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The Science Community Has Had Enough of Trump and Is Finding Their Voice.

Posted on | September 18, 2020 | No Comments

Mike Magee

In its 175-year history, Scientific American has never endorsed a US presidential candidate – until now. This week they endorsed Joe Biden for president. One week earlier, H. Holden Thorp, the spicy new editor of Science, penned an editorial titled “Trump Lied About Science.”

Scientists have historically looked the other way and allowed the dust to settle. That’s what they did when George W. Bush flirted with creationism and put forward his cockeyed stem cell policy.  And they didn’t blink twice as Ronald Reagan super-charged  science infrastructure  while refusing to utter the words HIV/AIDS.

What especially had the Science editor worked up in an interview this week in Wired magazine, was Trump’s “constant drumbeat that scientists and science are somehow out to get the administration.” Add to this that the president is “willing to go into the Rose Garden or the briefing room and just say things that are blatantly untrue.”

But really what got Thorp’s goat was Trump’s March, 2020 remark to Pharma execs to “Do me a favor. Speed up a vaccine.”  That kind of interference can bend the risk/benefit curve, and have a long-lasting ill effect on the public’s trust of science in general.

“I believe we’ve been overly deferential to the idea that we should stay out of it. Look what that’s gotten us. It’s gotten climate denial. It’s gotten us creationism. It’s gotten us prohibited from doing stem cell research.”, said Thorp.

Scientific American, in its historic endorsement, was no more diplomatic. They wrote, “The evidence and the science show that Donald Trump has badly damaged the U.S. and its people—because he rejects evidence and science. The most devastating example is his dishonest and inept response to the COVID-19 pandemic, which cost more than 190,000 Americans their lives by the middle of September.”

Don’t expect any dampening of the controversy in the next sixty days. This week’s mental collapse of political hatchet man, Michael Caputo, and this headline in the New York Times – “C.D.C. Testing Guidance Was Published Against Scientists’ Objections:  A controversial guideline saying people without Covid-19 symptoms didn’t need to get tested for the virus came from H.H.S. officials and skipped the C.D.C.’s scientific review process.” – clearly suggests otherwise.

Structural Racism Within The Medicaid Program – Still Present a Half-Century Later.

Posted on | September 9, 2020 | 2 Comments

Mike Magee

If you would like to visit the meeting place of America’s two great contemporary pandemics –COVID-19 and structural racism – you need only walk down the historic Medicaid path and enter the dangling door of its weakest health care link, the Nursing Home.

The current pandemic is disproportionately killing and maiming Black Americans. This should come as no surprise to Medical Historians familiar with our Medicaid program. Prejudice and bias were baked in well before the signing of Medicaid and Medicare on July 30, 1965.

President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was the endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Predictably, Southern states feigned support, and enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South “Black Belt.”

Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards” by 1977. But by 1972, after seven years of skirmishes, the provision disappeared.

Ever the political pragmatist, President Johnson had focused instead on Medicare and hospital compliance, rather than Medicaid and Nursing Homes. And that alone was a pitched battle at the time.

In the 1960s, hospitals throughout the South still maintained segregated restrooms and segregated floors and wards designed to separate black and white populations. The passage of the Civil Rights Act in July 1964 had sent a clear warning: Title VI of the bill stated, “No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, denied benefits of, or be subject to discrimination under any program receiving federal assistance.”

Johnson deployed 1,000 federal inspectors across the country to ensure that the letter of the law was being implemented. Even with this, 10 months after Medicare had been signed into law, and a month or two before the launch date, half the hospitals inspected in 12 Southern states were still noncompliant. So he leaned on Vice President Humphrey to head south and communicate directly with every mayor in the noncompliant Southern cities and simply, one way or another, get the job done.

By May 23, 1966, all hospitals were compliant except in Alabama, Louisiana, Mississippi, and South Carolina. By July, they were clearly heading in the right direction, though 320 hospitals had not yet completed the conversions. All would soon comply.

Medicaid has always disproportionately served as a backstop for Black Americans. They are more likely to be financially eligible, and more likely to spend their final years in Nursing Homes funded by Medicaid dollars. They are also likely to die younger than white counterparts, have twice the rate of heart disease, high blood pressure and stroke. For younger Black women, lack of access to maternity care and mental health services places them at high risk. Their children are 500% more likely to die of asthma than white children.

As for Medicaid, a half-century later, we’re still fighting the same discriminatory battle, and largely in the very same states.

Southern states, led by Republican governors, have led the way in a decade long battle to collapse the Affordable Care Act, and most notably the 90% federally funded expansion of Medicaid services and eligibility which the Supreme Court deemed voluntary in a landmark 2012 decision. Until 2017, eighteen states stubbornly held ranks. But in the past three years six states (Idaho, Utah, Oklahoma, Nebraska, Maine and Missouri) have fallen in line after voter propositions passed in their states.

That leaves some 2 million vulnerable citizens without coverage that is readily available. Polls in those states show that 2/3rds of their citizens favor Medicaid expansion in opposition to their own governors – and that was before the pandemic. Even in red counties of red states, 1/3 of Republicans are polling in favor of Medicaid expansion.

When COVID-19 hit, Nursing Homes were at the epicenter. The major Southern states resisting enrollment in Kerr-Mills in 1965 were Texas, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Florida, Georgia, South Carolina, and North Carolina. Today, eight of the twelve states resisting Medicaid are the same. These 12 states account for 92% of adults eligible for but not covered by expanded coverage. As such, they are last in line for COVID-19 testing, PPE, and vaccines when they arrive.

As a recent Health Affairs article concluded: “Addressing these ills through policy is not the only step needed to end racism in our country, but it is a necessary—and long overdue—step.”

Trump “Compstockery” – Militarizing Our Post Office!

Posted on | September 3, 2020 | 2 Comments

Mike Magee

As we witnessed in last month’s Republication convention, when in doubt, go with the golden oldies. Australian songwriter Peter Allen said as much in the fourth stanza of his classic song, “Everything Old Is New Again”, which reads:

“Don’t throw the past away

You might need it some rainy day

Dreams can come true again

When everything old is new again”

In fact, there’s nothing original in Trump’s playbook, and that includes his postal service gambit. Manipulating and militarizing the US Postal Service dates back to 1873 in the form of one Anthony Comstock, a zealot who was fond of describing himself as a “weeder in God’s garden.”

A savvy New York City insider, he created the New York Society for the Suppression of Vice declaring himself committed to stamping out smut. But to accomplish this task, he needed a hammer. He turned to political allies in the United States Postal Service who provided him with police powers and the right to carry a weapon.

Still, the weapon was of little use without a law to enforce. So he turned to his friends in industry who reached out to Congress.  “An Act for the Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use” was passed on March 3, 1873, ch. 258, § 2, 17 Stat. 599. Forever after known as the Comstock Law, the statute’s lofty intent was “to prevent the mails from being used to corrupt the public morals.”

“Obscenity” was broadly described and included all print materials advancing birth control, abortion or family planning. Comstock held the post as special agent to the Postal Service for the next 42 years, and during that time bragged that he had prosecuted 3,600 defendants and destroying 160 tons of obscene literature.

In the face of Congressional failure back then, opposition among citizenry stiffened. There was Margaret Sanger who labeled Comstock a “moral eunuch” and edited “The Woman Rebel” whose motto was “Working Women, build up within yourselves a conscious fighting character against all things which enslave you.” 

Sanger not only promoted family planning and women’s access to health care including abortions, but also challenged Comstock’s allies in industry writing, “We know the capitalist class must have a slave class, bred in poverty and reared in ignorance. That is why it is quite consistent with their laws that there should be a heavy penalty of five years’ imprisonment for imparting information as to the means of preventing conception. Industry…(must) undersell its rival competitors. They have only one way to do this, and that is to get labor cheap. The cheapest labor is that of women and children; the larger the number of children in a family, the earlier they enter the factory.”

Our nation then (and hopefully now) maintains the capacity to self-correct. In doing so, we rely on autocrats to over-play their hands. Trump is currently doing so with his face-off’s with LeBron James, Chris Webber and Doc Rivers.

A century ago, Comstock made poor choices as well. For example, he picked a fight with Irish playwright George Bernard Shaw by instigating the placement of his play “Man and Superman” on the “restricted book list” at the New York Public Library.  Queried by the New York Times for his reaction to the affront, Shaw posted this response from London on September 25, 1905:

“Dear Sir – Nobody outside of America is likely to be in the least surprised. Comstockery is the world’s standing joke at the expense of the United States. Europe likes to hear of such things. It confirms the deep-seated conviction of the Old World that America is a provincial place, a second-rate country-town civilization after all.”

Ouch!

The Supreme Court upheld the Comstock Law until 1983. In Bolger v. Youngs Drug Products Corp., 463 U.S. 60, 103 S. Ct. 2875, 77 L. Ed. 2d 469 (1983), the Supreme Court re-examined the Comstock Law and concluded it did not support “a substantial governmental interest.”  In an historic smack down the Court declared, “that a restriction of this scope is more extensive than the Constitution permits, for the government may not reduce the adult population … to reading only what is fit for children.“

____________________________________________________________________________

Originally Published: The Health Care Blog/Sept. 1, 2020

Americans Need To Stay Well To Get Better.

Posted on | August 27, 2020 | No Comments

Source: Commonwealth Fund 2020 Insurance Study

Mike Magee

In the face of the covid-19 rolling disaster, Americans without adequate health insurance are now closing in on 50%.

Relying on employers to provide health insurance has always been a bad idea. Lose your job/lose your insurance is crazy. That’s why no other developed nations go for it. As Warren Buffett says, its the “tapeworm on America’s economic competititiveness” restricting job mobility, productivity and efficiencies at every turn.

According to the recently released Commonwealth Fund study, in the first six months of this year, 12.5% of Americans lacked any insurance and another 10% had a period of absent coverage (a coverage gap). But what’s worse is that 21% were demonstrably underinsured – lacking basic benefits and hobbled by high deductibles and crippling copayments.

Over the past decade, many employers have purposefully shifted the financial risk to employees and with stealth degraded their offerings. Fully one quarter of all employers providing health coverage purposefully “under-insure.” Back in 2010, only 7% of plans had deductibles of 5% or more of their income. Now it’s above 15%. In 2010, 22% elected plans with base deductibles of $1000 or more. Now it’s a startling 46%.

Even before the pandemic – with its huge rates of unemployment and increases in mortality and morbidity – Americans couldn’t pay their health care bills. One in four with a job were dogged by medical debt. For the uninsured and underinsured, it was one in two.

As the pandemic hit, Americans tightened their belts, and checked their savings. But 37% said they had used up all their savings to pay their bills. Medical debt had already tarnished the credit ratings of 40% of Americans.

As Trump fiddles, and the pandemic spreads out-of-control, a quarter of our citizens already report problems paying for the basics – like food, medicines, and rent. With federal relief packages now in limbo, and the cold weather arriving (bringing seasonal flu into the mix), it becomes clear we are vulnerable as a nation.

There’s much to do. But none of it can be done if the citizenry is sick or disabled. We need to stay well to get better. And no one understands that better than employers. They need to come clean and simply say out loud, “We want out of the health care business.”

Open Source and Worth Sharing: A Jesuit Perspective – “Contemplating U.S. Health Care After Covid-19”

Posted on | August 24, 2020 | No Comments

“Show Me State” Abandons Trumpian Orbit and Embraces Medicaid Expansion.

Posted on | August 18, 2020 | 4 Comments

Mike Magee

Idaho

Utah

Oklahoma

Nebraska

Maine

…..

(and now) Missouri.

Since 2017, six Republican-led states have buckled under the crippling costs of health care and embraced the ACA offer to subsidize expanded Medicaid coverage for vulnerable populations in their states.

The “Show Me State”  showed its defiance and hard-heartedness until their state budget bled bright red in response to mismanagement of the Covid-19 pandemic. The final reversal came in earshot of Trump’s musings to Chris Wallace on FOX about a “health-care plan within two weeks, a full and complete health-care plan” and laughable pledges to “repeal Obamacare” just as 45 million additional Americans became unemployed and uninsured simultaneously.

By 6%, Missourians voted to extend health coverage to an additional 200,000 state dwellers. Those votes came dramatically from former Trump leaning suburbians. Even the state’s rural voters are beginning to get the message, having seen 10 rural hospitals shut their doors in the past few years.

Twelve hold-out states remain – 8 of the 12 from the Old South. That leaves some 2 million vulnerable citizens without coverage that is readily available. Polls in those states show that 2/3rds of their citizens favor Medicaid expansion in opposition to their own governors – and that was before the pandemic. Even in red counties of red states, 1/3 of Republicans are polling in favor of Medicaid expansion.

Democratic politicians like Montana Senate candidate Steve Bullock  are running with the news. He’s up on the air promoting state expansion of Medicaid to benefit “rural hospitals all across Montana.”

Who’s next? All eyes are on Florida and its 2.7 million uninsured residents.

Is This Seasonal Flu or Covid-19?

Posted on | August 14, 2020 | 2 Comments

Mike Magee

“Is this seasonal flu or Covid-19?” That’s the question many doctors and patients hope to avoid this fall.

Here are three strategies designed to avoid panic and even greater disruption of individuals lives and malfunction of our already over-stressed health care system:

Strategy 1: Get Your Flu Shot Early.

Approximately 200 million flu vaccine doses have already begun to hit the market in the U.S.  This is a 20% increase over last year and presumes an above-normal demand for the preventitive inoculation. AstraZenca has already released its first shipment of their FluMist vaccine after bumping up its original production by 25%.

Strategy 2: Dual Testing for Flu and Covid-19.

Last month the FDA approved a joint COVID-19 and flu test. This potentially will arm health professionals with a tool to avoid the either/or dilemma that faces them just around the corner.“With the authorization of these tests, the FDA is helping address concerns in anticipation of this upcoming flu season during the COVID-19 pandemic, which might be especially worrying for some Americans” said FDA Commissioner Stephen M. Hahn .

Strategy 3: Target vulnerable populations

In early June, with Trump undercutting infectious disease risk at every turn, the CDC gave $140 million to 64 localities to help states prepare for the flu season. By targeting an increase in flu vaccinations for vulnerable populations and increasing access for uninsured, high-risk people, the agency believes it will achieve a multiplying effect – decreasing hospitalizations for both flu and COVID-19.

Experts at the Institute for Health Metrics and Evaluation now predict over 300,000 U.S. deaths from COVID-19 by December accompanied by a 75% increase in hospitalizations over the next 3 months due to Trump’s encouragement of lax policies for containment. Even if defeated in November, Trump is signaling his intention to spend his last two months in office further complicating and undermining a “good government” response to this health and economic catastrophe.

This leaves control mesures in the hands of local leaders, health care professionals and patients. Three things you can do: 1) VOTE, 2) Mask and distance, 3) Get your Flu vaccine early.

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