Tag Archives: racism

COVID-19 and the End of the Neoliberal Era in Health Care

The subject of neoliberalism has been discussed in this blog five times between 2018 and 2019, and is the focus of an article in The Milbank Quarterly, by John E. McDonough, professor of public health practice at Harvard’s TH Chan School of Public Health.

In the article, Professor McDonough points to a Commonwealth Fund chart (see below) that shows the growth in gross domestic product (GDP) for health care, comparing the US to 10 other high income nations. The chart shows that from 1980 to 2018, spending by the US was among the highest 40 years ago, but that in the early 1980s, US spending leapt above the others. and growing wider over four decades.

 

He then asks, “what happened to US health care in the early 1980s-and since then?”

McDonough responds by pointing to two New York Times columns by Austin Frakt, Medical Mystery: Something Happened to U.S. Health Care Spending After 1980 and Reagan, Deregulation and America’s Exceptional Rise In Health Care Costs.

McDonough suggested that a big part of the answer involves the broad economic and political trade winds of the late 1970s and 1980s, often called “Reaganomics” or “supply-side economics”, because Reagan ushered in a new era in the US. Some, like George H. W. Bush, running for President in 1980 for the Republican nomination, called it “voodoo economics.” However. as McDonough states, and as my previous posts on the subject calls it, it is “neoliberalism.”

This term evokes Adam Smith, but the 20th century version owes itself more to the works of Friedrich Hayek and Milton Friedman, among others. According to McDonough, the neoliberal agenda consists of cutting taxes, repealing regulations, shrinking or privatizing government (remember Grover Norquist’s desire to shrink government to fit in his bathtub and strangle it), suppressing labor, encouraging free-market trade, accepting inequality as price for economic freedom (something that has come under fire this year and since the 2016 election, making people receiving services and benefits pay as much as possible, and reorienting corporate thinking and behavior to promote return on equity as their only goal.

The New Deal era that was replaced by neoliberalism, McDonough states, lasted 48 years, from 1933 to Reagan’s inauguration in 1981. The neoliberal era, he points out, is 40 years old and showing signs of rust, cracks, and failing systems. Signs of this are Trump’s war on trade, deficit-exploding tax cuts for the wealthy and corporations,, anger over “deaths of despair” from opioid and other addictions and economic distress, awareness and revulsion about rising levels of inequality across society, and spreading rejection of absolutist “shareholder capitalism.”

In addition, recent protests over the deaths of African-American males at the hands of police, coupled with the Corona virus pandemic, are all signs that something is terribly wrong.

But what about health care, McDonough asks again?

Reiterating what he said above, US health care between 1980 and 2020 saw spending rise far above US economic growth, while growth in insurance premiums and cost-sharing increased well beyond advances in household incomes. On key indicators, he reports, the US performs worse than most nations on life expectancy, infant and maternal mortality, chronic disease mortality, levels of overweight and obesity, suicides, and gun violence, as well as glaring systemic health inequalities, as has been discussed during the BLM protests as one factor in people taking to the streets.

Despite the advances in technology and high spending, Americans give their system the lowest satisfaction ratings.

Yet, between 1965 and the 1980s, major infusions of investor capital has gone to all corners of our health care system, courtesy of shareholder-owned for-profit companies who often cut long-lasting ties with local communities, according to McDonough. It did not help that in 1986, the Institutes of Medicine, instead of convicting for-profits of “killing” health care, released a 600 page report on “For-Profit Enterprises in Health Care, that identified pluses and minuses that called for greater monitoring.

Finally, McDonough concludes that the US need to look outward, not inward, as is usually the case to solve big problems with health care. One such study, in 2018 from the William and Flora Hewlett Foundation, Beyond Neoliberalism, is a clarion call for a new policy sphere forming in think tanks, academia, advocacy and activist groups, and the legal community, as well as some Republican/conservative quarters as Marco Rubio, who rejects shareholder primacy. He says the search is on for a new paradigm, and hopes the election in November will bring it forth.

He doesn’t have to look far. Bernie Sanders, Elizabeth Warren, the PHNP, and others have the paradigm. It is Medicare for All/Single Payer. But first we have to rid ourselves of the baboon in the Oval Office and his economic minions, Mnuchin the Mieskeit, and Kudlow the Meshuggeneh.

Stay safe everyone.

Public Health Emergencies and Health Care

In light of recent protests and violence, especially the state-sponsored violence that was unleashed by a fascist would-be dictator last night in the nation’s capital for a political photo-op that cleared peaceful protesters with tear gas and flash bombs, we must stop defending an economic system that believes that human rights such as health care are a priviledge of one’s pocketbook, and not their humanity. This attitude is not limited to health care, but in the midst of a pandemic, it is imcumbent on us to begin somewhere.

The statement below from Dr. Adam Gaffney, President of the Physicians for a National Health Program (PNHP) rightly states that police violence and racism are public health emergencies, must be understood from an historical perspective as well.

In my post, Why The US Doesn’t Have Universal Health Care – It Is Not What You Think, the reluctance of the US to implement universal health care is tied to Southern White racism.

So, those whose career or jobs depend on the status quo, and you know who you are, are  standing in the way of change or defend the status quo, are the ones who can bring change, or else change will be made without you.

Here is the statement:

June 2, 2020

Statement from Physicians for a National Health Program:

The horrific murder of George Floyd at the hands of Minneapolis police has sparked protests nationwide. Physicians for a National Health Program (PNHP), an organization of more than 23,000 doctors who support Medicare for All, denounces police brutality and racism in all forms; demands immediate steps to ensure racial justice at all levels of government; and calls for racism and racial health inequity to be treated as public health emergencies.

“The murder of Floyd,” said Dr. Adam Gaffney, president of PNHP, “is yet the latest example of the pervasive racism that sickens our nation. It is emblematic of the deeply entrenched system of institutionalized racism that afflicts both our criminal justice and health care systems.”

Police violence is a public health emergency.

Police violence is a leading cause of death for young men of color. Black men in particular face a 1 in 1,000 chance of being killed by police, and are 2.5 times more likely to be killed by police than are white men. Over-policing in communities of color and sentencing disparities mean that in the U.S. — which has the highest rate of incineration in the world — Black Americans are incarcerated at a rate that is 5.1 times that of whites.

Mass incarceration imposes a particular threat to health during the COVID-19 pandemic given crowding and poor access to health care in these facilities. PNHP has previously joined other groups in calling for immediate actions to safeguard the health of prisoners during the COVID-19 pandemic, including early release.

Racism is a public health emergency.

The current COVID-19 pandemic has laid bare the deep inequalities in our health system, as Black Americans are more than twice as likely (and in some states seven times as likely) to die from the virus than whites.

“Racial inequities have, for too long, been tolerated and accepted as normal in this country,” stated Dr. Susan Rogers, president-elect of PNHP. “The overt brutality displayed by police makes this clear, but these inequities extend to health care, housing, and education.”

Compared to whites, people of color are more likely to be uninsured, face barriers to care, and suffer and die from preventable health conditions like diabetes, heart disease, and cancer. Black families are also three times more likely to live in poverty compared to white families, and twice as likely to be food insecure, factors known to contribute to poor health.

PNHP is committed to fighting all forms of racial inequity, including the structural racism that puts Black people at substantially higher risk of police violence and incarceration, and a broken health care system that denies patients of color the right to health and health care.

Now more than ever we must speak out against all acts of racial injustice. Here are a few ideas for what you can do today:

  • Support racial justice organizations in your community with your time or financial resources.
  • Educate yourself about racial disparities in health care by exploring PNHP’s TOOLKIT on racial health inequities, which includes materials for hosting webinars, a guide for writing letters and op-eds, talking points, and materials to share on social media.
  • Commit to educating your colleagues on racial justice with this slide show and with tools for a Grand Rounds presentation.

Please join me in demanding an end the scourge of police violence, as well as racism and discrimination in all its forms.

Sincerely,

Adam Gaffney, M.D., M.P.H.
President

The Cry of the Children

Taking a break from writing about health care, workers’ comp, and medical travel, I want to talk about something I saw, or rather heard yesterday afternoon on MSNBC.

It was an audio (furnished by ProPublica) of children crying at a detention center (more like Concentration Camp) that broke my heart. I was in tears, and very seldom do so. But those cries went right to me.

If they did to you, then you are a good human being. If not, then you have no soul. And please, don’t quote me that that’s the law, or it is in the Bible, or they are illegal and have no rights.

EVERY HUMAN BEING HAS RIGHTS.

And as for whether or not they are “illegal”, I guess you forgot that when your ancestors arrived on the Mayflower or whatever ship they sailed on, the landlords here for thousands of years knew you were “illegal” too.

The ancestors of all of these people now streaming to our border came to this hemisphere some 20,000 years ago, so by those standards, you, me, and all the rest of us are undocumented aliens. But no one tells us to leave. Or yanks our kids from our arms.

That we do this and many other things to minorities is a symptom of our greed, ignorance, and stupidity that never seems to die out. Take for example, our Confederate-era Attorney General, Jeff “Foghorn Leghorn” Sessions. That refugee from the set of “Gone With the Wind” is not only a religious zealot, but a full-out bigot and racist from a region of the nation that still has not given up its racism and hatred of non-whites, and non-Christians. In this case, non-Protestants from Catholic Latin America.

Too many of our fellow Americans have been poisoned by talk radio, Fox News, and local politicians to see that we are all immigrants and that at times in the long history of the human species, we were migrants too. Our prehistoric ancestors migrated, as did many more recent peoples. But none ever subjected to such cruelty, except during the 1930’s and 1940’s.

We were all taught in school to believe in the ideals of America as a shining city on a hill (incidentally, an idea the Puritans created), and was more about a religious view than a secular one. We were all taught about why we fought a revolution, why we have a Declaration of Independence, and why we have a Constitution that secures our rights and liberties.

And now we are throwing all that away because of a clique of neo-fascist, racist bullies and bigots, headed by a pathological liar and con man, who has conned a large segment of the American people (by which I mean White people) that he can make America great again, all the while cozying up to dictators and dissing our friends.

Folks, this is how Hitler and the Nazis began. And it ended with 6 million dead (my maternal great-uncle, aunt and their six children among them), so don’t tell me it is legal or biblical. You know where you can put that.

And those of you who say they have stolen our jobs or they are criminals and rapists, I have news for you…next time you are in a restaurant, or a family member is in a hospital, bus your own table, and clean up your family member’s dirty linen. Because if Herr Miller (Stephen) gets his way, there won’t be any bus boys, nurses’ aides, home health aides, janitors, and other occupations Americans won’t be filling begging for workers. Oh, and you can come to Florida and pick your own fruits and vegetables, because there won’t be anyone to do it for you.

AMERICA IS A NATION OF IMMIGRANTS, SO WE NEED THESE PEOPLE.

 

Disgusted!

I want to take a break from writing about medical travel, health care and workers’ comp, and address my comments to my many readers around the world from Africa, Asia, Europe, and Latin America and the Caribbean.

As a second-generation American, whose paternal grandparents arrived here from Russia more than a century ago, and whose maternal grandparents also arrived from Russia (they both held Polish passports when they emigrated) almost a hundred years ago, 1921 and 1923, respectively, I am disgusted, angry, and outraged that the Chief Executive of my country is an outright racist and bigot.

I am only glad that my parents, the children of my aforementioned grandparents did not live to see this asshole either become President, or was unable to understand that he was President due to suffering from Alzheimer’s.

I, like this moron, was born and grew up in New York City, having been born in Brooklyn, and lived in two different neighborhoods that had diverse populations. I also lived on NY’s Long Island, and while my town was less diverse than my previous residences; nevertheless, the proximity of New York City to where I lived, went to school and worked meant that I was never too far away from people of different cultures, ethnicities, racial makeups, and religions. When I had the chance, I always visited the United Nations and felt a great deal of joy knowing that such an organization, as flawed as the world is, existed and that my hometown was its headquarters.

On September 11, 2001, I was more than a thousand miles from NY when the planes struck the two towers, places I had spent time in during my early working life. In point of fact, I was driving to work in Houston, Texas when the first plane struck, and was listening to the local classical radio station on my car’s radio, The news came on at 8 am, local time, and the announcer said a plane had struck the World Trade Center. My first thought was terrorism, but I soon realized that many small planes fly up and down the Hudson, and that perhaps this is what happened.

When I arrived at my office, because we had very little work to do, and because we were all new, I took a brief nap, and when I went out into the hallway of my floor, I was told to go upstairs to the break room and watch the newscast on television. When I arrived in the break room, the first tower collapsed, and this boy from New York City saw my hometown under attack.

I never lashed out at an entire group of people, but knew immediately and from what the reporters were saying, that this was the work of Al Qaeda and Osama bin Laden. But I will tell you what I did see on television. I saw people in the West Bank cheering the attacks, not people in Jersey City, like the current occupant of the Oval Office has claimed he saw.

In fact, one of my high school alumna was interviewed on television, and has been on American television and written of in the New York Times many times. She came to the US from India and is a Muslim woman, married to the Iman who wanted to build a cultural center near the WTC. Our yearbook pictures are diagonally opposite each other in our school’s yearbook, and she was very friendly with a neighbor, whose brother was responsible for the biggest financial disaster of the last decade.

There have been American presidents of this person’s party who I did not vote for, or agree with, but at no time in my life, or that of my parents and grandparents, did they have to feel ashamed, disgusted, and incensed at the blatant racism, sexism, homophobia, crudeness, and Antisemitism of any of them, including FDR, who many have accused as not doing enough to save the six million Jews who perished in the Holocaust, including my maternal grandfather’s older brother, his wife and six children.

So I say to you, my dear and devoted readers around this wonderful world of ours, I am sorry if this idiot offends you, your country, your race, ethnicity, religion or culture. He does not speak for me, nor does he speak with the vast number of Americans who feel like I do. We, the American people, apologize. It is our fault, and our fault alone.

RESISTANCE IS FUTILE!: What is the reason behind Medical Tourism’s Rejection?

My friend, Maria Todd, PhD, noted International Expert on Healthcare & Health Tourism Business Strategies & Operations, Business Owner, Author, and Speaker, has written a very cogent and to the point article challenging American hospitals on why they eschew inbound medical tourism.

For the uninitiated, inbound medical tourism, or travel, refers to foreign patients traveling to the US or other countries for medical care from their home country.

A case in point was the late, and not lamented, Shah of Iran who was allowed to come to the US for treatment of his cancer, and which led to the taking hostage of our embassy staff, destroying what was left of one presidential administration, and secretly aiding another to win the election, and thus look good in the eyes of the American people, only some time later to that administration selling arms to Iran for other hostages, the cash then used to support the Contras in Nicaragua.

But I digress.

As the Shah had money, he was welcomed with open arms, but Maria wonders why other American hospitals, knowing that they will receive cash, still refuses to seek out inbound medical tourism as an alternative source of revenue.

According to Dr. Todd, “It is estimated that the USA is the 3rd most popular destination for inbound medical tourism from other countries, but the practice of traveling for health has been a “thing” in the USA for more than 100 years.

Corporations such as Pepsico, Lowe’s Home Improvement, Boeing, WalMart and many other corporations, she writes, with self-funded health plans under ERISA, have the freedom to contract with any hospital, anywhere in the world without going through a managed care network, but can’t because the hospitals with lots of value to offer simply don’t seem interested enough to talk to them.

She wants to know why not? In order for her to find the answer to that and other questions, she is asking her colleagues in healthcare business development and business administration who are executives at leading healthcare institutions and well-equipped ASCs across America: “Why do you eschew medical tourism business?

This question, and the others that she poses in her article, also relate to outbound medical tourism as well.

Why do employers, insurance companies, the domestic health care industry, which is beset by so many problems and potential shortages and inefficiencies, as well as the entire workers’ compensation industry eschew medical travel for non-work-related illnesses and diseases, and work-related injuries requiring surgery?

I’ve written about this many times before. I have cited American Exceptionalism, racism, xenophobia, greed, ignorance of the quality of medical care abroad, and many other factors, but as Maria points out for US hospitals turning down cash patients, employers and carriers can save money by looking outside our broken and dysfunctional medical care system under workers’ comp.

It’s high time the US joins the rest of the world, and allows our citizens the freedom to go wherever they want for medical care, no matter what the cause, or condition that prompts them to seek medical care that is high quality, and will save money for their employer, and provide them an opportunity to see the world that also belongs to them.

Not to do so is tantamount to enslavement to a corrupt and rigged system that benefits unscrupulous physicians, pharmacies, pain management centers, and other workers’ comp service providers, and harms injured workers.

Medical travel will happen. Resist at your peril.

Angry People Buy Guns, Smart People Write Articles

While perusing my email today, I chanced upon the scriblings of the self-styled, right-winger who had called medical travel a hoax and my idea a non-starter.

This individual saw fit to announce to the world that he had recently purchased 1000 rounds of ammunition, and said that it was for him and his wife.

The point of his rantings was something about letting in new ideas into workers’ comp, and called me an angry man. Funny, if I am angry, then how come he’s the one who bought ammo?

It must be obvious that he is the angry one, just like all the rest of his kind who shoot first (their mouths, then their guns) and ask questions later.

One is not angry if they advocate for an idea they believe will benefit injured workers, when the person calling you angry, buys 1000 rounds of ammo. One is visionary and forward-thinking, unlike the gun nut who shoots his mouth and gun off.

I am not really worried. You see, one day, he will be dead, and hopefully so will his outright hatred and disgust for medical care outside the “good ole US of A”, where we all know only Americans are good at providing quality medical care.

And I also know that when the space plane is made available later in this century for commercial flights, traveling to “Turkishmaninacanstan” will take no more time than going from NYC to Washington, DC, and maybe even less so.

No, the really angry man is the one who, making up for his shortcomings, both physical and mental, needs to buy 1000 rounds of ammunition to hold off new ideas in workers’ comp. Why? So that the status quo stays the status quo.

Or maybe, the only new ideas he likes are the ones that conform to his racist, bigoted, xenophobic hysteria, and that is why he needs 1000 rounds of ammo.

 

‘Turkishmaninacanstan’ Strikes Back

Readers of this blog know that from time to time, I have had to criticize those in the workers’ comp industry for their short-sightedness, narrow-mindedness, excessive American Exceptionalism, “Know-nothingism”,  xenophobia and subtle racism.

But when a well-respected online journal re-posts an article by the chief anti-medical travel opponent in the workers’ comp world, it is high time that the medical travel industry speak up and defend itself.

As a tireless advocate for medical travel in workers’ comp, I am leading the charge that you, my friends around the world must do for yourselves.

You will notice the title of this post. This is what the individual in question calls those countries that provide medical travel services. Also, please note that by using this canard as my title, I am in no way insulting Turkey, or any other nation that markets their medical care to the world.

There is fair criticism of Turkey and many other countries in the medical travel industry, but those criticisms are meant to improve the services and to correct the mistakes of the past, and not to pass judgement on them.

But when someone uses a term such as ‘Turkishmaninacanstan’, it conjures up the worse images of third world poverty and backwardness in all aspects of life of the nations so broadly brushed with that epithet.

The individual who coined that despicable name is a self-styled, right-wing American conservative who lives on the gulf coast of the state of Florida, a region where many individuals like him retire to after their careers have declined to play golf.

While this individual may not be one of those just yet, the fact that he dismisses new ideas, that he insults the millions of men and women around the world who are trying to offer real low cost medical care at equal or better quality, that he insults the very nations who could use those resources they are spending to bring medical travelers to their countries as a way to improve their balance of trade and economic power in the global economy, when they could be used to raise the living standards of their poorest citizens, is something that can no longer go unanswered.

So, I ask all of you, doctors, nurses, travel agents, medical tourism promoters and facilitators who are legitimately trying to provide better medical care at lower cost to all of the world’s citizens, to speak up and tell this individual and those like him, that your countries are not ‘Turkishmaninacanstans’, and that you are developing world-class medical facilities that outshine those in his own country, and mine.

Basically, he is calling you con artists and frauds, and that is something that only you can stop.