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Number of Separated Children Now 4,100 and climbing!

Posted on | June 30, 2018 | No Comments

As Health Commentary predicted this week, the number of missing children resulting from the Trump “zero-tolerance” policy would far exceed 2,300. New estimates by NBC News place the number at 4,100 and climbing. Will it be 5,000, 10,000, more? We don’t know.

From NBC News:

“Officials have said that at least 2,342 children were separated from their parents after being apprehended crossing the border unlawfully since May 5, when the Trump administration’s “zero tolerance” policy towards migrants went into effect.

But numbers provided to NBC News by the Department of Homeland Security show that another 1,768 were separated from their parents between October 2016 and February 2018, bringing the total number of separated kids to more than 4,100.”

ProPublica Has Mapped 97 Immigrant Children Retention Sites – Please Help!

Posted on | June 27, 2018 | No Comments

1450 Children Here

ProPublica has established an open source registry to identify and map all immigrant children retention sites. So far, 97 sites all over the US have been verified. The Trump administration says there are only 2,300 children out there. But the Walmart site in Texas has 1,450 alone.

If you are caring for immigrant children in retention, register them with ProPublica HERE.

Doctors and Nurses – Called To “Bear Witness!”

Posted on | June 26, 2018 | 2 Comments

Mike Magee

Edmund Burke, a member of the British Parliament in 1787, stated “There are Three Estates in Parliament; but, in the Reporters Gallery yonder, there sits a Fourth Estate more important far than they all.” Even lacking formal recognition by the political system, Burke was acknowledging the “indirect but significant influence on society” of the news media or press.

Two hundred and twenty years later, in United States vs. PFC Bradley E. Manning, one expert witness described the “4th Estate as a “set of practices, organizing models, and technologies that are associated with the free press and provide a public check on the branches of government.” But he also was quick to note that modern day non-traditional journalistic media and Wikileaks were challenging well-accepted norms.

Trump, with the help of Bannon and the Russian government, have seriously undermined our “4th Estate.” By confusion and obfuscation, they have successfully undermined public confidence in “the truth.” Of course, in unleashing these forces, unintended consequences redound to the perpetrators. For example, Americans question the number 2,300 for the number of missing immigrant children spread in the dead of night across the United States. Could it not as easily be 5,000 or 10,000 explaining why they had to be dispersed far and wide? After all, this is the same crowd that 10-fold understated casualties in last year’s Puerto Rican hurricane disaster.

Legitimate journalists are fighting hard to uncover the truth. But it’s an uphill battle as they follow the finger pointing from the DHS to ICE to HHS to the DOD. Is it incompetence, malevolence, intransigence? We don’t know.

What we do know is that our Executive Branch has been occupied and is on a tear to dismantle democratic institutions and expand autocratic control. Our legislature is feckless, and thus far unwilling to “check” the unbalanced. Our Judiciary is slow to catch up, awaiting perhaps a Muller-driven spark. And our “4th Estate” for the time being at least, has been at least partially neutered.

One reason for hope is the emergence of a “5th Estate” led by America’s doctors and nurses. Two decades ago, I had the benefit of serving as faculty at the Jefferson Medical College led by Paul Brucker, one of the early founders of the American Academy of Family Physicians. With his encouragement, our team identified the characteristics of 188 of the nation’s most proactive and empathetic health leaders. Their psychological profiles showed extraordinary scores in scales for Activity, Competence, Dutifulness, Trust, Assertiveness, and Altruism.

Last week, medical and nursing organizations, en masse, spoke out for the children and parents torn from each other. Trump appeared to acquiesce, but trusting his word without independent verification is quite pointless.

This week, the American Academy of Family Physicians followed up with this statement:

“The American Academy of Family Physicians continues to place high priority on the mental and physical health and safety of families separated during border crossings. The AAFP notes that an executive order purports to ensure that, going forward, migrating children will remain with their parents and/or caregivers during the detention process. We are deeply concerned that the order fails to address the previously separated families.

The children originally detained at the southern border remain held apart from their parents, some as far away as Michigan, New York and South Carolina. The administration is silent on its plans to reunite these families in an expeditious and humane manner. Further, while we assume the children’s physical needs are being met, with each passing day apart from their families, the mental and emotional toll taken on these children continues to mount.

Accordingly, we urge the following of the administration:

· Immediately place the highest priority on reuniting the previously separated families.

· Ensure the mental and physical health and safety of the families, in particular, by providing access to qualified medical professionals to assess and monitor the emotional well-being of the children in the custody of the U.S. government.”

“Bearing Witness” is a critical role for doctors and nurses serving at the crossroads of injustice and human cruelty, as Médecins Sans Frontières has so nobly revealed over many decades. But now it is our turn, on our own native soil.

Paul Brucker died one year ago at age 85. Were he here today, he might reflect on the emergence of doctors and nurses as the “5th Estate”, a final stopgap and protectorate who, by their actions not their words, have earned the titles of “doctor” and “nurse” by serving on the receiving end of our Statue of Liberty’s invitation to, “Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore.”

Now we must bear witness, and our “5th Estate” needs to organize and act. Here are three steps we should take together.

1. Activate doctors and nurses nationwide to help identify immigrant patients and detention centers of those in their care who appear to have been incarcerated, detained, and dispersed by the government.

2. Use the Propublica open source site (HERE) to list the names and locations of all illegal immigrant children you’ve cared for who have been incarcerated and dispersed throughout the U.S. since January 1, 2018.

3. Create a genomic database and philanthropic funding, under the guidance of  original human genome-decoders Francis Collins and Craig Venters, to test and match all separated illegal immigrants and children with a goal of reunification by August 1, 2018.

The House of Medicine Stands Tall – A Day of Reckoning.

Posted on | June 20, 2018 | 6 Comments

 VIDEO

 

Mike Magee

Last evening, the normally controlled Rachel Maddow could no longer contain her humanity when forced to report that the Trump administration has been placing innocent babies and and other young children in three  “tender age shelters” in south Texas. She broke down in tears and could not speak on camera.

Long time Republican strategist, Steve Schmidt, spoke for her and the majority of Americans this morning when he resigned membership in Trump’s party stating, “This child separation policy is connected to the worst abuses of humanity in our history. It is connected by the same evil that separated families during slavery and dislocated tribes and broke up Native American families. It is immoral and must be repudiated. Our country is in trouble.”

As a physician and a Roman Catholic, I am proud to say that Schmidt’s  words followed the words and actions of leaders of both the House of Medicine and the Church last week.

One week ago, with the support of the Pope, Cardinal Daniel N. DiNardo, president of the U.S. Conference of Catholic Bishops, labeled participants in this policy as “sinners” adding these words, “Separating babies from their mothers is not the answer and is immoral.”

This was 9 days after the American Academy of Pediatrics public rebuke of the president, followed on CNN by AAP President Colleen Kraft’s blunt critique, “That’s child abuse!”

The American Academy of Family Physicians stood side by side with the pediatricians echoing “the gravity of the long-term harm that can be caused by forced separation at this critical and stressful time for a family.” Pushing back on the Trump/Bannon denigration of immigrants, the AAFP stated, “Once on American soil, regardless of their citizenship status, migrating children are the concern of the American Academy of Family Physicians.”

The American Medical Association last week issued a carefully worded rebuke stating, “The separation of children from their parents who are detained while seeking safe haven causes unnecessary distress, depression, and anxiety”, and that Trump’s actions “will do great harm to children and their parents or caregivers, who felt compelled to make a dangerous and uncertain journey because of safety concerns in their own countries.”

A week later, their CEO, Dr. James Madara, added his own exclamation point with these words, “Families seeking refuge in the U.S. already endure emotional and physical stress, which is only exacerbated when they are separated from one another. It is well known that childhood trauma and adverse childhood experiences created by inhumane treatment often create negative health impacts that can last an individual’s entire lifespan.”

The American College of Physicians, representing the nation’s internists, were on this issue nearly a month ago. On May 31st they stated, “a policy of universally separating children from their parents entering U.S. borders will do great harm to children, their parents, and their families… The American College of Physicians calls on the Department of Homeland Security, Attorney General Sessions, and President Trump to withdraw its new policy.”

The American Psychiatric Association a day earlier had stated, “These children deserve our protection and should remain with their families as they seek asylum. The APA recommends an immediate halt to the policy of separating children from their parents.”

By June 15th, the American Public Health Association labeled Trump’s actions as “inhumane…a dire impact on their health, both now and into the future. Decades of public health research has shown that family structure, stability and environment are key social determinants of a child’s and the communities health.”

In taking the steps they have taken, the Trump/Cannon cabal has revealed itself. It’s intentions are sinful, and beyond defense. They demand not only an immediate response, but an enduring solution as well. Tears reveal the magnitude of this inhumanity. Resignations from the party of Trump reflect a weakening of the iron grip of an oppressor. The Roman Catholics swift response in the defense of human dignity and human life is reassuring. And Medicine’s ability to place patients first – especially those most vulnerable and at risk – is a source of pride for this aging physician.

The Pharmacy Benefit Manger (PBM) Syndicate

Posted on | June 14, 2018 | 4 Comments

Mike Magee

“Syndicate: a self-organizing group of individuals, companies, corporations or entities formed to transact some specific business, to pursue or promote a shared interest. In most cases formed groups aim to scale up their profits.”

Drug channel companies including Pharmacy Benefit Managers (PBMs) (like United Healthcare’s Optum, Express Scripts and CVS/Caremark) and distributors (like AmerisourceBergen, Cardinal Health, and McKesson) are now 6 of the the top 25 companies in the Fortune 500.

What’s the source of all that market power? Let us count the ways:

1. Management of outpatient prescription drug benefits (including kickbacks)

2. Representing insurers and large employers (including kickbacks)

3. Organizing Medicare Part D benefits (including kickbacks)

4. Setting formulary policies (including kickbacks)

5. Negotiating with drug manufacturers (including kickbacks)

6.  Assigning formulary tiers (including kickbacks)

7. Distributing drugs through mail order and retail outlets (including kickbacks)

The parentage of PBM’s from insurers like UnitedHealth Group, or  pharma companies like Merck, or pharmacy chains like CVS helps explain how we have now arrived at an opaque system of profit sharing that deals in everyone except the patient.

It also helps explain the stratospheric rise in profitability usually associated with crime syndicates and money laundering operations. Since 1990, the prescription drug market in the U.S. has grown tenfold from $38 billion to over $360 billion.

PBMs may appear to be independent but in reality they have been built out “alongside a dominant fee-for-service health insurance system”. They are in fact agents and managers for a syndicate hidden in plain sight. It features contractural profit sharing, market protections to members that prevent competition and intrusion, and distribution of the spoils in a manner that prevents open warfare among participating members in the scheme.

And since DTC advertising was given the green light in 1997 (the only place on Earth besides New Zealand that allows it), the spoils have grown exponentially with the help of a “dog-eat-dog culture” reinforced by remarkable over-prescribing. 50% of Americans have filled a prescription in the past 30 days and 10% of Americans are on more than 5 prescription drugs. That’s quite an appetite!

If there was ever cause for pushing the “reset” button, this must be it.

Is it time for the “next” health care, or a total reboot?

Posted on | June 6, 2018 | 2 Comments

Mike Magee

This week’s big news is no big surprise. “Medicare’s Trust Fund Is Set to Run Out in 8 Years. Social Security, 16”, said the New York Times. We told you so, screamed the Republicans, anxious to fulfill Paul Ryan’s dream of taming endowments. We told you so, blared the Democrats, claiming this was always the end game with the recently passed, mega-deficit enhancing tax break for the rich which purposefully pushed the programs over the cliff.

Both are right in that this was predictable. But both are wrong in expending energy pointing fingers at each other rather than addressing the real issues: 1) our health system is massively inefficient, 2) our system rewards profiteering at every turn, 3) our system fails to deliver health in an even and equitable manner compared to all other developed nations.

A few facts:

More than 60 million Americans rely on Social Security, Medicare or both.

Social Security and Medicare currently consume 40 cents of every federal dollar.

Trump’s weakening of the ACA, most especially the penalty for going uninsured, means that our broken system will have more “uncompensated care” which simply adds fuel to the fire.

American taxpayers contribute $13,600 for every Medicare beneficiary. In five years, the projected figure will be $17,000.

Quasi-privatization of Medicare through the use of Medicare Advantage plans that further pad the pockets of insurers, Pharma, and PBMs, skimmed off 20 million seniors this year. In 10 years, that number is projected to increase by 50%.

The ratio of workers to beneficiaries is in steep decline. It was 3.3/1 in 2005, 2.8/1 in 2016, and is projected to be 2.2/1 in 2035. By then, there will be nearly 90 million eligible for Medicare.

While elderly numbers are rising fast, teenagers and young adults are dying at record rates causing economists to worry about the “work-loss costs.” Unintentional deaths from opioids, firearms (suicides and homicides), and motor vehicle accidents (mostly tied to texting) have risen from 15,851 in 2012 to 23,984 in 2016.

Princeton economist Alan Krueger estimates that negative health impacts have led to a 20% decline in workforce participation in males 25 to 54, and a 25% decline in women.

As record spending and profiteering fuel biotech speculation, public health spending continues a decades long decline. We are the only developed nation that spends more on fighting disease than on all our other social service programs combined.

Mayo Clinic’s Michael Joyner says, “In addition to the specific mix of greed, bad corporate governance, and too much ‘next’ Steve Jobs, Theranos (the fraudulent testing company led by Elizabeth Holmes) thrived in a biomedical innovation world that has become prisoner to a seemingly endless supply of hype.”

Life expectancy in the U.S. will decline for the third straight year in 2018. Ironically, the last time that happened was exactly a century ago, during the Spanish flu epidemic.

Bottom line: Bad policy is killing us and killing our future. We need to nationalize health planning and health insurance for all. We need to admit that fighting disease is not the same as providing health. And we need to mandate price transparency and appropriate protections for all Americans.

Does Maternal Health Care in America Deserve Its “Me-Too” Moment?

Posted on | May 23, 2018 | 3 Comments

Mike Magee

The U.S. birth rate dropped for the second year in a row, down 3% from the prior year, the largest decline since 2010. In 2017, there were nearly 4 million births, 500,000 fewer births than in 2007, even though there has been a 7% increase in women 20 to 39, prime childbearing years, over the past 10 years.

The declines cut across all demographics but are especially evident in women of color. While birth rates in white women over the past 10 years were down 4%, Hispanic women declined 27%, black women 11% and Asian women 5%.

If you look at US health care outcomes, women can hardly be criticized for being cautious. Moms giving birth in the U.S. are three times as likely to die in the process as moms in Canada or the U.K. But that’s not the worst of it. For every woman who does die, 70 more (an estimated 50,000 moms) come close to dying.

There’s a laundry list of contributors – for example pre-eclampsia induced stroke or organ failure, placentas incompletely removed leading to hemorrhage and sepsis, and pulmonary emboli following delivery. These problems are more likely in the uninsured and poor, in those with obesity and diabetes, and in older moms. Women in their 30’s are now having more babies than women in their 20’s.

If a mom is lucky enough to have an uncomplicated birth in the U.S., she is discharged in less than 48 hours and still not completely out of the woods. That’s because post-partum care in America is abysmal. The critical 12 weeks after delivery, which advocates for women’s health have taken to calling the “4th trimester”, traditionally includes one solitary office visit for moms at 6 weeks.

As moms quietly struggle to manage their new infants needs, they end up ignoring their own substantial recovery challenged by perineal and incisional pain, depression and anxiety, bleeding and cramping, chills and night sweats, engorged breasts, constipation, hemorrhoids and more.

If she were in Switzerland, the hospital stay would be longer. In England or France, a midwife would be by in the first week for a home visit. In Sweden or Norway, there’d be a generous maternity leave. (In the U.S., ¼ of women go back to work less than two weeks after birth.)

Maternal care looks bad when numbers are rolled up and averaged. But, as with all other measures in U.S. health care, the geographic, economic and racial disparities are far, far worse. What we tolerate in women’s health care is pitiful.

The Affordable Care Act took measures to address this abuse. Prior to the ACA, 1/3 of women attempting to purchase health insurance were either rejected, surcharged with a higher premium, or excluded based on a prior condition. Numbers of uninsured women under 65 climbed from 13% in 2001 to 20% in 2010. For those who were covered, maternity coverage was often missing. ACA outlawed these skinny benefits and exclusions.

By 2016, only 11% of women under 65 remained uninsured, down from 20%. For those uninsured below 200% of the poverty level, the change after ACA was even more striking with uninsured falling from 34% to 18%. In parallel with these changes, all measurers of access to care, from office visits to pharmaceuticals for these vulnerable women have improved.

And yet, the Republican led Congress in lockstep with Trump, stills dreams of “repeal and replace”, and focuses on renewed attacks on women’s health services through defunding of Planned Parenthood.

The “Me-Too” movement is here to stay. There will be no turning back on individual abuse of women. But now is the time to also address broad scale institutional abuse of women as part of the movement. Universal health coverage with a consistent single payer package of meaningful maternal health offerings is an obvious and long overdue response.

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