at work here, perhaps hidden even to the physicians themselves, and related to the one noted above. A greater-than-healthy ego is often part of the baggage carried by physicians. The same unwillingness to enlist the support of diagnostic databases that we witnessed 20 years ago may also explain the sluggish adoption of records-related automation in the office.

That a technology so powerful, so useful, so inarguably essential to the efficient management of a vital sector of our society should be so little adopted at the end of the first decade of the 21st century is a national scandal—in keeping with the general scandal that is health care in this country.

Next time you visit your doctor for a checkup, check up on them, and find out if they are among the four percent enjoying the manifest advantages of a full-functioning electronic records system in their office. If they aren’t, you might want to take yourself, and the rest of your life, elsewhere.

Meanwhile, we googled fatigue chills muscle strain and inverted T cells and zeroed in on hypothyroidism in .30 seconds.

À votre santé!
tags: Health

Read the Article

One Life to Live

Jun 07, 2008
Here and there, here and there.

Here, fewer than 15 mothers die during every 100,000 live births; there, over 1,000. Here a man may expect to live 79 years; there, half that. Here three children out of 1,000 may be expected to die before the age of five; there, 260.

The inequities we tolerate may be the heaviest cross we bear as a species. Nowhere—not in the economic or political spheres—are those inequities more blatant, heartbreaking, or unforgivable as they are in the sphere of health care.

The World Health Organization (WHO) has just released its World Health Statistics 2008 report. Read it and weep.
tags: Health

Read the Report (.pdf)

Copyright © 2008 All Together Now.

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