The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
Observations on the needs for, the contents of, and many of the practical effects of the Affordable care Act or Obamacare. Understanding its benefits and shortcomings
A fact based, detailed analysis of the economic stress on middle American families and the malfunction of democratic institutions, producing distrust, anger, and an epidemic of unnecessary deaths. Explains the dynamics of the 2016 Presidential election.
Shocking study in JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION of 1.4 billion person-years documenting rising death rates among middle aged whites, amounting to over 600,000 lives lost due to alcoholism, drug overdoses and suicides
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
What's Influencing Food Choice in Americaajarchibald
What's influencing the state of America's Plate? These slides are part of an ongoing presentation about key influences impacting the state of our nation's plate. This presentation is updated several times annually and is built on research initiated in the early part of this decade
Brought to you by Rick Rosenquist from The Creative Juice Agency.
This paper addresses 31 statistics for those close to or ready for retirement.
Feel free to reach out to Rick to learn more.
Observations on the needs for, the contents of, and many of the practical effects of the Affordable care Act or Obamacare. Understanding its benefits and shortcomings
A fact based, detailed analysis of the economic stress on middle American families and the malfunction of democratic institutions, producing distrust, anger, and an epidemic of unnecessary deaths. Explains the dynamics of the 2016 Presidential election.
Shocking study in JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION of 1.4 billion person-years documenting rising death rates among middle aged whites, amounting to over 600,000 lives lost due to alcoholism, drug overdoses and suicides
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
What's Influencing Food Choice in Americaajarchibald
What's influencing the state of America's Plate? These slides are part of an ongoing presentation about key influences impacting the state of our nation's plate. This presentation is updated several times annually and is built on research initiated in the early part of this decade
Brought to you by Rick Rosenquist from The Creative Juice Agency.
This paper addresses 31 statistics for those close to or ready for retirement.
Feel free to reach out to Rick to learn more.
FIX HEALTHCARE AND HEAL THE NATION (Jamie Koufman)Jamie Koufman
Unethical for-profit healthcare is bankrupting the United States. This presentation makes a convincing argument for a National Health Service (NHS) (not an insurance system) as Tier-One in a Three-Tier medical system.
As who lives in our rural communities changes, so too are the way these communities support themselves. As tax dollars shrink, the philanthropy community is finding itself being asked to play a bigger role.
Is it possible to provide health care without rationing In 1948 eve.pdfarchiesgallery
Is it possible to provide health care without rationing? In 1948 every household in Britain
received a leaflet stating that the new National Health Service would \"provide you with all
medical, dental and nursing care. Everyone - rich or poor, man, woman, or child - can use it or
any part of it. There are no charges, except for a few special items.\"
c) What system of rationing would you recommend?
Solution
Now a days it is not possible to provide health care without rationing. Healthcare rationing is
used by health insurers, the government and individuals to save money. Some would even argue
healthcare rationing supports the greater good. Citing with the text for the answer of the question
is mentioned below :-
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug
called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost
of $54,000. Is a few more months worth that much.
If you can afford it, you probably would pay that much, or more, to live longer, even if your
quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger
covered by your health-insurance fund. If the insurer provides this man — and everyone else like
him — with Sutent, your premiums will increase. Do you still think the drug is a good value?
Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any
limit to how much you would want your insurer to pay for a drug that adds six months to
someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that
much,” then you think that health care should be rationed.
In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting
last month with five governors, President Obama urged them to avoid using the term, apparently
for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a
Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration
Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described
how in Britain the national health service does not pay for drugs that are regarded as not offering
good value for money, and added, “Americans will not put up with such limits, nor will our
elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator
Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the
proposed reform.
Remember the joke about the man who asks a woman if she would have sex with him for a
million dollars? She reflects for a few moments and then answers that she would. “So,” he says,
“would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do
you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the
price.” The man’s response implies that if a woman will sell herself at.
FIX HEALTHCARE AND HEAL THE NATION (Jamie Koufman)Jamie Koufman
Unethical for-profit healthcare is bankrupting the United States. This presentation makes a convincing argument for a National Health Service (NHS) (not an insurance system) as Tier-One in a Three-Tier medical system.
As who lives in our rural communities changes, so too are the way these communities support themselves. As tax dollars shrink, the philanthropy community is finding itself being asked to play a bigger role.
Is it possible to provide health care without rationing In 1948 eve.pdfarchiesgallery
Is it possible to provide health care without rationing? In 1948 every household in Britain
received a leaflet stating that the new National Health Service would \"provide you with all
medical, dental and nursing care. Everyone - rich or poor, man, woman, or child - can use it or
any part of it. There are no charges, except for a few special items.\"
c) What system of rationing would you recommend?
Solution
Now a days it is not possible to provide health care without rationing. Healthcare rationing is
used by health insurers, the government and individuals to save money. Some would even argue
healthcare rationing supports the greater good. Citing with the text for the answer of the question
is mentioned below :-
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug
called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost
of $54,000. Is a few more months worth that much.
If you can afford it, you probably would pay that much, or more, to live longer, even if your
quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger
covered by your health-insurance fund. If the insurer provides this man — and everyone else like
him — with Sutent, your premiums will increase. Do you still think the drug is a good value?
Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any
limit to how much you would want your insurer to pay for a drug that adds six months to
someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that
much,” then you think that health care should be rationed.
In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting
last month with five governors, President Obama urged them to avoid using the term, apparently
for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a
Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration
Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described
how in Britain the national health service does not pay for drugs that are regarded as not offering
good value for money, and added, “Americans will not put up with such limits, nor will our
elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator
Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the
proposed reform.
Remember the joke about the man who asks a woman if she would have sex with him for a
million dollars? She reflects for a few moments and then answers that she would. “So,” he says,
“would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do
you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the
price.” The man’s response implies that if a woman will sell herself at.
Presentation at 2012 Houston Economic Summit by Dr. Leonard A. Zwelling of MD Anderson Cancer Center, about process of passing the Affordable Care Act (aka Obamacare)
4.1 INTRODUCTION
The United States of America (USA) covers 3,717,727 square miles and is made up of 50 states
(Infoplease, 2010). The USA’s population in 2004 was 293,027,571 (U.S. Census, 2004). In 2010
the population reached over 307 million. The proportion of the population that is under 15 years
old in the United States (U.S.) is 21%, and the over-60 population proportion is 16% (UNO,
2004). Slightly more than 12.4% of the population were 65 years and older of which 1,557,800
(4.5%) were living in nursing homes (U.S. Census, 2010). The primary languages spoken in the
United States are English and Spanish. The largest ethnic groups are European American (75%).
African American and Latino groups each constitute approximately one-eighth of the population.
The largest religious groups are Protestant (over 50%) and Roman Catholic (25%).
The United States is the largest, most powerful nation in the industrialized (developed) world, and
it has a high literacy rate. However, in 2006, while it led the world in healthcare spending per
capita, it ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male
mortality, and 36th in life expectancy, earning an overall ranking of 37th in the industrialized world
in healthcare performance (Murray & Frenk, 2010, p. 1). Life expectancy in the United States is 80
years of age for European American women, 75.9 for African American women, 75.3 for
European American men, and 68.9 for African American men. The life expectancy rate for the
United States is among the lowest for the industrialized world, and infant mortality is among the
highest. Americans consider quality, affordable health care a birthright, an expectation. Yet, unlike
other world powers, the U.S. government plays a small role in ensuring that everyone has equal
access to quality health care and services.
Although the United States is envied for its wealth, high technological capabilities, and research
savvy, historically it has not kept pace with other industrialized nations in the area of healthcare
delivery. This is reflected by its poor outcomes in infant mortality and life expectancy. The
healthcare system is also overwhelmed by disparities and inequities in care and lack of access
(except for the most aff ...
1Identifying the VulnerableLearning ObjectivesAfteEttaBenton28
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxaulasnilda
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxfelicidaddinwoodie
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Artificial Intelligence to Optimize Cardiovascular Therapy
Ethics presentation 2-b
1. 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, MPH
paradocs2@hotmail.com
Originally presented May 1, 2011
Updated August, 2015
3. “Seniors and the disabled
"will have to stand in front of
Obama's '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 care."
Sarah Palin on Friday, August
7th, 2009 in a message posted
on Facebook
.
4.
5.
6. "I'm still trying to find the first American to talk to who's 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. "I've not talked to one
and I get to a lot of places," he told reporters at his weekly press
availability. "I've not had anyone come up to me -- I know I'm
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 government.
Throughout 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.
7. Critical Letter By Catholics Cites Boehner On Policies
By 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.
“Mr. Speaker, your voting record is at variance from one of the
church’s most ancient moral teachings,” the letter says. “From 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 it.”
8. Peter Singer, NEW YORK TIMES, July 15, 2009
PUBLIC
HEALTH
INSURANCE
SHOULD PAY
UP TO $_____
FOR A
TREATMENT
THAT WOULD
EXTEND A
PATIENT’S
LIFE FOR ONE
YEAR
9. Texas Futile Care Law: “Death Panels” Signed Into Law… By Bush
Advance Directives Act
The 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 & Safety Code. Controversy over these provisions
mainly centers on Section 166.046, 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 team.
The law was signed by George W. Bush, when he was governor of
Texas.
Life-Support Stopped for 6-Month-Old in Houston March 16, 2005
Yesterday Sun Hudson, the nearly 6-month-old at Texas Children's 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 hospital's action, and Sun died shortly thereafter….
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 child's parent.
10. Hammurabi’s Code and U.S. Health Care
By 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 follows:
"I 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 children.“ 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 Jersey’s 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.
11.
12. Nursing facility providers in the United States (1997)
1,813,665 total nursing facility beds;
16,995 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 pay.
Medicaid in the United States
1,031,364 Medicaid only beds;
400,122,716 Medicaid nursing facility days;
1,667,319 total Medicaid nursing facility residents;
$85.05 per diem Medicaid nursing facility rate.
Medicare in the United States
53,138 Medicare only beds;
1,113,237 total Medicare stays;
$234 average per diem Medicare rate;
There are nearly nine million people, representing
one in five Medicare beneficiaries, who are eligible
for services through both Medicare and Medicaid
-- often called “dual eligibles.” They are the poorest
Providing tools for those who are eligible for Medicare
and Medicaid would save money and make the
programs work better for the elderly. They consume
about 25 percent of Medicare’s spending and nearly
half of Medicaid’s -- more than $250 billion in 2008.
13. Patients Are Not Consumers
By 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 costs….
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 choice."
Here's 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 isn't commercial enough.
What has gone wrong with us?
14. The Inverse Care Law
JULIAN 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.
15. VALUES IN HEALTH CARE:
THE MORAL AND ETHICAL
IMPERATIVE
The 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)
23. Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer.
Smith AK1
, Earle CC, McCarthy EP., J Am Geriatr Soc. 2009 Jan;57(1):153-8. doi: 10.1111/j.1532-5415.2008.02081.x.
Epub 2008 Nov 21.
OBJECTIVES:
To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illness.
SETTING:
Surveillance, Epidemiology, and End Results-Medicare Database from 1992 to 1999 with follow-up data until December
31, 2001. 49,960 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 cancer.
RESULTS:
Whereas 42.0% of elderly white patients with advanced cancer enrolled in hospice, enrollment was lower for black
(36.9%), Asian (32.2%), and Hispanic (37.7%) 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 hospital
CONCLUSION:
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.
25. Health Care Costs Concentrated in Sick Few—
Sickest 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 U.S. population,
by magnitude of expenditure, 2009
1%
5%
10%
50%
65%
22%
50%
97%
Population Share of Health Spending
25
26. Medical loss
ratio
2Q 2008 2Q 2009
Aetna 81.9% 86.8%
Cigna 86.0% 86.7%
Coventry 85.8% 86.4%
Health Net 85.3% 86.2%
Humana 85.8% 83.6%
WellPoint 83.3% 82.9%
UnitedHealth
Group
83.6% 83.6%
Source: Securities and Exchange Commission
27.
28. •Among medical debtors, hospital bills were the largest medical expense for 48% drug costs for 19%,
doctors’ bills for 15% and insurance premiums for 4%. In 38% of cases, lost income due to illness was
a factor.
•Out-of-pocket medical costs since the onset of illness averaged $17,943.
•For the privately-insured, out-of-pocket costs averaged $17,749.
•For the uninsured, out-of-pocket costs averaged $26,971.
•Patients with neurologic disorders such as multiple sclerosis faced the highest costs, and average of
$34,167, followed by diabetics at $26,971.
•Illness and medical bills were linked to at least 62.1% of all
personal bankruptcies in 2007. Based on the current bankruptcy
filing rate, medical bankruptcies will total 866,000 and involve 2.346 million
Americans this year – about one person every 15 seconds.
•Using identical definitions in both years, the proportion of bankruptcies attributable
to medical problems rose by 49.6% between 2001 and 2007.
•Most medically bankrupt families were middle class before they suffered financial setbacks. 60.3% of
them had attended college and 66.4% had owned a home; 20% of families included a military veteran
or active-duty soldier.
29. Nigerians Receive First Payments for Children Who Died in 1996 Meningitis
Drug Trial
By DONALD G. McNEIL Jr., THE NEW YORK TIMES, August 11, 2011
The 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
“pleased” that payments were finally being made under a settlement reached two years ago. Four families
received $175,000 each from a $35 million fund created under the settlement between Pfizer and
Nigeria’s 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 5,000 Americans and Europeans. Pfizer said Trovan saved lives in Nigeria, because
94 percent of the Nigerian children who received the drug survived — more than normally do if no
medicine is administered. Nonetheless, according to a 2006 Washington Post article, the trial’s certificate
of approval from a hospital ethics board was forged, and Pfizer said its own investigation had proved that
the certificate was “incorrect.” 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 world’s 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 “uncover
corruption links” to Nigeria’s former attorney general in order to pressure him to drop the Trovan
lawsuits.
30. PUBLIC GOODS
• Medical services and a person’s state of wellness
itself are “Public Goods” in a technical economic
sense. A “public good” is a product or service
which benefits everyone in the community and
has “externalities,” that is, it has benefits and
value to people who do not purchase it.
• Medical services and a person’s state of wellness
itself are “Public Goods” in a technical economic
sense. A “public good” is a product or service
which benefits everyone in the community and
has “externalities,” that is, it has benefits and
value to people who do not purchase it.
31. PUBLIC GOODS
• EXAMPLES OF PUBLIC GOODS
• Police and Fire Departments
• Interstate Highways and Bridges
• The Internet and GPS systems
• Public Schools
• Water distribution and Sewage treatment
• ? ALL MEDICAL SERVICES ?
• EXAMPLES OF PUBLIC GOODS
• Police and Fire Departments
• Interstate Highways and Bridges
• The Internet and GPS systems
• Public Schools
• Water distribution and Sewage treatment
• ? ALL MEDICAL SERVICES ?
32.
33. It was Ronald Reagan who
said “freedom is always just
one generation away from
extinction. We don’t 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
we’re going to find ourselves
spending our sunset years
telling our children and our
children’s children about a
time in America, back in the
day, when men and women
were free.”
34. 3. THE RECENT HEALTH REFORM IS
MOSTLY
A GOVERNMENT SUBSIDY OF
COMMERCIAL
HEALTH INSURANCE
35. Congress Passes Socialized Medicine and Mandates
Health Insurance - In 1798
RICK UNGAR POLICY PAGE FORBES Jan. 17 2011 - 9:08 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 -
“The 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 coverage.” State of Florida, et al. vs. HHS
It turns out, the Founding Fathers would beg to disagree.
In July of 1798, Congress passed – and President John Adams signed - “An Act
for the Relief of Sick and Disabled Seamen.” The law authorized the creation
of a government operated marine hospital service and mandated that
privately employed sailors be required to purchase health care insurance.
Keep 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 Constitution…. But those were the days when
members of Congress still used their collective heads to solve problems – 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.
36.
37. 85 percent: The percentage
of all enrollees receiving tax
credits for their insurance
premiums — 8.7 million
people.
38.
39. 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 Court’s 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 expansion.
Since 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 15.3 percent, compared to 3.3 percent for non-Medicaid
40. Supreme Court Justice Antonin
Scalia’s dissent in the same-sex
marriage cases, June 26, 2015:
“Four 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).”
41. GOP Governors' Obamacare Opposition Is Denying The Poor Health Care
Nonelderly Poor Uninsured Adults
in the Coverage Gap in States Not
Expanding Medicaid by
Race/Ethnicity
Total, United States:
4,832,000 - All races/Ethnicities
2,248,000 - White
1,327,000 - Black
992,000 - Hispanic
265,000 - Other
2,584,000 - People of Color
43. Hobby Lobby 101: explaining the Supreme Court's 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 beliefs.
The 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
Pennsylvania.
It 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 Act’s 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 woman’s contraceptives even
though that person has religious objections to doing so.
44. 4. “HEALTH CARE IS A HUMAN
RIGHT”
HAS REAL MEANING
OPTIMAL HEALTH
OUTCOMES DEPEND
ON SOCIAL and
ECONOMIC JUSTICE
45.
46.
47.
48. 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
healthcare".
He 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?"
Editor's Notes
Costs concentrated on small percentage of the sick
The other aspect of economic theory that “free market fundamentalists” have ignored and buried which is one explaination why medical services cannot be subject to free market distribution