Tuesday, February 14, 2017

Why Healthcare is a Right, and is Consistent with our Founding Principles...

Donald J. Trump has been our President since he was sworn in on January 20th . One of the biggest issues he'll have to deal with is the nation's approach to health care. He has been quite clear that he believes the Affordable Care Act to be a disaster and had promised to repeal it in first week or so in office.

Today, February 14, 2017 marks the twenty-sixth day of his Presidency. He is two days into his fourth full week. The Affordable Care Act has not yet been repealed.

There is no consensus what will happen to the 30 million or so people who have signed up for health insurance via the ACA. Some think a repeal and delay approach would be best where the ACA would carry on for a year or two while its replacement was negotiated, but still give the Trump White House and Congress the ability to look America mostly in the eye and say, "We repealed the Affordable Care Act. Obamacare is no more!"

A smaller number of Conservative voices feel there should be no repeal of the ACA until the "replacement" plan is ready to be transitioned to. Still others have suggested all those currently covered via the ACA could keep their coverage and eventually the "greatness" of the new polices available after "Trumpcare" is introduced will be so appealing, so superior that over time, people will eventually abandon the polices and/or coverage via the ACA marketplace exchanges or the medicaid expansion.

Talk of terminating the main funding streams for the ACA may sound good, but if those streams are ended, while those services are permitted to be still provided is rife with problems. Such an approach will grow the deficit and debt, which combined with Mr. Trump's other campaign promise of a massive infrastructure program that will cost a lot would start the next Administration off on an odd way given all the rhetoric we heard about shrinking government and reducing spending.

Delivering healthcare is a complicated endeavor under the best of circumstances, and we're not remotely delivering healthcare to anyone in the United States under the "best of circumstances." More on that point later on.

A question that often comes up in the debate about what role, if any, should the government play in the delivery of health care to Americans - maybe the fundamental question behind the acrimonious discussion on the matter - is this.

Is health care in the United States of America a right or a privilege?

IN the typical debate about this question, one thing that those who think its a privilege bring up is that the words "healthcare" appear nowhere in our Constitution. The "its a right" crowd usually counter by saying its covered by the general welfare clause. Not really. "General Welfare" really meant that the Government would be able to keep itself healthy and in tact and able to function.

Keep in mind, the Supreme Court ruled the ACA and its "individual mandate" that required most Americans to obtain health insurance to pay a fine, to be essentially a tax, which gave it a different status than many thought it should have.

I think the place to look is in the Declaration of Independence.

Here's the phrase:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. 


You won't find the phrase "healthcare" here either...

However...

"Men are endowed by their creator with certain unalienable rights." This basically means God has given us certain rights (not privileges,) that no one can take away.

"Among these are life, liberty and the pursuit of happiness." So... God gives us the right to be alive, to have Liberty from birth and to be able to pursue happiness. Let's look at the first of these unalienable rights from God.

Life: We have a right to live. I know we still execute people across the United States for various crimes and we're told those people lost their rights because they broke the law. Those words don't appear in the Constitution either, so it appears there's some negotiable wiggle room. If death can be an exception, can't life? Further, if life is a God given right, and its unalienable - then it can't be taken away. (Yet it is...)

We know African Americans, for example, weren't considered people and were abused terribly. The text of the Constitution doesn't include Blacks or Negroes or anything else.

We know women were denied the right to vote until the 19th Amendment was added in 1920. The Constitution doesn't mention women in its text.

It doesn't say except for crooks or Blacks... it says "men." Not some men or certain men or special men or white men or men who can afford it. It just says "men."

If we want to say we should apply the Constitution literally, then it has to be a 2 way street.

If we're entitled to live, its also implied we're entitled to have access to the basic things one needs to be able to live. Not live like a King, but not expire due to lack of food, heat, water, and yes...health care. 

We decided over fifty years ago that Americans should be able to get help buying food if they met certain financial criteria. Generally speaking, these were the poor people of our society, and while we hear about abuses (which OF COURSE should be addressed) we know that a LOT of people get public assistance. There's also assistance available to qualified people for heat, water, etc.

Next in the usual course of a discussion is the following, "Everyone CAN get healthcare.. all they have to do is go to the emergency room and they can get treated..."

Yes and no...

If a person is in an "emergent condition" the hospital must treat them to the extent that they are stabilized. That may take minutes, hours, days or potentially weeks depending on the circumstances. Emergency room care here in the US is very good, but also very expensive. We lead the world in medical bankruptcies, and this is one of the reasons why. People with no insurance have to pay cash for their medical services and for many - its a catastrophic amount of debt that buries them forever.

The law that compels the hospitals to treat such acutely ill or injured people doesn't afford much protections to those not yet in a emergent condition. You can't walk into an ER and ask for nutritional advice. You can't ask them to review your medications. You can't stroll in to an ER and ask for a treadmill test because you think you need one. You can't pop in and ask for a cup of dialysis. You can't ask for anything really.

Folks in that situation were typically turned away, and they were welcome to return when they were in a bad way. Then and only then would the Emergency Room staff be happy to help them. Hopefully, things wouldn't be too hard to repair or fix and there would be a happy ending. Too often, it wasn't a happy ending.

Emergency room care isn't health care. Its emergency medicine. Its not the sort of preventative health care one would receive from their primary care doctor. It's not screenings. It's not education. It's not routine checkups, blood work, urine tests, etc. It's not contraception. It's not nutritional guidance. It's not learning how to walk again or write again or speak again after something took those skills away. It's not an discussion on the options for end of life care that's occurring while a patient is in the middle of a crisis that may end their life.

In other words, its not the kind of health care that could help a person stay healthy or address a small issue on their own under the guidance of a primary care physician before it becomes an emergent condition which may be life threatening. 


Maybe they were kidding about life being unalienable?


So, allowing people to not have access to affordable health care creates a perverted dynamic. We, the people of this fine country won't help you to access the cheaper but vital healthcare that might in fact, keep you out of the very, very, very expensive emergency room where the care is great but where people still die in every hour of every day.

This also makes financial sense...

To which the General Welfare clause makes a a return visit to this discussion. The Congress is compelled to secure the general well-being of our government's fiscal health. GDP issues due to health care costs pose a major threat....

A look at thirty four other industrialized countries healthcare spending as a percent of their GDP:





From the managed care of the 1980's to the Affordable Care Act of 2010, the United States pays a higher percent of our GDP than any other country on earth. That's bad...

Another thing to note. Those other countries on the chart have universal coverage. They are able to provide health insurance to all of its citizens, while spending less as a percent of their GDP.

Pick your poison in terms whether you prefer Conservative or Liberal, Republican or Democratic style plans and approaches to address health care delivery in the US. Its inefficient and consuming more of our dollars than any other country in the world.

The so-called "greatest healthcare system in the world" also has major issues with its delivery and outcomes when compared to other industrialized countries around the world who offer universal coverage.

Consider...

*The United States has fewer physicians per 1000 (2.6) than the median OECD Country in 2013 (3.2)...

*Data from this decade shows Americans see their doctor on average fewer times (4/yr. ) than the median OECD country (6.5 visits per year.) Canadians saw their doctor on average 7.7 times a year. In Japan, the average number of visits is 12.9 per year.

*The US also has fewer hospital beds per thousand people (2.5) compared to the average median OECD (2.9), Germany has twice the number of beds as we do and Japan has over three times the number of beds we do.

*In terms of outcomes...

US life expectancy - 78.8 years
OECD Median  - 81.2 years

US Infant Mortality - 6.1 deaths among 1000 live births (highest among 11 countries studied)
OECD Median IM - 3.5 deaths

Chronic disease prevelance in the US (2 or more chronic conditions) = 68% of adults >65 yrs. old
Other countries in study, figures range from 33% in the UK to 56% in Canada

Obesity in the US is the worst in OECD countries...  35.3% of the US population is considered obese. Higher than any other country in the study.

While we do well with treating cancers, we don't compare well to other countries in treating diabetes, amputations due to diabetes, ischemic heart disease...

See the entire study from the Commonwealth Group here...

So...

We cover fewer people, in many cases our outcomes are less than steller to say the least and we pay significantly more for this level of "...effectiveness."

Bottom line:

Our approach to health care delivery in the United States since the 1980's through today is expensive, inefficient, unavailable to many and consuming far more of our GDP than any other industrialized country in the world.

If you have money or a job that provides you the access to health insurance you still have to deal with the terribly flawed, segmented and inefficient US health care system. If you're poor or don't have a job that provides health insurance benefits, depeneding on where you live - you may be with out access to even Medicaid, the public safety net program for poor people. Medicaid is administered by the States, and many have refused to participate in the Medicaid Expansion within the ACA. Currently, 32 States and DC have adopted the expansion, while 19 have rejected it. 

Without access to affordable health care and health insurance, people have a impediment to life, liberty and a pursuit of happiness afforded them by our Declaration of Independence. This issue hurts both individuals as well as the welfare of the United States.

The above reasons are the foundation of my position as to why healthcare is a right and not a privilege.





Wednesday, October 12, 2016

Opinion: Conservatism has no one to blame but itself...


The Republican candidate for President is at a war of sorts against the Republican Speaker of the House.

Think about that.

The Republican party is in crisis mode with their whirlwind and morally repugnant candidate, Donald Trump driving the GOP train off the rails. Escape routes are nowhere to be found for the party members. Stay loyal to Trump - pay a price. Reject Trump - pay a price. Try to quietly take no stand - pay a price.

Most people wouldn't feel sorry for politicans, political parties, and those that glom onto them for self promotion, and neither do I. Politicans are typically their own worst enemy, so usually they deserve what they get. No tears from me, sorry.

Way back when Trump first made rumblings about seriously running for POTUS this cycle, people laughed it off as just another public relations stunt. As it became evident he was serious this time, they still laughed and called it a joke that shouldn't and needn't be taken seriously. When the Donald would tangle with serious, professional politicians he would quickly be cut down to size. Nothing to worry about, let's all enjoy the good laughs Trump is sure to provide.

No one's laughing now, are they?

I've felt from very, very early on that a candidate like Trump would be well-positioned to take advantage of our current political polarization.

Since the days of Reagan, there's been a steady drip, drip, drip of anti-government, anti-progressive rhetoric in the US. The merging of the conservative movement and the religious right, cable news outlets like Fox News, media outlets like Brietbart and right wing talk radio, etc... all stoked the divisions we have now.

The hard right, which preached the message of we're losing our freedoms, liberty, our country, etc.. staked out a very loud but very tiny sliver of the american electorate as they grew in influence over the last few decades.

As more and more people bought into the notion that all government is bad, the appeal of a true outsider grew and grew. Most weren't viable and faded away during general election campaigns.

This cycle, the far right voices demonized almost everyone, except for their chosen few like Ted Cruz. Enter Donald Trump who isn't a politician, but IS a celebrity and has great name recognition.

He jumped on the bandwagon the far right was preaching and scaring people with. He hijacked their movement and one by one, kicked another conservative, then another and another to the curb until only he and Cruz were left.

Ted Cruz, despite his education and his speaking skills is not well liked, by most people. He comes across like a dick to most people, so he didn't get the support he needed to survive.

By attrition, Trump prevailed as a true outsider who heard people's pain and had no fucks to give about running roughshod over the other GOP candidates.

Basically, IMO, the conservative movement and the religious right, cable news outlets like Fox News, media outlets like Brietbart and right wing talk radio, etc. created the conditions for a wildcard outsider with an appearence of ability to stroll in to american politics and win the nomination. When you lay down with the likes of Sean Hannity, Mark Levin, Rudy Guliani, Breitbart, Rush, etc. did you really think you could walk away from that unholy union undiseased?

Put more crassly, if you willfully lie down with pigs in a pigpen, you will surely walk away smelling much like the shit you just embraced. What did you think was going to happen?

The GOP has no one to blame but themelves for the epic ass kicking Mr. Trump is about to receive.

They swore they were going to re-inivent themselves after the '12 relection of President Obama. They did a nice internal study, them tossed it in a drawer and kept going they way they had been.

If there's not a significant, meaningful self-examination of their party, their values and policy positions in the next few months, they deserve their demise.

America will be MORE diverse in the coming decades, not less and the Republican Party's myopic allegience to older Christian white males will come with a high price.

We need a vibrant, contempoary Republican party in the United States. The Democratic party has its own issues and a history of incompetance. A viable 3rd party option would be healthy as well. The dye is cast, and barring something utterly unforseen, Hillary Clinton will be our next President of the United States.

If the Republican leaders and party movers and shakers don't embrace new ideals and shun, publicly shun their rabble-rousers and fear-mongerers, they will move closer to, not further away from national irrelevance.

And it will be well-deserved...

Sunday, July 10, 2016

Guns: We're Arguing Over the Wrong Things...


June 12, 2016: 49 dead, 50 wounded, Orlando, FL.
December 2, 2015: 14 dead, 22 wounded,  San Bernardino, CA.
November 29th, 2015: 3 dead, 9 injured, Colorado Springs, CO.
October 1, 2015: 9 dead, 9 injured, Roseburg, OR.
July 16, 2015: 5 dead, 3 wounded, Chattanooga, TN.
June 18th, 2015: 9 dead, Charleston, SC.

You get the idea...

Gun debates are ubiquitous.  We don’t seem to be getting anywhere however.
Some thoughts...

1) If you’re truly fearful that President Obama or Hillary Clinton are going to confiscate all the guns in this country, you can relax. Obama hasn’t taken anyone’s guns away, and Hillary is less liberal than he is on this issue. No matter what you hear from the NRA or talk show hosts like Shawn Hannity or Rush Limbaugh, it’s fear-mongering. You’re being played. Talk shows can be informative and entertaining as hell, but they should never be anyone’s primary source of information about anything. Gun sales are robust, especially after a big event like the shootings in Dallas this past week. (Gun stocks rose over 5% the next day...)

2) Mass shootings are horrific and terribly sad but they make up a very small percentage of gun deaths. According to Center for Disease Control, over 33,000 people died from gun violence in 2013. Of those 33,000 victims, “mass shootings” accounted for just 1.5% of all gun deaths. The vast majority of gun deaths are suicides. Homicides have stayed pretty consistent in the 11,000/yr. range. Suicides using a gun are rising in the US. In 1999, we had roughly 16,500 firearm suicides in the US. In 2013, that number grew to a staggering 21,175 firearm suicides. In Ohio alone, more than 3 Ohioans die by suicide every day. Roughly, 1,100 of our fellow Buckeyes commit suicide and guns are the most common way to end your life for men and the second most common for women.

3) In 1996, Congressmen Jay Dickey from Arkansas who, along with like minded fellow Representatives, didn’t like what the CDC was coming up with in their research in gun violence and its effect on public health. In 1996, Dickey added an amendment onto a House Bill that prohibited the CDC from using any public funds to “...advocate or promote gun control.” The language was vague and researchers didn’t want to risk their careers or other funding to find out how far they could go. Therefore, gun violence research basically ground to a halt.

They weren’t done. The House then voted to strip $2.6M from the CDC’s budget, precisely the amount spent on firearm injury research the year before. Congress also applied the same restrictions on other Federal Agencies including the Department of Health and Human Services and the National Institute for Health.

To quote physician and epidemiologist Arthur Kellerman, “Health researchers are ethically bound to conduct, analyze, and report studies as objectively as possible and communicate the findings in a transparent manner...criticizing research is fair game; suppressing research by targeting its sources of funding is not.

Jay Dickey reversed himself in 2012 after the Aurora, CO theater shootings where 12 people were killed and another 73 were injured. Dickey said “...scientific research should be conducted into preventing firearm injuries and that ways to prevent firearm deaths can be found without encroaching on the rights of legitimate gun owners. The same evidence-based approach that is saving millions of lives from motor-vehicle crashes, as well as from smoking, cancer and HIV/AIDS, can help reduce the toll of deaths and injuries from gun violence.“

4) The NRA in all of its infinite purity contributes heavily to those conservative congressional entities and candidates who can aid them in their policy interests. Those conservatives then toe the line when it comes to blocking or voting down any legislation the NRA finds objectionable. The NRA continues to wail that Obama/Hillary are COMING FOR YOUR GUNS, the 2nd Amendment is UNDER ATTACK, etc... Gun sales/gun stocks are healthy... Congressmen get re-elected, nothing ever changes, life is good for the whores on the Hill and in the executive suites of the NRA.

We should be demanding the removal of the impediments preventing us from studying the gun issue on a Federal level.

What is the NRA afraid of?









Friday, April 22, 2016

Let's Take A Breath on the Wright-Patt Air Force Base Bible Removal…

(This column was published in the Dayton Daily News on April 26th, 2016...)

From the Dayton Daily News  earlier this month…

 "Wright-Patterson Medical Center has removed a Bible from a POW/MIA display after the Military Religious Freedom Foundation lodged a complaint, according to a base spokesperson."

  The social media discussions on this issue I’ve seen are pretty heavily in favor of those who feel the Bible should not have been removed. Many stated their positions on the premise that the United States is a Christian Country and the actions taken by WPAFB were just the latest in a long string of widespread, anti-Christian actions, aimed at spreading the “War on Christians.”

That’s right, the “War on Christians.”

Sigh…

A quick Google search tells me there’s roughly 575 churches in the Dayton area. Nationally, according to the 2010 “Religious Congregation Membership Study” there are roughly 350,000 churches in the United States. That’s seven thousand for each State. That’s 116.4 churches for every county in the country.

That’s a lot of churches.

The vast, vast majority of these churches also receive tax exempt status on their income. Instead of closing down churches and/or arresting those trying to conduct or attend services, the United States government grants them building permits and tax breaks. A rather odd “war strategy.” I don’t believe for a second anyone who plans on attending a church service this weekend in the Dayton area has any real reason to worry about being arrested, forced to confront protesters or face personal injury. You shouldn’t either.

There are Christians actually under attack in the world. Not here in the US, but in places like Iraq, Syria and elsewhere. People trying to practice their faith are being targeted, apprehended and usually sentenced to long prison terms or death. Likewise, missionaries who bravely chose to enter such lands knowing the price tag should they be caught is harsh and severe. Those people can legitimately comment on the war on their faith.

Every time I read someone’s online screed about how they and their like minded “Believers“ are the victims of this imaginary “War on Christians,” I think about those other Christians actually in  danger. It’s not some hyperbole written between sips of a Pumpkin Spice Latte by someone who sits with their feet up in a comfortable booth at Starbucks while they listen to their favorite Pandora mix on their earbuds. “That guy” isn’t under attack.

This thing at Wright-Patt AFB isn’t an attack on religion.

Given that it’s Government property, any inclusion of any one religious text like the Bible, Torah, Koran, etc. in a display like the one at the WPAFB medical clinic is best left out of it. Despite what some folks apparently think, the United States doesn’t have an army of Christian warriors. It is comprised of Americans. Christians, Jews and Muslims. Agnostics and Atheists.  White and Black. Yellow and Brown. Rich and Poor. Educated and uneducated. City kids and country kids. Men and women. Conservatives and Progressives.

Americans, all of them.

I hope, out of respect for those truly facing danger for practicing their faith, the next time someone thinks they’re a victim of religious persecution, they slow down for a second and think about those other people.

“War on Christians?”

It ain’t happening here.

Let’s take a breath.

Wednesday, April 6, 2016

Local nursing homes need your time, help...

(This column was published in the Dayton Daily News on April 2nd, 2016...)

In the greater Miami Valley, located in Southwest Ohio, there are approximately 250 nursing homes and assisted-living facilities within an hour or so drive from downtown Dayton. Almost every community you can name has at least one. Dayton and Springfield have a lot, but smaller towns like Eaton, New Carlisle, Urbana and Sidney each have at least one of these places for seniors, as well.
For 20 years, I’ve traveled around thie region performing for the folks that call these places home. I often see volunteers helping out the activity professionals who coordinate activities for the residents. These volunteers help out in many different ways. Some bring residents to and from music programs, call bingo, deliver mail, paint nails, read aloud today’s newspaper or serve refreshments.
Some read verses from the Bible, while some sing hymns. A volunteer may visit a person who is lonely, perhaps depressed and craves the comfort of a hand to hold, a face to smile at or arms to be held by. Someone to talk to. Despite the very best efforts of the special people who work as activities professionals (and they are highly dedicated and caring people), the hours can go by awfully slowly for some residents.
After talking with several of my clients, one thing is clear: We need more volunteers in our Dayton-area nursing homes. Carolyn Hoff, Activity Director at Brookhaven Nursing and Rehab in Brookville, OH, says, “The volunteer programs have been on the decline due to the overall aging of our population and also increased longevity. The baby boomers are now caretaking of their parents, children and grandchildren — and at times, their spouse — often on top of maintaining their careers thus they no longer have time to volunteer.”
Families also play an important part with those confined in these facilities, but as Hoff adds, “Often when family visit, the resident speaks to them about personal issues such as wanting to go home, finances and family issues. Whereas when a volunteer stops in, it’s relaxing light topics, comfort, social.”
Volunteers play a unique and valuable role in residents’ lives. The benefit isn’t limited to the recipients. Those who volunteer often find the work to be quite fulfilling and worthwhile.
We are transitioning in the need for care from the Silent Generation, (those 71 years of age or older) to the Baby Boomers, (those between 52 and 70). As boomers (in greater numbers) replace the previous generation, need for these facilities will grow, as will demand for additional health care professionals and other staff to provide care for the residents. Volunteers can play a vital role in this challenge.
April 10-16 is National Volunteer Week in the United States. The need for volunteers, especially in nursing homes and assisted-living facilities, has never been greater. The people who reside in these facilities are our mothers and fathers, our grandparents, our aunts and uncles and our brothers and sisters. They are our teachers, our coaches, our bosses and our co-workers.
They are our friends. Someday, they may very well be us.
Please give some thought to volunteering.
To learn more about volunteer opportunities contact a nursing home or assisted living facility near you for more information or call your local Area Agency on Aging.