Ethics presentation 2-b
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Transcript of Ethics presentation 2-b
AMONG ALL THE WEALTHY COUNTRIES ON EARTH THE UNITED STATES HAS THE MOST INEFFECTIVE
UNJUST INEQUITABLE AND UNETHICAL MEDICAL SYSTEM and
the 2009 health reforms made matters worse
Jeoffry B Gordon MD MPHparadocs2hotmailcom
Originally presented May 1 2011Updated August 2015
Part 1 ndash The BIG PICTURE amp VALUES
ldquoSeniors and the disabled will have to stand in front ofObamas death panel so his bureaucrats can decide based on a subjective judgment of their level of productivity in society whether they are worthy of health careSarah Palin on Friday August 7th 2009 in a message posted on Facebook
Im still trying to find the first American to talk to whos in favor of the public option other than a member of Congress or the administration said Representative Boehner whose sole recent foray into a public discussion of health care reform was a tea-party-style event in Ohio a few weeks back Ive not talked to one and I get to a lot of places he told reporters at his weekly press availability Ive not had anyone come up to me -- I know Im inviting them -- and lobby for the public option This is about as unpopular as a garlic milkshake
John Boehner elected to represent the Eighth Congressional District of Ohio for a 10th term in November 2008 is a national leader in the fight for a smaller more accountable governmentThroughout his time as a small businessman state legislator and Member of Congress John has been a straight-shooting and relentless advocate for freedom and security
Critical Letter By Catholics Cites Boehner On PoliciesBy LAURIE GOODSTEIN THE NEW YORK TIMES Published May 11 2011
More than 75 professors at Catholic University and other prominent Catholic colleges have written a pointed letter to Mr Boehner saying that the Republican-supported budget he shepherded through the House will hurt the poor the elderly and the vulnerable and that he therefore has failed to uphold basic Catholic moral teachings ldquoMr Speaker your voting record is at variance from one of the churchrsquos most ancient moral teachingsrdquo the letter says ldquoFrom the apostles to the present the magisterium of the church has insisted that those in power are morally obliged to preference the needs of the poor Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress This fundamental concern should have great urgency for Catholic policy makers Yet even now you work in opposition to itrdquo
Peter Singer NEW YORK TIMES July 15 2009
PUBLIC HEALTH INSURANCE SHOULD PAY UP TO $_____ FOR A TREATMENT THAT WOULD EXTEND A PATIENTrsquoS LIFE FOR ONE YEAR
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Part 1 ndash The BIG PICTURE amp VALUES
ldquoSeniors and the disabled will have to stand in front ofObamas death panel so his bureaucrats can decide based on a subjective judgment of their level of productivity in society whether they are worthy of health careSarah Palin on Friday August 7th 2009 in a message posted on Facebook
Im still trying to find the first American to talk to whos in favor of the public option other than a member of Congress or the administration said Representative Boehner whose sole recent foray into a public discussion of health care reform was a tea-party-style event in Ohio a few weeks back Ive not talked to one and I get to a lot of places he told reporters at his weekly press availability Ive not had anyone come up to me -- I know Im inviting them -- and lobby for the public option This is about as unpopular as a garlic milkshake
John Boehner elected to represent the Eighth Congressional District of Ohio for a 10th term in November 2008 is a national leader in the fight for a smaller more accountable governmentThroughout his time as a small businessman state legislator and Member of Congress John has been a straight-shooting and relentless advocate for freedom and security
Critical Letter By Catholics Cites Boehner On PoliciesBy LAURIE GOODSTEIN THE NEW YORK TIMES Published May 11 2011
More than 75 professors at Catholic University and other prominent Catholic colleges have written a pointed letter to Mr Boehner saying that the Republican-supported budget he shepherded through the House will hurt the poor the elderly and the vulnerable and that he therefore has failed to uphold basic Catholic moral teachings ldquoMr Speaker your voting record is at variance from one of the churchrsquos most ancient moral teachingsrdquo the letter says ldquoFrom the apostles to the present the magisterium of the church has insisted that those in power are morally obliged to preference the needs of the poor Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress This fundamental concern should have great urgency for Catholic policy makers Yet even now you work in opposition to itrdquo
Peter Singer NEW YORK TIMES July 15 2009
PUBLIC HEALTH INSURANCE SHOULD PAY UP TO $_____ FOR A TREATMENT THAT WOULD EXTEND A PATIENTrsquoS LIFE FOR ONE YEAR
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
ldquoSeniors and the disabled will have to stand in front ofObamas death panel so his bureaucrats can decide based on a subjective judgment of their level of productivity in society whether they are worthy of health careSarah Palin on Friday August 7th 2009 in a message posted on Facebook
Im still trying to find the first American to talk to whos in favor of the public option other than a member of Congress or the administration said Representative Boehner whose sole recent foray into a public discussion of health care reform was a tea-party-style event in Ohio a few weeks back Ive not talked to one and I get to a lot of places he told reporters at his weekly press availability Ive not had anyone come up to me -- I know Im inviting them -- and lobby for the public option This is about as unpopular as a garlic milkshake
John Boehner elected to represent the Eighth Congressional District of Ohio for a 10th term in November 2008 is a national leader in the fight for a smaller more accountable governmentThroughout his time as a small businessman state legislator and Member of Congress John has been a straight-shooting and relentless advocate for freedom and security
Critical Letter By Catholics Cites Boehner On PoliciesBy LAURIE GOODSTEIN THE NEW YORK TIMES Published May 11 2011
More than 75 professors at Catholic University and other prominent Catholic colleges have written a pointed letter to Mr Boehner saying that the Republican-supported budget he shepherded through the House will hurt the poor the elderly and the vulnerable and that he therefore has failed to uphold basic Catholic moral teachings ldquoMr Speaker your voting record is at variance from one of the churchrsquos most ancient moral teachingsrdquo the letter says ldquoFrom the apostles to the present the magisterium of the church has insisted that those in power are morally obliged to preference the needs of the poor Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress This fundamental concern should have great urgency for Catholic policy makers Yet even now you work in opposition to itrdquo
Peter Singer NEW YORK TIMES July 15 2009
PUBLIC HEALTH INSURANCE SHOULD PAY UP TO $_____ FOR A TREATMENT THAT WOULD EXTEND A PATIENTrsquoS LIFE FOR ONE YEAR
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Im still trying to find the first American to talk to whos in favor of the public option other than a member of Congress or the administration said Representative Boehner whose sole recent foray into a public discussion of health care reform was a tea-party-style event in Ohio a few weeks back Ive not talked to one and I get to a lot of places he told reporters at his weekly press availability Ive not had anyone come up to me -- I know Im inviting them -- and lobby for the public option This is about as unpopular as a garlic milkshake
John Boehner elected to represent the Eighth Congressional District of Ohio for a 10th term in November 2008 is a national leader in the fight for a smaller more accountable governmentThroughout his time as a small businessman state legislator and Member of Congress John has been a straight-shooting and relentless advocate for freedom and security
Critical Letter By Catholics Cites Boehner On PoliciesBy LAURIE GOODSTEIN THE NEW YORK TIMES Published May 11 2011
More than 75 professors at Catholic University and other prominent Catholic colleges have written a pointed letter to Mr Boehner saying that the Republican-supported budget he shepherded through the House will hurt the poor the elderly and the vulnerable and that he therefore has failed to uphold basic Catholic moral teachings ldquoMr Speaker your voting record is at variance from one of the churchrsquos most ancient moral teachingsrdquo the letter says ldquoFrom the apostles to the present the magisterium of the church has insisted that those in power are morally obliged to preference the needs of the poor Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress This fundamental concern should have great urgency for Catholic policy makers Yet even now you work in opposition to itrdquo
Peter Singer NEW YORK TIMES July 15 2009
PUBLIC HEALTH INSURANCE SHOULD PAY UP TO $_____ FOR A TREATMENT THAT WOULD EXTEND A PATIENTrsquoS LIFE FOR ONE YEAR
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Critical Letter By Catholics Cites Boehner On PoliciesBy LAURIE GOODSTEIN THE NEW YORK TIMES Published May 11 2011
More than 75 professors at Catholic University and other prominent Catholic colleges have written a pointed letter to Mr Boehner saying that the Republican-supported budget he shepherded through the House will hurt the poor the elderly and the vulnerable and that he therefore has failed to uphold basic Catholic moral teachings ldquoMr Speaker your voting record is at variance from one of the churchrsquos most ancient moral teachingsrdquo the letter says ldquoFrom the apostles to the present the magisterium of the church has insisted that those in power are morally obliged to preference the needs of the poor Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress This fundamental concern should have great urgency for Catholic policy makers Yet even now you work in opposition to itrdquo
Peter Singer NEW YORK TIMES July 15 2009
PUBLIC HEALTH INSURANCE SHOULD PAY UP TO $_____ FOR A TREATMENT THAT WOULD EXTEND A PATIENTrsquoS LIFE FOR ONE YEAR
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Peter Singer NEW YORK TIMES July 15 2009
PUBLIC HEALTH INSURANCE SHOULD PAY UP TO $_____ FOR A TREATMENT THAT WOULD EXTEND A PATIENTrsquoS LIFE FOR ONE YEAR
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Texas Futile Care Law ldquoDeath Panelsrdquo Signed Into Lawhellip By Bush
Advance Directives ActThe Texas Advance Directives Act (1999) also known as the Texas Futile Care Law describes certain provisions that are now Chapter 166 of the Texas Health amp Safety Code Controversy over these provisions mainly centers on Section 166046 Subsection (e) which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice if the continuation of life-sustaining treatment is considered medically inappropriate by the treating medical teamThe law was signed by George W Bush when he was governor of Texas
Life-Support Stopped for 6-Month-Old in Houston March 16 2005Yesterday Sun Hudson the nearly 6-month-old at Texas Childrens Hospital in Houston diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia) was taken off the ventilator that was keeping him alive A Houston court authorized the hospitals action and Sun died shortly thereafterhellip This is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the childs parent
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Hammurabirsquos Code and US Health CareBy Uwe E Reinhardt The New York Times April 6 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as followsI teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it It is a basic tenet of economics Leaning on that tenet I conclude that the value you in your role as state legislators put upon the professional work of say a pediatrician if applied to a poor child on Medicaid is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured childrenldquo Physicians clearly understand this relative valuation being signaled to them According to a recent estimate almost a third of American physicians are unwilling to accept any new patients covered by Medicaid Naturally New Jerseyrsquos legislators were not well pleased by my comment Perhaps these legislators believe that the Hippocratic Oath sworn to by all physicians at the onset of their careers compels that egalitarian approach In fact neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Nursing facility providers in the United States (1997)1813665 total nursing facility beds 16995 total nursing facilities 83 percent nursing facility occupancy rate Nursing facility ownership in the United States 66 percent for profit 27 percent not-for-profit 7 percent government Nursing facility reimbursement in the United States 8 percent Medicare 68 percent Medicaid 23 percent private payMedicaid in the United States 1031364 Medicaid only beds 400122716 Medicaid nursing facility days 1667319 total Medicaid nursing facility residents $8505 per diem Medicaid nursing facility rate Medicare in the United States 53138 Medicare only beds 1113237 total Medicare stays $234 average per diem Medicare rateThere are nearly nine million people representing one in five Medicare beneficiaries who are eligible for services through both Medicare and Medicaid -- often called ldquodual eligiblesrdquo They are the poorestProviding tools for those who are eligible for Medicareand Medicaid would save money and make the programs work better for the elderly They consume about 25 percent of Medicarersquos spending and nearly half of Medicaidrsquos -- more than $250 billion in 2008
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Patients Are Not ConsumersBy Paul Krugman The New York Times 21 April 11
Earlier this week The Times reported on Congressional backlash against the Independent Payment Advisory Board a key part of efforts to rein in health care costshellip But something else struck me as I looked at Republican arguments against the board which hinge on the notion that what we really need to do as the House budget proposal put it is to make government health care programs more responsive to consumer choiceHeres my question How did it become normal or for that matter even acceptable to refer to medical patients as consumers The relationship between patient and doctor used to be considered something special almost sacred Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction like buying a car - and their only complaint is that it isnt commercial enoughWhat has gone wrong with us
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
The Inverse Care LawJULIAN TUDOR HART The Lancet Saturday 27 February 1971 Glyncorrwg Health Centre Port Talbot Glamorgan Wales The availability of good medical care tends to vary inversely with the need for the population served This inverse care law operates more completely where medical care is most exposed to market forces and less so where such exposure is reduced The market distribution of medical care is a primitive and historically outdated social form and any return to it would further exaggerate the maldistribution of medical resources
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
VALUES IN HEALTH CARETHE MORAL AND ETHICAL
IMPERATIVEThe Values of a Healthy Society
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
(1) MAXIMIZE HEALTHY STATES (provide good quality medical care)
(2) COMPASSION and CARING (relieve individual pain suffering and anxiety)
(3) SOCIAL and ECONOMIC JUSTICE (provide for the vulnerable )
(4) CIVIC RESPONSIBILITY (society as a commonwealth)
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Part 1 HEALTH DISPARITIES
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
MALE LIFE EXPECTENCY AT AGE
65 BY YEAR OF BIRTH
SOCIAL SECURITY DATA
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Adult Admissions for Uncontrolled Diabetes Without Complications per 100000 Population by Race
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
FIGURE 10 Cancer Survival by
Insurance Status
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancerSmith AK1 Earle CC McCarthy EP J Am Geriatr Soc 2009 Jan57(1)153-8 doi 101111j1532-5415200802081x Epub 2008 Nov 21OBJECTIVES To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illnessSETTING Surveillance Epidemiology and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31 2001 49960 non-Hispanic white non-Hispanic black Asian and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung colorectal breast and prostate cancerRESULTS Whereas 420 of elderly white patients with advanced cancer enrolled in hospice enrollment was lower for black (369) Asian (322) and Hispanic (377) patients Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors Higher proportions of black and Asian patients than of white patients were hospitalized two or more times spent more than 14 days hospitalized and were admitted to the intensive care unit (ICU) in the last month of life and died in the hospitalCONCLUSION Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods be admitted to the ICU die in the hospital and be enrolled in hospice at lower rates
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
2 ECONOMICSTHE MEDICAL
MARKETPLACE(1)CONSUMER CHOICE
(2) PROVIDER INCOME
(3) ECONOMIC EFFICIENCY
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Health Care Costs Concentrated in Sick FewmdashSickest 10 Percent Account for 65 Percent of Expenses
Source Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey
Distribution of health expenditures for the US population by magnitude of expenditure 2009
15
10
50
65
22
50
97
Population Share of Health Spending
25
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Medical loss ratio
2Q 2008 2Q 2009
Aetna 819 868
Cigna 860 867
Coventry 858 864
Health Net 853 862
Humana 858 836
WellPoint 833 829
UnitedHealth Group
836 836
Source Securities and Exchange Commission
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
bullAmong medical debtors hospital bills were the largest medical expense for 48 drug costs for 19 doctorsrsquo bills for 15 and insurance premiums for 4 In 38 of cases lost income due to illness was a factorbullOut-of-pocket medical costs since the onset of illness averaged $17943bullFor the privately-insured out-of-pocket costs averaged $17749bullFor the uninsured out-of-pocket costs averaged $26971bullPatients with neurologic disorders such as multiple sclerosis faced the highest costs and average of $34167 followed by diabetics at $26971
bullIllness and medical bills were linked to at least 621 of all personal bankruptcies in 2007 Based on the current bankruptcy
filing rate medical bankruptcies will total 866000 and involve 2346 million Americans this year ndash about one person every 15 secondsbullUsing identical definitions in both years the proportion of bankruptcies attributable to medical problems rose by 496 between 2001 and 2007bullMost medically bankrupt families were middle class before they suffered financial setbacks 603 of them had attended college and 664 had owned a home 20 of families included a military veteran or active-duty soldier
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial By DONALD G McNEIL Jr THE NEW YORK TIMES August 11 2011The first payments were made Thursday to Nigerian families who lost children during a 1996 trial of an experimental meningitis drug and Pfizer which had tested the drug a new antibiotic said it was ldquopleasedrdquo that payments were finally being made under a settlement reached two years ago Four families received $175000 each from a $35 million fund created under the settlement between Pfizer and Nigeriarsquos northern Kano State where the brief trial of the experimental drug Trovan took place The four families had DNA evidence proving they were related to children who died during the trial In all 11 children died in the trial five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial Others suffered blindness deafness and brain damage Although Pfizer said that only 200 children had been given Trovan or the older antibiotic 547 families sued Despite having settled the case the company still contends that meningitis not its drugs was responsible for the deaths and injuries a Pfizer spokesman said Thursday The company also said that Trovan had first been tested in 5000 Americans and Europeans Pfizer said Trovan saved lives in Nigeria because 94 percent of the Nigerian children who received the drug survived mdash more than normally do if no medicine is administered Nonetheless according to a 2006 Washington Post article the trialrsquos certificate of approval from a hospital ethics board was forged and Pfizer said its own investigation had proved that the certificate was ldquoincorrectrdquo Families of children who died or were injured while on the second antibiotic contended that Pfizer had prescribed low doses of the drug to make the results for Trovan look better The distrust of Western medicine that the dispute engendered was one of several factors that led many families in northern Nigeria to refuse to let their children be vaccinated against polio Northern Nigeria is still one of the worldrsquos last remaining epicenters of polio Trovan was introduced in 1998 and became a lucrative product for Pfizer but it was later withdrawn in Europe and restricted in the United States after the drug was blamed for cases of fatal liver damage Last year a secret 2009 State Department cable exposed by WikiLeaks said that a Pfizer official in Nigeria told American diplomats that the company had hired private investigators to ldquouncover corruption linksrdquo to Nigeriarsquos former attorney general in order to pressure him to drop the Trovan lawsuits
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
PUBLIC GOODS
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
bull Medical services and a personrsquos state of wellness itself are ldquoPublic Goodsrdquo in a technical economic sense A ldquopublic goodrdquo is a product or service which benefits everyone in the community and has ldquoexternalitiesrdquo that is it has benefits and value to people who do not purchase it
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
PUBLIC GOODSbull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
bull EXAMPLES OF PUBLIC GOODSbull Police and Fire Departments
bull Interstate Highways and Bridgesbull The Internet and GPS systems
bull Public Schoolsbull Water distribution and Sewage treatment
bull ALL MEDICAL SERVICES
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
It was Ronald Reagan who said ldquofreedom is always just one generation away from extinction We donrsquot pass it
to our children in the bloodstream we have to
fight for it and protect it and then hand it to them so that
they shall do the same or wersquore going to find ourselves
spending our sunset years telling our children and our childrenrsquos children about a
time in America back in the day when men and women
were freerdquo
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
3 THE RECENT HEALTH REFORM IS MOSTLY
A GOVERNMENT SUBSIDY OF COMMERCIAL
HEALTH INSURANCE
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798RICK UNGAR POLICY PAGE FORBES Jan 17 2011 - 908 pm |
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court The pleadings in part read -ldquoThe Constitution nowhere authorizes the United States to mandate either directly or under threat of penalty that all citizens and legal residents have qualifying health care coveragerdquo State of Florida et al vs HHS
It turns out the Founding Fathers would beg to disagreeIn July of 1798 Congress passed ndash and President John Adams signed - ldquoAn Act for the Relief of Sick and Disabled Seamenrdquo The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insuranceKeep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitutionhellip But those were the days when members of Congress still used their collective heads to solve problems ndash not create them Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade Congress and the President resolved to do something about it
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
85 percent The percentage of all enrollees receiving tax credits for their insurance premiums mdash 87 million people
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
As originally envisioned the ACA would have extended Medicaid coverage to everyone below 133 percent of the federal poverty level regardless of previous Medicaid eligibility The Supreme Court however ruled in June of 2012 that the provisions proposed in the ACA to enforce state compliance with Medicaid expansion were too coercive and that states could choose not to implement Medicaid expansion Since the Courtrsquos decision only 26 states have chosen to expand Medicaid coverage The split of states on this question has largely followed political party lines with most blue states choosing expansion and most red states rejecting expansionSince Medicaid expansion has gone into effect the number of individuals receiving Medicaid has increased by 6 million roughly a 10 percent increase in Medicaid enrollment overall The increase in Medicaid expansion states is 153 percent compared to 33 percent for non-Medicaid expansion states
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Supreme Court Justice Antonin Scaliarsquos dissent in the same-sex marriage cases June 26 2015
ldquoFour of the nine are natives of New York City Eight of them grew up in east- and west-coast States Only one hails from the vast expanse in-between Not a single Southwesterner or even to tell the truth a genuine Westerner (California does not count)rdquo
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
GOP Governors Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by RaceEthnicity
Total United States4832000 - All racesEthnicities2248000 - White1327000 - Black992000 - Hispanic265000 - Other
2584000 - People of Color
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Preventable Deaths from Heart Disease amp Stroke
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Hobby Lobby 101 explaining the Supreme Courts birth control ruling By Warren Richey Staff writer The Christian Science Monitor July 10 2014
The US Supreme Court ruled on June 30 2014 that the owners of closely-held profit-making corporations cannot be forced under the Affordable Care Act to provide their employees with certain kinds of contraceptives that offend their religious beliefsThe decision arose from litigation filed by the owners of the national chain of craft stores called Hobby Lobby and the owners of Conestoga Wood Specialties a cabinetmaker in PennsylvaniaIt has sparked a heated debate about the scope of religious liberty in the United States and whether bosses are now empowered to impose their religious beliefs on their employees It has also raised concerns that female workers will now be denied access to contraceptives Both Hobby Lobby and Conestoga Wood are controlled by family members with shared religious beliefs Those beliefs hold that life begins at conception and that any birth control method that may result in the destruction of a fertilized egg is a form of abortion and killing that is forbidden by their faith They also believe that supporting and financing their company health care plan in a way that provides their employees with the means to destroy a fertilized egg makes them complicit in a sinful and immoral act Their objections were to four of 18 methods required to be provided to female employees under the Affordable Care Actrsquos contraception mandate They objected to paying for two forms of the emergency morning-after pill and two kinds of intrauterine device (IUD)They did not object to providing their employees cost-free access to the most common forms of birth control including daily birth-control pills Women have a constitutional right to access to birth control and abortion but there is no constitutional right to have someone else pay for it The question in the Hobby Lobby case was whether the government can force someone else to pay for a womanrsquos contraceptives even though that person has religious objections to doing so
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
4 ldquoHEALTH CARE IS A HUMAN RIGHTrdquo
HAS REAL MEANING
OPTIMAL HEALTH OUTCOMES DEPEND
ON SOCIAL and ECONOMIC JUSTICE
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points
Pope Francis called for renewal of the Roman Catholic Church and attacked unfettered capitalism as a new tyranny urging global leaders to fight poverty and growing inequality in the first major work he has authored alone as pontiff The 84-page document Evangelii Gaudium known as an apostolic exhortation amounted to an official platform for his papacy In it Francis went further than previous comments criticizing the global economic system attacking the idolatry of money and beseeching politicians to guarantee all citizens dignified work education and healthcareHe also called on rich people to share their wealth Just as the commandment Thou shalt not kill sets a clear limit in order to safeguard the value of human life today we also have to say thou shalt not to an economy of exclusion and inequality Such an economy kills Francis wrote in the document issued on Tuesday( Nov 26 2013) How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses 2 points