Bill de Blasio’s Grand Health Care Illusion

https://www.city-journal.org/de-blasios-health-care-for-all-illusion

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Mayor Bill de Blasio announced Tuesday a plan to “guarantee health care to all New Yorkers.” Responding to what he described as Washington’s failure to achieve single-payer health insurance, the mayor laid out a “transformative” plan to provide free, comprehensive primary and specialized care to 600,000 New Yorkers, including 300,000 illegal immigrants. “We are saying the word ‘guarantee’ because we can make it happen,” he announced, pledging to put $100 million toward the new initiative.

If spending an additional $100 million is all it takes to pay the health costs of a half-million people, you may wonder why New York City Health + Hospitals (HHC) is going broke spending $8 billion annually to treat 1.1 million people. The answer: Mayor de Blasio is not really proposing anything new; nor is he planning to expand services or care to anyone currently ineligible. All of New York City’s uninsured—including illegal aliens—can go to city hospitals and receive treatment on demand. The mayor is trying to do what some of his predecessors attempted—shift patients away from the emergency room and into primary care, or clinics. In 1995, for instance, then-mayor Rudy Giuliani empaneled a group of experts to address the future of the city’s public hospitals. The panel concluded, in the words of a Newsday editorial, that “for patients, emphasis would be on primary care instead of hurried emergency-room sessions and days of hospitalization.”

The tendency of a segment of the population to avoid the health-care system until a critical moment, relying in effect on emergency rooms for primary care, has been the knottiest problem in public health for decades. Letting simple problems fester makes them more expensive to treat. Using ERs designed to handle resource-intensive trauma situations for basic medical problems is inefficient and wasteful. The city has spent lots of money trying to convince poor, often dysfunctional people to develop regular medical habits by signing up for Medicaid and getting a primary-care doctor.

De Blasio makes it sound as though illegal immigrants have not been able to get health care until now. But in 2009, Alan Aviles, then the city’s hospitals chief, spoke of “hundreds of millions of dollars in federal funds that cover the costs of serving uninsured patients including undocumented immigrants.” Aviles said that the city was renowned for its “significant innovations in expanding access to care for immigrants, including our financial assistance policies that provide deeply discounted fees for the uninsured, our comprehensive communications assistance for limited English proficiency patients, and our strictly enforced confidentiality policies that afford new immigrants a sense of security in accessing needed care.”

In 2013, Lincoln Hospital in the Bronx announced a new “Integrated Wellness Program” targeting seriously mentally ill people with chronic health problems—the same population that tends to be uninsured, to neglect their own care, and to wind up in the emergency room when their diabetes or cardiovascular disease catches up with them. “At Lincoln, we aim to establish best practices that combine physical and mental health—two services which have historically been treated separately,” said Milton Nuñez, then as now Lincoln’s director—words not much different from what Chirlane McCray said at Tuesday’s “revolutionary” press conference.

HHC director Mitchell Katz practically admitted that the mayor’s announcement of guaranteed health care for all is just fanfare, amounting to more “enabling services” for already-existing programs. Asked if uninsured people—largely illegal immigrants—can get primary care now, Katz explained, “you can definitely walk into any emergency room, you can go to a clinic, but what is missing is the good customer service to ensure that you get an available appointment. . . . that’s what we’re missing and the mayor is providing.”

Dividing $100 million by 600,000 people comes to about $170 per person—perhaps enough money to cover one annual wellness visit to a nurse-practitioner, assuming no lab work, prescriptions, or illnesses. Clearly, the money that the mayor is assigning to this new initiative is intended for outreach—to convince people to go to the city’s already-burdened public clinics instead of waiting until they get sick enough to need an emergency room. That’s fine, as far as it goes, but as a transformative, revolutionary program, it resembles telling people to call the Housing Authority if they need an apartment and then pretending that the housing crisis has been solved. Mayor de Blasio is an expert at unveiling cloud-castles and proclaiming himself a master builder. His “health care for all” effort seems little different.

 

 

How government shutdown is hampering some federal health efforts — 5 takeaways

https://www.beckershospitalreview.com/hospital-management-administration/how-government-shutdown-is-hampering-some-federal-health-efforts-5-takeaways.html?origin=bhre&utm_source=bhre

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Despite a meeting between President Donald Trump and various members of Congress, officials have not come to an agreement to end the partial government shutdown, which began Dec. 22. While the majority of the federal government’s public health efforts are continuing as usual, several agencies, including the FDA, are at a loss for funding as long as the temporary closure is in placeKaiser Health News reports.

Here are five things to know:

1. Congress has already passed five major appropriations bills, which were responsible for funding roughly 75 percent of the federal government, including HHS and the U.S. Department of Veterans Affairs. However, seven bills are still outstanding, including bills funding the Interior, Agriculture and Justice departments, the report states.

2. While the government’s flagship programs, like Medicare, Medicaid and the ACA, are insulated from the effects of the shutdown, other public health agencies are beginning to feel the squeeze from narrowing funding streams. For example, the FDA’s food safety operations are funded through the Department of Agriculture, which has been affected by the shutdown. The FDA’s contingency plan states that in the event of a shutdown, roughly 40 percent of the the agency’s workforce is furloughed.

3. Funding for the Indian Health Service — which is funded by the Department of the Interior — has also not been approved, meaning that the only IHS’ services currently available are those that meet the “immediate needs of the patients, medical staff, and medical facilities,” according to the agency’s contingency plan cited by Kaiser Health News. Many IHS facilities across the country remain open, with staffers reporting to work because they are necessary employees and  “excepted” from the furlough, an agency spokesperson told the publication.

4. The Department of Homeland Security’s Office of Health Affairs has also been scaling back its resources to survey threats posed by infectious diseases, pandemics, and biological and chemical attacks, the report states.

5. Roughly 800,000 federal employees nationwide have been affected by the shutdown and have found themselves in financial uncertainty, a New York City-based New York University professor told CNBC. One IRS employee told CNBC he cannot afford his more than $200 insulin prescription because he doesn’t know when he will begin work again.

 

Yes, Doctors ‘Stay In Their Lane’ on Gun Policy

https://www.realclearhealth.com/2018/11/20/yes_doctors_039stay_in_their_lane039_on_gun_policy_278297.html?utm_source=morning-scan&utm_medium=email&utm_campaign=mailchimp-newsletter&utm_source=RC+Health+Morning+Scan&utm_campaign=44ac32edb8-MAILCHIMP_RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b4baf6b587-44ac32edb8-84752421

Yes, Doctors 'Stay In Their Lane' on Gun Policy

What kind of ignorant troglodyte would tell a doctor to mind his own business?

This was, in essence, the question an incredulous media was asking after the National Rifle Association disparaged the American College of Physicians (ACP) for promoting an array of gun-control regulations last week. “Someone should tell self-important anti-gun doctors to stay in their lane,” the NRA tweeted. “Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

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http://thefederalist.com/2018/11/13/yes-doctors-stay-lane-gun-policy/

 

 

 

 

Doctors Start Movement in Response to NRA

https://www.realclearhealth.com/2018/11/20/doctors_start_movement_in_response_to_nra_278296.html?utm_source=morning-scan&utm_medium=email&utm_campaign=mailchimp-newsletter&utm_source=RC+Health+Morning+Scan&utm_campaign=44ac32edb8-MAILCHIMP_RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b4baf6b587-44ac32edb8-84752421

Doctors Start Movement in Response to NRA

The feud between the National Rifle Association and the medical community still rages on, with the latest round coming from physicians who released an editorial saying they disagree with the NRA, published in the journal Annals of Internal Medicine on Monday.

In a tweet this month, the NRA told “anti-gun” doctors to “stay in their lane” after a series of research papers about firearm injuries and deaths was published in the Annals of Internal Medicine, including new recommendations to reduce gun violence.

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https://www.cnn.com/2018/11/19/health/nra-stay-in-your-lane-physicians-study/index.html

 

 

The 2017 Flu Killed 80,000 in the US. Get a Flu Shot!

https://theincidentaleconomist.com/wordpress/healthcare-triage-the-2017-flu-killed-80000-in-the-us-get-a-flu-shot/

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Influenza killed 80,000 people last year in the United States. That is the highest number of deaths since the CDC started keeping records in the 1970s. Help protect yourself and those around you. Get a flu shot!

Percentage of young U.S. children who don’t receive any vaccines has quadrupled since 2001

https://www.washingtonpost.com/national/health-science/percentage-of-young-us-children-who-dont-receive-any-vaccines-has-quadrupled-since-2001/2018/10/11/4a9cca98-cd0d-11e8-920f-dd52e1ae4570_story.html?noredirect=on&utm_term=.bff48313afaa&wpisrc=al_health__alert-hse&wpmk=1

A small but increasing number of children in the United States are not getting some or all of their recommended vaccinations. The percentage of children under 2 years old who haven’t received any vaccinations has quadrupled in the last 17 years, according to federal health data released Thursday.

Overall, immunization rates remain high and haven’t changed much at the national level. But a pair of reports from the Centers for Disease Control and Prevention about immunizations for preschoolers and kindergartners highlights a growing concern among health officials and clinicians about children who aren’t getting the necessary protection against vaccine-preventable diseases, such as measles, whooping cough and other pediatric infectious diseases.

The vast majority of parents across the country vaccinate their children and follow recommended schedules for this basic preventive practice. But the recent upswing in vaccine skepticism and outright refusal to vaccinate has spawned communities of undervaccinated children who are more susceptible to disease and pose health risks to the broader public.

Of children born in 2015, 1.3 percent had not received any of the recommended vaccinations, according to a CDC analysis of a national 2017 immunization survey. That compared with 0.9 percent in 2011 and with 0.3 percent of 19- to 35-month-olds who had not received any immunizations when surveyed in 2001. Assuming the same proportion of children born in 2016 didn’t get any vaccinations, about 100,000 children who are now younger than 2 aren’t vaccinated against 14 potentially serious illnesses, said Amanda Cohn, a pediatrician and CDC’s senior adviser for vaccines. Even though that figure is a tiny fraction of the estimated 8 million children born in the last two years who are getting vaccinated, the trend has officials worried.

“This is something we’re definitely concerned about,” Cohn said. “We know there are parents who choose not to vaccinate their kids . . . there may be parents who want to and aren’t able to” get their children immunized.

Some diseases, like measles, have made a return in the United States because parents in some areas have failed or chosen not to vaccinate their children. Last year, Minnesota suffered a measles outbreak, the state’s worst in decades. It was sparked by anti-vaccine activists who targeted an immigrant community, spreading misinformation about the measles vaccine. Most of the 75 confirmed cases were young, unvaccinated Somali American children.

The data underlying the latest reports do not explain the reason for the increase in unvaccinated children. In some cases, parents hesitate or refuse to immunize, officials and experts said. Insurance coverage and an urban-rural disparity are likely other reasons for the troubling rise.

Among children aged 19 months to 35 months in rural areas, about 2 percent received no vaccinations in 2017. That is double the number of unvaccinated children living in urban areas.

The new data shows health insurance plays a significant role, as well. About 7 percent of uninsured children in this age group were not vaccinated in 2017, compared with 0.8 percent of privately insured children and 1 percent of those covered by Medicaid.

Those differences are concerning because uninsured and Medicaid-insured children are eligible for free immunizations under the federally funded Vaccines for Children program.

“Parents may not be aware of this, so this may be an education issue,” Cohn said.

Other issues, such as child care, transportation and a shortage of pediatricians in rural areas, are also likely to affect vaccination coverage.

A second report on vaccination coverage for children entering kindergarten in 2017 also showed a gradual increase in the percentage who were exempted from immunization requirements. (The exemptions do not distinguish between one vaccine versus all vaccines.)

Eighteen states allow parents to opt their children out of school immunization requirements for nonmedical reasons, with exemptions for religious or philosophical beliefs.

The overall percentage of children with an exemption was low, 2.2 percent. But the report noted “this was the third consecutive school year that a slight increase was observed.” The report does not provide a breakdown, but the majority of exemptions are nonmedical, according to data reported by the states.

Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University, said that an analysis he and colleagues conducted a few years ago found the rate of increase in nonmedical exemptions had appeared to stabilize by the 2015-2016 school year after many years of increase.

But the latest CDC data appears to reflect a change, he said. “It seems that in recent years, exemptions are going up, and the trend is likely due to parents refusing to vaccinate,” he said.

In the 2017-2018 school year, 2.2 percent of U.S. kindergartners were exempted from one or more vaccines, up from 2 percent in the 2016-2017 school year, and from 1.9 percent in the 2015-2016 school year, according to the CDC report.

Reasons for the increase couldn’t be determined from the data reported to CDC, the agency said. But researchers said factors could include the ease of obtaining exemptions or parents’ hesitancy or refusal to vaccinate.

States such as West Virginia and Mississippi, which do not allow nonmedical vaccine exemptions, have higher percentages of children getting vaccinated, said Mobeen Rathore, a pediatric infectious disease physician in Jacksonville, Fla., and a spokesman for the American Academy of Pediatrics (AAP).

Earlier this year, researchers from several Texas academic centers identified “hotspots” where outbreak risk is rising in 12 of the 18 states that allow nonmedical exemptions because a growing number of kindergartners have not been vaccinated.

 

Suicide rates rise sharply across the United States, new report shows

https://www.washingtonpost.com/news/to-your-health/wp/2018/06/07/u-s-suicide-rates-rise-sharply-across-the-country-new-report-shows/?noredirect=on&utm_term=.2e83fb652ffe

 

Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a report released Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

In North Dakota, the rate jumped more than 57 percent. In the most recent period studied (2014 to 2016), the rate was highest in Montana, at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

Only Nevada recorded a decline — of 1 percent — for the overall period, although its rate remained higher than the national average.

Increasingly, suicide is being viewed not only as a mental health problem but a public health one. Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death.

The most common method used across all groups was firearms.

“The data are disturbing,” said Anne Schuchat, the CDC’s principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

It is hitting many places especially hard. In half of the states, suicide among people age 10 and older increased more than 30 percent.Percent change in annual suicide rate* by state, from 1999-2001 to 2014-2016 (Centers for Disease Control and Prevention)

“At what point is it a crisis?” asked Nadine Kaslow, a past president of the American Psychological Association. “Suicide is a public health crisis when you look at the numbers, and they keep going up. It’s up everywhere. And we know that the rates are actually higher than what’s reported. But homicides still get more attention.”

One factor in the rising rate, say mental health professionals as well as economists, sociologists and epidemiologists, is the Great Recession that hit 10 years ago. A 2017 study in the journal Social Science and Medicine showed evidence that a rise in the foreclosure rate during that concussive downturn was associated with an overall, though marginal, increase in suicide rates. The increase was higher for white males than any other race or gender group, however.

“Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide,” Sarah Burgard an associate professor of sociology at the University of Michigan, explained in an email on Thursday.

The dramatic rise in opioid addiction also can’t be overlooked, experts say, though untangling accidental from intentional deaths by overdose can be difficult. The CDC has calculated that suicides from opioid overdoses nearly doubled between 1999 and 2014, and data from a 2014 national survey showed that individuals addicted to prescription opioids had a 40 percent to 60 percent higher risk of suicidal ideation. Habitual users of opioids were twice as likely to attempt suicide as people who did not use them.

High suicide numbers in the United States are not a new phenomenon. In 1999, then-Surgeon General David Satcher issued a report on the state of mental health in the country and called suicide “a significant public health problem.” The latest data at that time showed about 30,000 suicides a year.

Kaslow is particularly concerned about what has emerged with suicide among women. The report’s findings came just two days after 55-year-old fashion designer Kate Spade took her own life in New York — action her husband attributed to the severe depression she had been battling.

“Historically, men had higher death rates than women,” Kaslow noted. “That’s equalizing not because men are [committing suicide] less but women are doing it more. That is very, very troublesome.”

National Institute of Mental Health director Joshua A. Gordon explains some of the latest research surrounding suicide rates in the U.S. 

Among the stark numbers in the CDC report was the one signaling a high number of suicides among people with no diagnosed  mental health condition. In the 27 states that use the National Violent Death Reporting System, 54 percent of suicides fell into this category.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need,” he said.

Cultural attitudes may play a part. Those without a known mental health condition, according to the report, were more likely to be male and belong to a racial or ethnic minority.

“The data supports what we know about that notion,” Gordon said. “Men and Hispanics especially are less likely to seek help.”

The problems most frequently associated with suicide, according to the study, are strained relationships; life stressors, often involving work or finances; substance use problems; physical health conditions; and recent or impending crises. The most important takeaway, mental health professionals say, is that suicide is an issue not only for the mentally ill but for anyone struggling with serious lifestyle problems.

“I think this gets back to what do we need to be teaching people — how to manage breakups, job stresses,” said Christine Moutier, medical director of the American Foundation for Suicide Prevention. “What are we doing as a nation to help people to manage these things? Because anybody can experience those stresses. Anybody.”People without known mental health conditions were more likely to be male and to die by firearm. (CDC)

The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System. Information about contributing circumstances for those who died by suicide was obtained via the National Violent Death Reporting System, which is relatively new and in place in only 27 states.

“If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach, mortality rates decline,” Moutier said. “We know that same approach can work with suicide.”