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The Law Says She Should Have Been Protected From Birth. Instead, She Was Left in the Care of Her Drug-Addicted Mother, Who Killed Her.

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Governments in the US are not doing their job and in fact are betraying the public. That’s harsh and not entirely true, but examples of the failure of government are myriad, including those described in this ProPublica report by Emily Palmer and Jessica Huseman:

KOSCIUSKO, Miss. — The adults in her life began failing Jasmine Irwin before she ever left the hospital.

Born severely underweight — just 4 pounds, 3 ounces — to a mother with a history of dealing and abusing methamphetamine, Jasmine might have been exposed to drugs in the womb, doctors believed, which should have jump-started intensive efforts to keep her safe.

But hospital records show staff never followed up, failing to conduct drug tests on the baby or her mother, Tami Mann, before letting Mann take Jasmine home to the family’s trailer in this small town north of the state capital.

Countless children live with neglectful or abusive caretakers, which is why federal law requires states to ensure that certain professionals — like doctors and police officers — intercede when they suspect a child is in danger.

But a national survey by The Boston Globe and ProPublica found that not a single state fully complies with the nation’s primary child abuse law for children who are not in state custody. Mississippi is a significant offender. During Jasmine Irwin’s life, the state violated the law in multiple ways. For example, the state did not have procedures in place to protect infants affected by their mother’s drug use when Jasmine Irwin was born on Christmas Eve 2013.

And so she went unprotected. For almost two years, Jasmine lived in a home plagued by her parents’ violence and addiction. Ten months after giving birth to Jasmine, Mann made clear that she was struggling to parent her children. When she entered drug rehab, she wrote on medical forms that the sight and smell of children triggered incredible anxiety for her.

But Mann’s cry for help didn’t bring the support she needed — including protections that could have started the day Jasmine was born. Instead, Mann, struggling with both addiction and domestic violence, snapped. One day in September 2015, Mann grabbed Jasmine by the legs and pounded her head first into the living room floor as Jasmine’s older brother watched.

“My mom just keeps being mean to her,” the 4-year-old boy told investigators at the time. “And, finally, she had to go to the doctor.”

Jasmine died three days later. Her short life casts a long shadow, marking her as a casualty of both a brutally dysfunctional family — and of America’s ongoing failure to effectively combat child abuse. The Globe and ProPublica reviewed thousands of pages of legal, criminal, medical and child welfare records, along with recorded interviews, to piece together a full picture of the failings that led to Jasmine’s death, an all-too-common tragedy.

Child abuse and neglect have never received the national attention of other American scourges such as AIDS and terrorism, even as an estimated 700,000 children are mistreated in the United States each year. It’s not that Americans don’t care about protecting children, but Congress and the White House have long regarded combating child abuse as a state or local concern rather than a national one. It is an attitude that goes back at least to the 1970s and the presidency of Richard Nixon.

And almost 50 years later, that ambivalence persists — down to the most basic understanding of the issue.

Today, the federal government doesn’t even know how many children die from abuse and neglect — or whether the death toll is rising or falling. The most commonly cited numbers, from the National Child Abuse and Neglect Data System, put the death toll at 1,750 in 2016, the most recent year available, the highest total since the government started keeping track in 1992. But researchers believe that the voluntary reporting which yields that figure badly undercounts child deaths and that the real number of fatally mistreated children could be more than twice that: somewhere between 3,000 and 4,500 each year.

The nation’s primary child abuse law for children not in state custody, the Child Abuse Prevention and Treatment Act of 1974, was supposed to help address this tragic toll by requiring states to make public the name and some basic information on almost every child who died from abuse and neglect.

But when the Globe and ProPublica tried to obtain this information from all 50 states, the District of Columbia and Puerto Rico, nine simply refused to provide it, while many others released only some of what’s required. The result is a murky, incomplete picture that makes it impossible to calculate the national death toll.

And that’s only the beginning of how states are failing.

In addition to filing reports on child abuse, the law, known as CAPTA, requires states to create plans to protect infants affected by drugs and provide mistreated children with representatives in court proceedings, among dozens of other mandates, in order to receive federal dollars dedicated to child abuse prevention. But still, noncompliance runs rampant.

“Every single state,” said one leading child welfare expert, Michael Petit, is “vulnerable to successful class action litigation for being in violation of federal law, every single one of them.”

Vulnerable but also, strangely, protected. One glaring weak link in CAPTA is that it severely restricts lawsuits by private organizations, meaning children’s advocates can rarely file class action lawsuits to force change. As a result, attorneys have largely given up on using the federal law to protect children who have not been taken into state custody. By comparison, federal laws protecting foster children give advocates more power to sue to improve their care.

But the survey of state governments by the Globe and ProPublica, the first such national assessment of the law ever conducted, shows Petit’s assertion of noncompliance is spot on. Although states routinely file reports with the federal Children’s Bureau — the agency charged with enforcing the CAPTA requirements — broadly claiming to follow the law, the Globe and ProPublica’s survey shows that is not true. In fact, not a single state upholds all 27 provisions of the anti-child-abuse law.

The 76-question survey, which was answered by 49 states, Washington, D.C., and Puerto Rico, focused on five key areas of CAPTA, including proper care for drug-affected infants. State responses to the survey suggest that many treat strict compliance with the federal law as optional. Mississippi’s record is nothing special — in fact, its level of compliance puts the state in the middle of the pack. As a result, vulnerable children across the country are left in the lurch.

Survey analysis revealed that:

  • 49 of the 52 child protection agencies surveyed don’t follow federal rules to protect babies affected by drugs during their mother’s pregnancy.
  • 49 of the states as well as Puerto Rico are unable to show that they follow rules mandating that children receive representation for any court proceedings regarding their possible mistreatment. The result is that, far too often, no one speaks for the best interests of the mistreated child.
  • 45 agencies, including Mississippi’s, do not comply with three or more of the five CAPTA mandates that the Globe and ProPublica asked about. Yet, almost every state, including Mississippi, routinely files letters with the federal Children’s Bureau claiming to follow the law in order to be eligible for federal funding.
  • Six agencies, including those in Florida and Michigan, do not comply with any of the federal rules the Globe and ProPublica asked about. And not one agency was found fully compliant with the federal law.

The Globe and ProPublica monitored state compliance with the five provisions over the course of two years, contacting about 100 agencies in the process. Some states seemed almost to welcome the rankings, even if the findings made them look bad. Louisiana was found fully compliant with just two of the measured CAPTA provisions, but Catherine Heitman, a spokeswoman for the child welfare department, said that the new scrutiny could force systemwide improvements.

“We need help, we need funding,” she said. “And, hey, this might actually get us the help we need.” . . .

Continue reading. There’s much more.

Mahatma Gandhi: “The true measure of any society can be found in how it treats its most vulnerable members.”

Written by LeisureGuy

13 December 2019 at 8:21 pm

Finland Is a Capitalist Paradise

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The US, by comparison, is a broken system with little prospect of being fixed. Anu Partanen and  write in the NY Times:

Two years ago we were living in a pleasant neighborhood in Brooklyn. We were experienced professionals, enjoying a privileged life. We’d just had a baby. She was our first, and much wanted. We were United States citizens and our future as a family should have seemed bright. But we felt deeply insecure and anxious.

Our income was trickling in unreliably from temporary gigs as independent contractors. Our access to health insurance was a constant source of anxiety, as we scrambled year after year among private employer plans, exorbitant plans for freelancers, and complicated and expensive Obamacare plans. With a child, we’d soon face overwhelming day-care costs. Never mind the bankruptcy-sized bills for education ahead, whether for housing in a good public-school district or for private-school tuition. And then there’d be college. In other words, we suffered from the same stressors that are swamping more and more of Americans, even the relatively privileged.

As we contemplated all this, one of us, Anu, was offered a job back in her hometown: Helsinki, Finland.

Finland, of course, is one of those Nordic countries that we hear some Americans, including President Trump, describe as unsustainable and oppressive — “socialist nanny states.” As we considered settling there, we canvassed Trevor’s family — he was raised in Arlington, Va. — and our American friends. They didn’t seem to think we’d be moving to a Soviet-style autocracy. In fact, many of them encouraged us to go. Even a venture capitalist we knew in Silicon Valley who has three children sounded envious: “I’d move to Finland in a heartbeat.”

So we went.

We’ve now been living in Finland for more than a year. The difference between our lives here and in the States has been tremendous, but perhaps not in the way many Americans might imagine. What we’ve experienced is an increase in personal freedom. Our lives are just much more manageable. To be sure, our days are still full of challenges — raising a child, helping elderly parents, juggling the demands of daily logistics and work.

But in Finland, we are automatically covered, no matter what, by taxpayer-funded universal health care that equals the United States’ in quality (despite the misleading claims you hear to the contrary), all without piles of confusing paperwork or haggling over huge bills. Our child attends a fabulous, highly professional and ethnically diverse public day-care center that amazes us with its enrichment activities and professionalism. The price? About $300 a month — the maximum for public day care, because in Finland day-care fees are subsidized for all families.

And if we stay here, our daughter will be able to attend one of the world’s best K-12 education systems at no cost to us, regardless of the neighborhood we live in. College would also be tuition free. If we have another child, we will automatically get paid parental leave, funded largely through taxes, for nearly a year, which can be shared between parents. Annual paid vacations here of four, five or even six weeks are also the norm.

Compared with our life in the United States, this is fantastic. Nevertheless, to many people in America, the Finnish system may still conjure impressions of dysfunction and authoritarianism. Yet Finnish citizens report extraordinarily high levels of life satisfaction; the Organization for Economic Cooperation and Development ranked them highest in the world, followed by Norwegians, Danes, Swiss and Icelanders. This year, the World Happiness Report also announced Finland to be the happiest country on earth, for the second year in a row.

But surely, many in the United States will conclude, Finnish citizens and businesses must be paying a steep price in lost freedoms, opportunity and wealth. Yes, Finland faces its own economic challenges, and Finns are notorious complainers whenever anything goes wrong. But under its current system, Finland has become one of the world’s wealthiest societies, and like the other Nordic countries, it is home to many hugely successful global companies.

In fact, a recent report by the chairman of market and investment strategy for J.P. Morgan Asset Management came to a surprising conclusion: The Nordic region is not only “just as business-friendly as the U.S.” but also better on key free-market indexes, including greater protection of private property, less impact on competition from government controls and more openness to trade and capital flows. According to the World Bank, doing business in Denmark and Norway is actually easier overall than it is in the United States.

Finland also has high levels of economic mobility across generations. A 2018 World Bank report revealed that children in Finland have a much better chance of escaping the economic class of their parents and pursuing their own success than do children in the United States.

Finally, and perhaps most shockingly, the nonpartisan watchdog group Freedom House has determined that citizens of Finland actually enjoy higher levels of personal and political freedom, and more secure political rights, than citizens of the United States.

What to make of all this? For starters, politicians in the United States might want to think twice about calling the Nordics “socialist.” From our perch, the term seems to have more currency on the other side of the Atlantic than it does here.

In the United States, Senator Bernie Sanders and Representative Alexandria Ocasio-Cortez are often demonized as dangerous radicals. In Finland, many of their policy ideas would seem normal — and not particularly socialist.

When Mr. Sanders ran for president in 2016, what surprised our Finnish friends was that the United States, a country with so much wealth and successful capitalist enterprise, had not already set up some sort of universal public health care program and access to tuition-free college. Such programs tend to be seen by Nordic people as the bare basics required for any business-friendly nation to compete in the 21st century.

Even more peculiar is that in Finland, you don’t really see the kind of socialist movement that has been gaining popularity in some of the more radical fringes of the left in America, especially around goals such as curtailing free markets and even nationalizing the means of production. The irony is that if you championed socialism like this in Finland, you’d get few takers.

So what could explain this — the weird fact that actual socialism seems so much more popular in the capitalist United States than in supposedly socialist Finland?

A socialist revolution was attempted once in Finland. But that was more than a hundred years ago. Finland was in the process of industrializing when the Russian empire collapsed and Finland gained independence. Finnish urban and rural workers and tenant farmers, fed up with their miserable working conditions, rose up in rebellion. The response from Finland’s capitalists, conservative landowners and members of the middle and upper class was swift and violent. Civil war broke out and mass murder followed. After months of fighting, the capitalists and conservatives crushed the socialist uprising. More than 35,000 people lay dead. Traumatized and impoverished, Finns spent decades trying to recover and rebuild.

So what became of socialism in Finland after that? According to a prominent Finnish political historian, Pauli Kettunen of the University of Helsinki, after the civil war Finnish employers promoted the ideal of “an independent freeholder farmer and his individual will to work” and successfully used this idea of heroic individualism to weaken worker unions. Although socialists returned to playing a role in Finnish politics, during the first half of the 20th century, Finland prevented socialism from becoming a revolutionary force — and did so in a way that sounds downright American.

Finland fell into another bloody conflict as it fought off, at great cost, the Communist Soviet Union next door during World War II. After the war, worker unions gained strength, bringing back socialist sympathies as the country entered a more industrial and international era. This is when Finnish history took an unexpected turn.

Finnish employers had become painfully aware of the threats socialism continued to pose to capitalism. They also found themselves under increasing pressure from politicians representing the needs of workers. Wanting to avoid further conflicts, and to protect their private property and new industries, Finnish capitalists changed tactics. Instead of exploiting workers and trying to keep them down, after World War II, Finland’s capitalists cooperated with government to map out long-term strategies and discussed these plans with unions to get workers onboard.

More astonishingly, Finnish capitalists also realized that it would be in their own long-term interests to accept steep progressive tax hikes. The taxes would help pay for new government programs to keep workers healthy and productive — and this would build a more beneficial labor market. These programs became the universal taxpayer-funded services of Finland today, including public health care, public day care and education, paid parental leaves, unemployment insurance and the like.

If these moves by Finnish capitalists sound hard to imagine, it’s because people in the United States have been peddled a myth that universal government programs like these can’t coexist with profitable private-sector businesses and robust economic growth. As if to reinforce the impossibility of such synergies, last fall the Trump administration released a peculiar report arguing that “socialism” had negatively affected Nordic living standards.

However, a 2006 study by the Finnish researchers Markus Jantti, Juho Saari and Juhana Vartiainen demonstrates the opposite. First, throughout the 20th century Finland remained — and remains to this day — a country and an economy committed to markets, private businesses and capitalism.

Even more intriguing, these scholars demonstrate that Finland’s capitalist growth and dynamism have been helped, not hurt, by the nation’s commitment to providing generous and universal public services that support basic human well-being. These services have buffered and absorbed the risks and dislocations caused by capitalist innovation. . .

Continue reading. There’s much more.

Capitalists in the US are not so enlightened as those in Finland.

Later in the article:

But the Nordic nations as a whole, including a majority of their business elites, have arrived at a simple formula: Capitalism works better if employees get paid decent wages and are supported by high-quality, democratically accountable public services that enable everyone to live healthy, dignified lives and to enjoy real equality of opportunity for themselves and their children. For us, that has meant an increase in our personal freedoms and our political rights — not the other way around.

Yes, this requires capitalists and corporations to pay fairer wages and more taxes than their American counterparts currently do. Nordic citizens generally pay more taxes, too. And yes, this might sound scandalous in the United States, where business leaders and economists perpetually warn that tax increases would slow growth and reduce incentives to invest.

Here’s the funny thing, though: Over the past 50 years, if you had invested in a basket of Nordic equities, you would have earned a higher annual real return than the American stock market during the same half-century, according to global equities data published by Credit Suisse.

Written by LeisureGuy

8 December 2019 at 8:19 am

Inside the Cell Where a Sick 16-Year-Old Boy Died in Border Patrol Care

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The US government seems to be moving with some dispatch toward an authoritarian regime. Robert Moore, Susan Schmidt, and Maryam Jameel report in ProPublica:

Carlos Gregorio Hernandez Vasquez, a 16-year-old Guatemalan migrant, was seriously ill when immigration agents put him in a small South Texas holding cell with another sick boy on the afternoon of May 19.

A few hours earlier, a nurse practitioner at the Border Patrol’s dangerously overcrowded processing center in McAllen had diagnosed him with the flu and measured his fever at 103 degrees. She said that he should be checked again in two hours and taken to the emergency room if his condition worsened.

None of that happened. Worried that Carlos might infect other migrants in the teeming McAllen facility, officials moved him to a cell for quarantine at a Border Patrol station in nearby Weslaco.

By the next morning, he was dead.

In a press release that day, Customs and Border Protection’s acting commissioner at the time, John Sanders, called Carlos’ death a “tragic loss.” The agency said that an agent had found Carlos “unresponsive” after checking in on him. Sanders said the Border Patrol was “committed to the health, safety and humane treatment of those in our custody.”

But the record shows that the Border Patrol fell far short of that standard with Carlos. ProPublica has obtained video that documents the 16-year-old’s last hours, and it shows that Border Patrol agents and health care workers at the Weslaco holding facility missed increasingly obvious signs that his condition was perilous.

The cellblock video shows Carlos writhing for at least 25 minutes on the floor and a concrete bench. It shows him staggering to the toilet and collapsing on the floor, where he remained in the same position for the next four and a half hours.

According to a “subject activity log” maintained by the Border Patrol throughout Carlos’ custody, an agent checked on him three times during the early morning hours in which he slipped from unconsciousness to death, but reported nothing alarming about the boy.

The video shows the only way CBP officials could have missed Carlos’ crisis is that they weren’t looking. His agony was apparent, even in grainy black and white, making clear the agent charged with monitoring him failed to perform adequate checks, if he even checked at all. The coroner who performed an autopsy on Carlos said she was told the agent occasionally looked into the cell through the window.

The video makes clear that CBP, the Border Patrol’s parent agency, inaccurately described how Carlos’ body was discovered. Contrary to the agency’s press release, it was Carlos’ cellmate who found him, not agents doing an early morning check. On the video, the cellmate can be seen waking up and groggily walking to the toilet, where Carlos was lying in a pool of blood on the floor. He gestures for help at the cell door. Only then do agents enter the cell and discover that Carlos had died during the night.

Officials with the Department of Homeland Security, which includes CBP, wouldn’t say whether the scenes recorded by the camera during Carlos’ final hours were shown live on video monitors, as is the case in some Border Patrol facilities, and if they were, whether anyone had been assigned to watch the footage.

The video and other records reviewed by ProPublica document numerous missteps in the days leading up to Carlos’ final hours on the floor of Cell 199. Independent medical experts pointed in particular to the decision to send a 16-year-old suffering from the flu to a holding cell rather than a hospital as a pivotal mistake. . .

Continue reading. There’s more. And watch this 5-minute video:

Written by LeisureGuy

5 December 2019 at 11:55 am

Another red state may soon expand Medicaid. There’s a message in this.

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The message is, it seems to me, that people recognize that the US healthcare “system” is wretched and they want it fixed so that people have access to healthcare. Greg Sergeant writes in the Washington Post:

A remarkable two-track dynamic has developed on the politics of the Affordable Care Act. And it has obvious ramifications for both Democrats and Republicans in the 2020 elections.

It’s this: Even as President Trump and national Republicans remain as zealous as ever about destroying the ACA, the logic of its Medicaid expansion is proving politically irresistible in numerous states — including deep red ones.

The latest red state to move toward expanding Medicaid is Missouri. The state’s governor, Mike Parson, has announced that if a ballot referendum expanding Medicaid passes, he’ll carry out the proposal, even if he personally disagrees with it.

It remains to be seen if that will happen, and this is hardly a full-throated endorsement. But it’s more movement. The group pushing the expansion estimates it would mean health coverage for some 200,000 people, and it has collected around one-fourth of the signatures it needs for the referendum.

Polls suggest the initiative may indeed pass, and notably, Parson faces a Democratic challenger who supports the Medicaid expansion. Indeed, the Medicaid expansion is becoming a winning issue in many parts of the country: This comes right on the heels of Democrats winning control of the Virginia state legislature, and two high-profile gubernatorial contests in Kentucky and Louisiana.

In all of those, the Medicaid expansion was a big driver. Indeed, the pollster for the reelected Democratic governor in Louisiana recently told this blog that it was the single most important issue in the election.

What this really shows is how irresistible the logic of the Medicaid expansion is, even in places that opposed Obamacare with white-hot fury.

“Almost 10 years after the ACA was enacted, the anti-Obamacare symbolism of opposing the law’s Medicaid expansion is fading, and it’s becoming increasingly difficult for red states to stand in the way,” Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told me.

“With the federal government paying for 90 percent of the expansion,” Levitt added, “it’s hard for states to make a fiscal argument that it’s not affordable.”

Precisely because GOP lawmakers keep trying to stand in the way of it, the referendum is emerging as a tool for voters to try to force this logic on them. In 2018, referendums passed in three deep-red states — Idaho, Nebraska and Utah — and the expansion has been adopted in all three.

In total, 37 states have now expanded Medicaid — many of them red — while 14 have not. It’s true that the holdouts are some of the big ones — such as Texas, Florida and North Carolina — and this remains a serious impediment to progress.

But still, the expansion continues to march forward, and the politics of it are putting Republicans on the defensive in some of the reddest parts of the country.

And yet, even as this is happening, Trump and Republicans remain fully committed to trying to destroy the ACA. The law is in solid shape, with many millions enrolled all over the country, premiums falling in many places and the Medicaid expansion bringing health coverage to poor and working people in two-thirds of states.

Yet the Health and Human Services secretary amazingly continues to assert that it “doesn’t work,” apparently because this is a requirement in a GOP administration. And an ongoing lawsuit backed by Trump could still gut the law.

The forward march of the Medicaid expansion in red states shows how politically crazy this is. Indeed, we’re seeing lots of previous assumptions about the politics of health care get upended.

For instance, it’s sometimes said the reason Democrats won the House on health care was mainly through vowing to preserve the law’s protections for people with preexisting conditions. It’s also sometimes said that, by relying heavily on more affluent suburban voters as part of their anti-Trump coalition, Democrats may find it harder to enact more progressive change later.

Yet the Medicaid expansion’s continued momentum shows that the part of the law associated with expanding the safety net to lower-income people is also popular — in red territory, and in the suburbs, which drove the Virginia, Kentucky and Louisiana victories.

Indeed, one has to ask whether Medicaid is starting to approach the political durability of two other big welfare-state achievements of the 20th century — Medicare and Social Security. . .

Continue reading.

Written by LeisureGuy

2 December 2019 at 3:26 pm

The Bass technique for brushing teeth

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Very interesting, and thanks to Eddie of Australia for point this out.

There’s another video that shows the technique using a regular toothbruhs, and it is clear that the regular toothbrush has the weaknesses described in the video above — but the other video also offers a better look at the angle and teeth.

OralWellness.com sells toothbrushes of the Bass design and also Oral Mouth Blend:

Organic and wild crafted essential oils of: cinnamon leaf, peppermint, spearmint, clove, myrrh, and manuka in a base of certified organic almond oil (or certified organic jojoba oil for nut free version)

It has a very refreshing taste, and they note that it is “gluten free, soy free, GMO free, fluoride free, SLS free, glycerin free, and NO additives, toxins, ‘questionable ingredients’, or artificial anything.”

I like enough that I’ve also ordered a jar of their Shine Remineralizing Tooth Whitening Powder.

As I note in Disclaimer (see links at right):

I get no remuneration of any sort—money, discounts, products, services, meals, or gift—from any of the vendors or manufacturers mentioned in my blog or books except as specifically noted. Unless otherwise noted, the services, products, and merchants are mentioned purely because they impressed me and I wanted to share the knowledge. Nor do I get any remuneration from the blog itself, other than the satisfaction of bringing joy into the lives of my several readers. In other words: no affiliate links, other than the one case of linking to my own book, for which I do get a royalty. But when I praise (say) some brands of cast-iron or carbon-steel skillets, I get nothing other than the pleasure of sharing the knowledge I derived from my experience. — LeisureGuy (his mark)

So I’m telling about this for the same reason Eddie told me: I tried it and like it and am passing the word along. No affiliate links, kickbacks, no remuneration of any kind.

Written by LeisureGuy

26 November 2019 at 1:59 pm

Anti-vaxxers have blood on their hands: Samoa measles epidemic worsens with 24 children now dead

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Associate Press reports from New Zealand:

Authorities said Monday that a measles epidemic sweeping through Samoa continues to worsen with the death toll rising to 25, all but one of them young children.

“We still have a big problem at hand,” Samoa’s Director General of Health Leausa Take Naseri said in a video statement.

He said more than 140 new cases of people contracting the virus had been recorded within the past day, bringing the total to about 2,200 cases since the outbreak began last month. He said there are about 20 critically ill children who remain in hospital intensive care units.

Samoa declared a state of emergency nine days ago, closing all its schools, banning children from public gatherings and mandating that everybody get vaccinated. Teams of people have been traveling the country administering thousands of vaccines.

The government also shut down a private clinic and is investigating how hundreds of vaccines were taken without authorization and then sold for a fee.

The median age of those who have died is 13 months, according to government figures. The deaths include 24 children under the age of 5, 11 of whom were infants under 12 months. The other person who died was in their 30s. . .

Continue reading.

Written by LeisureGuy

25 November 2019 at 3:28 pm

Why Canada Doesn’t Allow Private Healthcare

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Tristan Hopper writes in The Capital:

A B.C. court could soon change the course of Canadian healthcare forever. For 10 years, Vancouver physician Brian Day, a former president of the Canadian Medical Association has been leading a legal crusade to argue that private healthcare should be allowed to operate alongside Canada’s public funded medicare system.

Canadians are allowed to pay for schools, libraries and even highways that exist outside of public systems, but all bets are off when it comes to medically necessary procedures like an MRI or heart surgery. Private clinics can sell cosmetic procedures and dental surgery all they want, but if a B.C. doctor is caught selling a service that is covered by medicare, they could be fined $10,000 for a first offence if caught.

So, as the closing arguments in Day’s case wrap up this week, we decided to answer why Canada forbids private healthcare in the first place.

The Canadian system is strange even by the standards of other countries with socialized healthcare. France, Germany, the U.K. and Australia, among others, all take great national pride in ensuring medical coverage for every citizen, but you can still cut a cheque for a boutique appendectomy if you feel like it.

“The (Canadian) system is unique in the world in that it bans coverage of … core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms,” reads a 2003 analysis in the New England Journal of Medicine.

It wasn’t too long ago that virtually all Canadian medical care existed in the public sphere. In the years leading up to the Second World War, Canadian healthcare resembled the current American system in that anybody who checked into a hospital without insurance would be handed a bill upon discharge.

Socialized medicine replaced this system gradually, starting with Saskatchewan’s introduction of a universal hospital care plan in 1947. But it was only with the 1984 passage of the Canada Health Act, drafted in the final months of Pierre Trudeau’s premiership, that Canada codified its de facto ban on private healthcare.

The reason was a wave of “extra billing” that had swept Canadian healthcare in the 1970s. Canadian patients were increasingly being hit with user fees and copays that were gradually chipping away at the supposed universality of Canadian healthcare.

landmark 1980 report condemned these new fees for undermining medicare. Canadians, wrote report author Emmett Hall, were people who had long ago agreed that health services should never “be bought off the shelf and paid for at the checkout stand.”

The Canadian Health Act which sprung from Hall’s recommendations explicitly forbade “extra billing,” and prescribed clawbacks in funding to any province found tolerating it. Notably, it’s one of the few major pieces of legislation in Canadian history that passed with virtual unanimous support by the House of Commons.

Still, there is technically no blanket federal ban on private healthcare in Canada. Any physician can decide to go private, provided that they completely opt out of working for the public system. A doctor can’t simultaneously bill the province while also billing patients directly; they have to pick one or the other.

In addition, since most provinces (including B.C.) ban private health insurance, there’s only so much business a private sector doctor can expect to find. Some provinces tighten the screws even further by restricting private doctors from charging more than the prescribed amounts under the provincial healthcare plan.

“In Canada, the absence of a private system is not due to the illegality of private health care per se,” reads a 2001 analysis in the Canadian Medical Association Journal. “Rather, the lack of a flourishing private sector in Canada is most likely attributable to prohibitions on subsidization of private practice from the public plan.”

Still, a very small private sector for medically necessary healthcare manages to cling to life in Canada. By some estimates, roughly 1% of critical medical care in Canada is done outside the public system.

Brian Day, the physician leading the challenge against the public health monopoly, is one of Canada’s rare examples of a private sector doctor. Day runs Cambie Surgery Centre in Vancouver, which touts itself as the “only free standing private hospital of its type in Canada.” However, the average British Columbian can’t just walk in and order a round of back surgery. Under B.C.’s Medicare Protection Act, the clinic cannot sell a medical procedure to a British Columbian if that procedure is offered by the B.C. Medical Services Plan.

As a result, Cambie Surgery Centre can only serve a small demographic of patients who are explicitly exempt from MSP provisions, including prisoners, members of the armed forces and injured workers covered by WorkSafeBC.

Defenders of Canada’s “single-tier” system typically argue that if Canada opens the door to private clinics, it will siphon talent and resources away from the country’s already overstretched public health system. “Doctors will be in a position to take patients who are in pain and who are vulnerable and say things to them like, ‘I can operate on you in nine months in the public system, but if you come to me in my private clinic, it’ll be two weeks or one month,’” said Michael Klein, a board member of Canadian Doctors for Medicare, in a 2016 warning of what could happen if Cambie Surgery Centre’s case was successful.

Those in Brian Day’s camp, meanwhile, contend that by allowing patients the option of ponying up for their own medical care, it frees up space in the public system for everyone else.

Private healthcare in Europe has definitely not eliminated wait times or the other pitfalls of rationed public health care, but it has proved able to co-exist alongside a public system without precipitating the collapse of a country’s system of socialized medicine.

“European countries have shown that it is possible to open their healthcare systems to private medicine without violating the basic commitment to equity that they share with Canada,” wrote the C.D. Howe Institute in a 2015 commentary.

That same paper also noted the curious dissonance of provinces rigorously cracking down on private hospital care while simultaneously leaving the likes of dental care or pharmacare almost entirely in the hands of for-profit actors.

“In other countries, the public-private financing mix is typically more balanced, with government plans paying for a larger share of drugs, dental and continuing care, but with more private financing for hospital and physician services,” it wrote.

Among the Canadian medical establishment, discussions of private healthcare can quickly get ugly. Day has often been accused of working to sabotage Canadian medicare in the service of pro-profit multinationals. The Cambie Surgery Centre founder, meanwhile, contends he is . . .

Continue reading.

The danger of a two-tier system — a public system (poorly funded and struggling) and a private system (wealthy and serving the wealthy) — seems real.

Written by LeisureGuy

21 November 2019 at 11:01 am

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