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“Best healthcare system in the world”: Social media fury follows video of dazed woman put out in cold by Baltimore hospital

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I am always surprised when someone opines that the US healthcare system is the best in the world. It’s not even close. Watch the videos in this Facebook post.

John Woodrow Cox, Theresa Vargas, and Justin Wm. Moyer report in the Washington Post:

The man hurried up the Baltimore sidewalk with a camera in his hand as four black-clad hospital security guards walked toward him, then past him. One of them was pushing an empty wheelchair.

“So wait, y’all just going to leave this lady out here with no clothes on?” said Imamu Baraka, referring to a dazed woman wearing only a thin hospital gown who they had left alone at a bus stop Tuesday night in mid-30s temperatures. Her face appeared bloody, her eyes empty.

It was the latest incident of “patient dumping” that has sparked outrage around the country — one that, according to an expert, probably violated a 1986 federal law that mandates hospitals release those in their care into a safe environment.

“This kind of behavior is, I think, both illegal and I’m sure immoral,” said Arthur L. Caplan, founding head of the division of medical ethics at the New York University School of Medicine. “You don’t just throw someone out into the street who is impaired and may have injuries. You try to get them to the best place possible, and that’s not the bench in front of the hospital.”

The phenomenon was pervasive two decades ago, when the law was largely unenforced, Caplan said, but remains a problem from California to Virginia.

On Tuesday, the woman left outside the University of Maryland Medical Center Midtown Campus could barely walk and seemed unable to speak.

Still filming, Baraka turned and followed the guards back to an entrance.

“That is not okay,” he shouted.

“Due to the circumstances of what it was,” one of them said.

“Then you all need to call the police,” replied Baraka, a licensed counselor.

At the doorway, Baraka asked for a supervisor, demanding to know why they were leaving her outside.

“She was . . . medically discharged,” one of the guards said, before the camera captured them walking into the hospital, their backs turned.

What Baraka filmed next — the woman, staggering and screaming into a night so cold that the sidewalk remained speckled with salt and bits of unmelted snow — has been viewed more than 1.4 million times on Facebook, triggering a cascade of online fury and an apology from the hospital.

At a news conference Thursday afternoon, the hospital’s chief pledged to investigate what he described as “a failure of basic compassion and empathy.” . . .

Continue reading.

Do read the whole  thing. The other examples are even worse.

Profits before patients.

Written by LeisureGuy

11 January 2018 at 6:43 pm

Posted in Business, Healthcare

The Irrationality of Alcoholics Anonymous

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Gabrielle Glaser writes in the Atlantic:

J.G. is a lawyer in his early 30s. He’s a fast talker and has the lean, sinewy build of a distance runner. His choice of profession seems preordained, as he speaks in fully formed paragraphs, his thoughts organized by topic sentences. He’s also a worrier—a big one—who for years used alcohol to soothe his anxiety.

J.G. started drinking at 15, when he and a friend experimented in his parents’ liquor cabinet. He favored gin and whiskey but drank whatever he thought his parents would miss the least. He discovered beer, too, and loved the earthy, bitter taste on his tongue when he took his first cold sip.

His drinking increased through college and into law school. He could, and occasionally did, pull back, going cold turkey for weeks at a time. But nothing quieted his anxious mind like booze, and when he didn’t drink, he didn’t sleep. After four or six weeks dry, he’d be back at the liquor store.

By the time he was a practicing defense attorney, J.G. (who asked to be identified only by his initials) sometimes drank almost a liter of Jameson in a day. He often started drinking after his first morning court appearance, and he says he would have loved to drink even more, had his schedule allowed it. He defended clients who had been charged with driving while intoxicated, and he bought his own Breathalyzer to avoid landing in court on drunk-driving charges himself.

In the spring of 2012, J.G. decided to seek help. He lived in Minnesota—the Land of 10,000 Rehabs, people there like to say—and he knew what to do: check himself into a facility. He spent a month at a center where the treatment consisted of little more than attending Alcoholics Anonymous meetings. He tried to dedicate himself to the program even though, as an atheist, he was put off by the faith-based approach of the 12 steps, five of which mention God. Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.

J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence. He went back to rehab once more and later sought help at an outpatient center. Each time he got sober, he’d spend months white-knuckling his days in court and his nights at home. Evening would fall and his heart would race as he thought ahead to another sleepless night. “So I’d have one drink,” he says, “and the first thing on my mind was: I feel better now, but I’m screwed. I’m going right back to where I was. I might as well drink as much as I possibly can for the next three days.”

He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like J.G., Alcoholics Anonymous says that person must be deeply flawed. The Big Book, AA’s bible, states:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.

J.G.’s despair was only heightened by his seeming lack of options. “Every person I spoke with told me there was no other way,” he says.

The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.

For J.G., it took years of trying to “work the program,” pulling himself back onto the wagon only to fall off again, before he finally realized that Alcoholics Anonymous was not his only, or even his best, hope for recovery. But in a sense, he was lucky: many others never make that discovery at all.

The debate over the efficacy of 12-step programs has been quietly bubbling for decades among addiction specialists. But it has taken on new urgency with the passage of the Affordable Care Act, which requires all insurers and state Medicaid programs to pay for alcohol- and substance-abuse treatment, extending coverage to 32 million Americans who did not previously have it and providing a higher level of coverage for an additional 30 million.

Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over booze, make amends to those they’ve wronged, and pray.

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered. According to AA, these figures are based on members’ experiences.

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

I spent three years researching a book about women and alcohol, Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, which was published in 2013. During that time, I encountered disbelief from doctors and psychiatrists every time I mentioned that the Alcoholics Anonymous success rate appears to hover in the single digits. We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?

When my book came out, dozens of Alcoholics Anonymous members said that because I had challenged AA’s claim of a 75 percent success rate, I would hurt or even kill people by discouraging attendance at meetings. A few insisted that I must be an “alcoholic in denial.” But most of the people I heard from were desperate to tell me about their experiences in the American treatment industry. Amy Lee Coy, the author of the memoir From Death Do I Part: How I Freed Myself From Addiction, told me about her eight trips to rehab, starting at age 13. “It’s like getting the same antibiotic for a resistant infection—eight times,” she told me. “Does that make sense?”

She and countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine. “Well, no kidding.”

Alcoholics Anonymous has more than 2 million members worldwide, and the structure and support it offers have helped many people. But it is not enough for everyone. The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods. At the top of the list are  . . .

Continue reading.

Written by LeisureGuy

11 January 2018 at 11:17 am

Why American doctors keep doing expensive procedures that don’t work

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The procedures are ineffective and expensive, but doctors keep doing them, in part because doctors get their income (for the most part) from their fees: no procedure, no fee. The same applies to hospitals: if you’re not hospitalized, the hospital doesn’t make money.

Eric Patashnik reports in Vox:

The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking. Each year, hundreds of thousands of American patients receive stents for the relief of chest pain, and the cost of the procedure ranges from $11,000 to $41,000 in US hospitals.

But in fact, American doctors routinely prescribe medical treatments that are not based on sound science.

The stent controversy serves as a reminder that the United States struggles when it comes to winnowing evidence-based treatments from the ineffective chaff. As surgeon and health care researcher Atul Gawande observes, “Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.”

Of course, many Americans receive too little medicine, not too much. But the delivery of useless or low-value services should concern anyone who cares about improving the quality, safety and cost-effectiveness of medical care. Estimates vary about what fraction of the treatments provided to patients is supported by adequate evidence, but some reviewsplace the figure at under half.

Naturally that carries a heavy cost: One study found that overtreatment — one type of wasteful spending — added between $158 billion and $226 billion to US health care spending in 2011.

The stunning news about stents came in a landmark study published in November, in The Lancet. It found that patients who got stents to treat nonemergency chest pain improved no more in their treadmill stress tests (which measure how long exercise can be tolerated) than did patients who received a “sham” procedure that mimicked the real operation but actually involved no insertion of a stent.

There were also no clinically important differences between the two groups in other outcomes, such as chest pain. (Before being randomized to receive the operation or the sham, all patients received six weeks of optimal medical therapy for angina, like beta blockers). Cardiologists are still debating the study’s implications, and more research needs to be done, but it appears that patients are benefitting from the placebo effect rather than from the procedure itself.

Once a treatment becomes popular, it’s hard to dislodge

Earlier cases in which researchers have called into question a common treatment suggest surgeons may push back against the stent findings. In 2002, The New England Journal of Medicine published a study demonstrating that a common knee operation, performed on millions of Americans who have osteoarthritis — an operation in which the surgeon removes damaged cartilage or bone (“arthroscopic debridement”) and then washes out any debris (“arthroscopic lavage”) — worked no better at relieving pain or improving function than a sham procedure. Those operations can go for $5,000 a shot.

Many orthopedic surgeons and medical societies disputed the study and pressed insurance companies to maintain coverage of the procedure. Subsequent research on a related procedure cast further doubt on the value of knee surgeries for many patients with arthritis or meniscal tears, yet the procedures remain in wide use.

Other operations that have continued to be performed despite negative research findings include spinal fusion (to ease pain caused by worn disks), and subacromial decompression, which in theory reduces shoulder pain.

There have been fitful efforts to improve the uptake of empirical studies of medical practices by doctors — one seemingly promising initiative being the “Choosing Wisely”campaign, launched in 2012 by the American Board of Internal Medicine Foundation in partnership with Consumer Reports. Its goal is to get medical societies to develop lists of treatments of minimal clinical benefit to patients.

But Choosing Wisely seems to have had little impact so far. One study of that campaign’s results examined seven procedures that have widely been shown to be ineffective, including imaging tests for “uncomplicated” headaches, cardiac imaging for patients without a history of heart problems, and routine imaging for patients with low-back pain. In the two-to-three-year period leading up to 2013, only two of the seven practices targeted for reduction showed any decrease at all in the US. (And the declines were tiny: The use of scans for those uncomplicated headaches decreased from 14.9 percent to 13.4 percent, for instance.) . . .

Continue reading.

Written by LeisureGuy

2 January 2018 at 9:39 am

Life expectancy in US down for second year in a row as opioid crisis deepens

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Update: See also Kevin Drum’s post “What’s Really Causing the Decline in US Life Expectancy? It’s Not Opioid Overdoses.”

Jessica Glenza reports in the Guardian:

Life expectancy in the US has declined for the second year in a row as the opioid crisis continues to ravage the nation.

It is the first time in half a century that there have been two consecutive years of declining life expectancy.

Drug overdoses killed 63,600 Americans in 2016, an increase of 21% over the previous year, researchers at the National Center for Health Statistics found.

Americans can now expect to live 78.6 years, a decrease of 0.1 years. The US last experienced two years’ decline in a row in 1963, during the height of the tobacco epidemic and amid a wave of flu.

“We do occasionally see a one-year dip, even that doesn’t happen that often, but two years in a row is quite striking,” said Robert Anderson, chief of the mortality statistics branch with the National Center for Health Statistics. “And the key driver of that is the increase in drug overdose mortality.”

Especially disconcerting, said Anderson, was preliminary data researchers received about overdoses in 2017: “It doesn’t look any better.” Together, the drug overdose epidemic and a plateau in improved mortality rates from cardiovascular disease are “affecting the entire national picture”.

“We haven’t seen more than two years in a row in declining life expectancy since the Spanish flu – 100 years ago,” said Anderson. “We would be entering that sort of territory, which is extremely concerning.”

Widely available prescription painkillers . . .

Continue reading.

Trump has tried to get some PR mileage from doing things that garner publicity but do nothing whatsoever to address the problem. So it’s getting worse. Big surprise.

Not a great time to try to take healthcare insurance away from millions.

Again, an obvious and glaring sign of the decline of the United States: It can’t even take care of its own citizens—or, more accurately, it won’t take care of its own citizens. I would guess that’s because of severe inequality: the ruling class of the very wealthiest Americans now feel totally separate from the rest of the country and really don’t care what happens to it so long as they can drain even more money from the public treasury. Avaricious greed knows no bounds (cf. Donald J. Trump).

Update: Another sign of decline: “FDA lacks “efficient and effective” food recall process, inspector general finds.”

Written by LeisureGuy

28 December 2017 at 1:25 pm

Americans are dying younger than people in other rich nations

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That seems to be an ominous trend (which belies the “best healthcare system in the world” boast). Christopher Ingraham reports in the Washington Post:

American lives are shorter on average than those in other wealthy nations, and the gap is growing ever wider, according to the latest data released by the Centers for Disease Control and Prevention.

As recently as 1979, the typical American could expect to live roughly 1.5 years longer than the average resident of one of the other countries in the Organization for Economic Cooperation and Development — a group of 35 wealthy, predominantly Western nations.

The typical American baby born in 1979 could expect to live about 73.9 years, while the typical baby born in one of the other 34 OECD countries would live roughly to age 72.3.

But by 2015 that gap had flipped. The average American born that year could expect to live a little less than 79 years, while the typical baby born in an OECD country had an expected life span of nearly 81 years.

In 2016, U.S. life expectancy dropped for the second year in a row, a statistical event that hasn’t happened since the early 1960s. Numbers for the remaining OECD countries aren’t yet available, but if prior trends continue, the gap between the United States and the rest of the wealthy world is likely to grow even larger.

The United States remains one of the wealthiest countries in the world. So what happened?

We can start with our health-care system, which is frankly something of a mess. We spend thousands of dollars more per capita on health care than any other country in the world, but in return we live shorter lives than people in most other rich nations.

While the care itself is generally quite good (it ought to be, for the price we’re paying), access to it remains spotty: The United States is the only OECD country without some sort of universal health-care coverage, and as a result millions of Americans have no form of health insurance. The recent repeal of the Affordable Care Act’s individual mandate will cause that number to swell by millions more in the coming decade.

Violence is also taking a toll on our life expectancy. While our homicide rate has been steadily falling since the early 1990s, Americans are still more likely to be murdered than people in nearly any other rich nations. A 2016 study found that “US homicide rates were 7.0 times higher than in other high-income countries, driven by a gun homicide rate that was 25.2 times higher.” Easy access to guns is the big factor there.

The United States also stands out for the stinginess of our social safety net relative to other rich countries. A 2014 review noted while plenty of individual factors lurk behind our short life spans — tobacco use, obesity, violence and disease among them — the lion’s share of the difference between American life spans and those in other countries can be explained by “variations in non-medical determinants of health, some of which result from dramatic differences in public policies across the US and other OECD countries.”

Among other things, that study noted:

A study published in December of last year found that if these and other social welfare factors were brought up to the OECD average, it would add nearly four years to our collective life expectancy. . .

Continue reading.

Written by LeisureGuy

27 December 2017 at 11:54 am

How climate change and disease helped the fall of Rome

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Kyle Harper, professor of classics and letters, and senior vice president and provost at the University of Oklahoma, wrote The Fate of Rome: Climate, Disease, and the End of an Empire (2017). Aeon has published what seems to be an excerpt from the book:

At some time or another, every historian of Rome has been asked to say where we are, today, on Rome’s cycle of decline. Historians might squirm at such attempts to use the past but, even if history does not repeat itself, nor come packaged into moral lessons, it can deepen our sense of what it means to be human and how fragile our societies are.

In the middle of the second century, the Romans controlled a huge, geographically diverse part of the globe, from northern Britain to the edges of the Sahara, from the Atlantic to Mesopotamia. The generally prosperous population peaked at 75 million. Eventually, all free inhabitants of the empire came to enjoy the rights of Roman citizenship. Little wonder that the 18th-century English historian Edward Gibbon judged this age the ‘most happy’ in the history of our species – yet today we are more likely to see the advance of Roman civilisation as unwittingly planting the seeds of its own demise.

Five centuries later, the Roman empire was a small Byzantine rump-state controlled from Constantinople, its near-eastern provinces lost to Islamic invasions, its western lands covered by a patchwork of Germanic kingdoms. Trade receded, cities shrank, and technological advance halted. Despite the cultural vitality and spiritual legacy of these centuries, this period was marked by a declining population, political fragmentation, and lower levels of material complexity. When the historian Ian Morris at Stanford University created a universal social-development index, the fall of Rome emerged as the greatest setback in the history of human civilisation.

Explanations for a phenomenon of this magnitude abound: in 1984, the German classicist Alexander Demandt catalogued more than 200 hypotheses. Most scholars have looked to the internal political dynamics of the imperial system or the shifting geopolitical context of an empire whose neighbours gradually caught up in the sophistication of their military and political technologies. But new evidence has started to unveil the crucial role played by changes in the natural environment. The paradoxes of social development, and the inherent unpredictability of nature, worked in concert to bring about Rome’s demise.

Climate change did not begin with the exhaust fumes of industrialisation, but has been a permanent feature of human existence. Orbital mechanics (small variations in the tilt, spin and eccentricity of the Earth’s orbit) and solar cycles alter the amount and distribution of energy received from the Sun. And volcanic eruptions spew reflective sulphates into the atmosphere, sometimes with long-reaching effects. Modern, anthropogenic climate change is so perilous because it is happening quickly and in conjunction with so many other irreversible changes in the Earth’s biosphere. But climate change per se is nothing new.

The need to understand the natural context of modern climate change has been an unmitigated boon for historians. Earth scientists have scoured the planet for paleoclimate proxies, natural archives of the past environment. The effort to put climate change in the foreground of Roman history is motivated both by troves of new data and a heightened sensitivity to the importance of the physical environment. It turns out that climate had a major role in the rise and fall of Roman civilisation. The empire-builders benefitted from impeccable timing: the characteristic warm, wet and stable weather was conducive to economic productivity in an agrarian society. The benefits of economic growth supported the political and social bargains by which the Roman empire controlled its vast territory. The favourable climate, in ways subtle and profound, was baked into the empire’s innermost structure.

The end of this lucky climate regime did not immediately, or in any simple deterministic sense, spell the doom of Rome. Rather, a less favourable climate undermined its power just when the empire was imperilled by more dangerous enemies – Germans, Persians – from without. Climate instability peaked in the sixth century, during the reign of Justinian. Work by dendro-chronologists and ice-core experts points to an enormous spasm of volcanic activity in the 530s and 540s CE, unlike anything else in the past few thousand years. This violent sequence of eruptions triggered what is now called the ‘Late Antique Little Ice Age’, when much colder temperatures endured for at least 150 years. This phase of climate deterioration had decisive effects in Rome’s unravelling. It was also intimately linked to a catastrophe of even greater moment: the outbreak of the first pandemic of bubonic plague.

Disruptions in the biological environment were even more consequential to Rome’s destiny. For all the empire’s precocious advances, life expectancies ranged in the mid-20s, with infectious diseases the leading cause of death. But the array of diseases that preyed upon Romans was not static and, here too, new sensibilities and technologies are radically changing the way we understand the dynamics of evolutionary history – both for our own species, and for our microbial allies and adversaries.

The highly urbanised, highly interconnected Roman empire was a boon to its microbial inhabitants. Humble gastro-enteric diseases such as Shigellosis and paratyphoid fevers spread via contamination of food and water, and flourished in densely packed cities. Where swamps were drained and highways laid, the potential of malaria was unlocked in its worst form – Plasmodium falciparum – a deadly mosquito-borne protozoon. The Romans also connected societies by land and by sea as never before, with the unintended consequence that germs moved as never before, too. Slow killers such as tuberculosis and leprosy enjoyed a heyday in the web of interconnected cities fostered by Roman development.

However, the decisive factor in Rome’s biological history was the arrival of new germs capable of causing pandemic events. The empire was rocked by three such intercontinental disease events. The Antonine plague coincided with the end of the optimal climate regime, and was probably the global debut of the smallpox virus. The empire recovered, but never regained its previous commanding dominance. Then, in the mid-third century, a mysterious affliction of unknown origin called the Plague of Cyprian sent the empire into a tailspin. Though it rebounded, the empire was profoundly altered – with a new kind of emperor, a new kind of money, a new kind of society, and soon a new religion known as Christianity. Most dramatically, in the sixth century a resurgent empire led by Justinian faced a pandemic of bubonic plague, a prelude to the medieval Black Death. The toll was unfathomable – maybe half the population was felled.

The plague of Justinian is a case study in the extraordinarily complex relationship between human and natural systems. The culprit, the Yersinia pestis bacterium, is not a particularly ancient nemesis; evolving just 4,000 years ago, almost certainly in central Asia, it was an evolutionary newborn when it caused the first plague pandemic. The disease is permanently present in colonies of social, burrowing rodents such as marmots or gerbils. However, the historic plague pandemics were colossal accidents, spillover events involving at least five different species: the bacterium, the reservoir rodent, the amplification host (the black rat, which lives close to humans), the fleas that spread the germ, and the people caught in the crossfire.

Genetic evidence suggests that the strain of Yersinia pestis that generated the plague of Justinian originated somewhere near western China. It first appeared on the southern shores of the Mediterranean and, in all likelihood, was smuggled in along the southern, seaborne trading networks that carried silk and spices to Roman consumers. It was an accident of early globalisation. Once the germ reached the seething colonies of commensal rodents, fattened on the empire’s giant stores of grain, the mortality was unstoppable. . .

Continue reading.

Written by LeisureGuy

15 December 2017 at 10:07 am

Author Of GOP Tax Plan Says Children’s Health Insurance Program Is Held Up “Because We Don’t Have Money Anymore”

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Rachel Cohen reports in The Intercept:

THE LEAD AUTHOR of the Senate Republican tax plan, Finance Committee Chair Orrin Hatch of Utah, said the federal government no longer has the money to fund the popular Children’s Health Insurance Program, known as CHIP.

“The reason CHIP is having trouble [passing] is because we don’t have money anymore,” Hatch said. “We just add more and more spending and more and more spending, and you can look at the rest of the bill for the more and more spending.”

CHIP is an $8 billion program. The Senate bill passed in the early hours of Saturday morning includes $6 trillion in tax cuts, financed by $4.5 trillion in tax hikes elsewhere. Hatch, though, promised CHIP would still pass. “We’re going to do CHIP, there’s no question about it in my mind. It has to be done the right way,” he said.

As the expiration date for CHIP loomed over the end of September, lawmakers similarly assured the public they would reauthorize the popular bipartisan program that provides coverage to nearly 9 million kids and roughly 370,000 pregnant women.

After all, when CHIP was last up for reauthorization in 2015, Congress got the job done with more than five months to go. In fact, CHIP — which passed in 1997 — has never had a lapse in funding except for just five days when former President George W. Bush twice vetoed its reauthorization. Congress responded with some short-term financing until CHIP could be formally reauthorized in 2009 under former President Barack Obama.

Well this year, April came and went. Then May. Then June. Then Congress stressed they would definitely get to it before the August recess. Except then a new effort to dismantle the Affordable Care Act took hold, crowding out all else. When the Obamacare dismantlement effort died, legislators said, “No, no, it will be coming back.” Then they promised to reauthorize CHIP at least before it expired in September. “Well … OK, we’ll get it done in October — states still have some federal funding left in their reserves,” they said next. And then, “All right, we hear you, we’ll definitely deal with it before Thanksgiving.”

Now it’s December and lawmakers are saying, “Don’t worry, we’ll get it done by the end of the year.”

As tax reform picks up, health experts are feeling nervous. Never mind that more than 60 percent of Americans say CHIP reauthorization should be a top federal priority, while only 28 percent say tax reform should be.

“Under normal circumstances I’d say, ‘Yeah they’ll pass it,’” said Bruce Lesley, president of First Focus, a children’s advocacy group. “But we’ve been promised this for months now, and Congress has shown no ability to focus on this, to get it done.”

The consequences of Congress’s inaction are already visible. While most states had some funds remaining in their coffers to last them a few months past CHIP’s expiration date, Governing magazine reported this week that Minnesota has officially run out of federal CHIP money. For now, Minnesota officials say they’ll work to bridge the funding gap, but not all states have laws that allow for that. Colorado also started sending out notices this week to CHIP enrollees, letting them know the state will be shutting down the program by January 31 if Congress doesn’t act soon. Pennsylvania, Texas, Utah, Virginia, and Washington are also expected to run out funds in early 2018, and the federal centers for Medicare and Medicaid Services say “the majority of states [are] projected to exhaust funding by March.” Even temporary enrollment freezes can lead to major drops in coverage. Researchers at Georgetown’s Center for Children and Families report that Arizona’s enrollment fell by more than 60 percent when the state temporarily froze the program in 2009, and North Carolina’s enrollment fell by nearly 30 percent when it froze CHIP for 10 months in 2001.

Even if states think that Congress might come through with funding, they have to prepare for the eventuality that it won’t — regardless of how much that costs, or how much confusion it creates.

“The way Congress is doing this is devoid of any understanding of how programs run,” said Lesley. “I used to work in state government. If you’re running a program, and there’s uncertainty, you have to plan to close it down. You have no choice.”

So what’s the hold-up?

Part of it involves Congress fighting over how CHIP will be paid for, with legislators looking for $8 billion in what’s known as “offsets.” There are rules requiring Congress to determine where these offsets — or money for new spending— will come from, but these rules are often waived. Just last month, when Congress passed a bill to repeal the Independent Payment Advisory Board, a panel created through the ACA to make cost-saving recommendations, legislators waived the $18 billion offset requirement. And now Congress is preparing to pass a mammoth tax reform bill that the Joint Committee on Taxation said Wednesday would fall almost $1 trillion short of paying for itself. Offsets be damned.

Before this, . . .

Continue reading.

Bottom line: The GOP takes healthcare from children in order to give more money to the wealthy. That is the US today.

Later in the article:

In early November, the House passed a bill, 242-174 largely on party lines, to reauthorize CHIP by taking money from the ACA’s public health preventative care fund, which pays for programs like opioid treatment and vaccinations. Energy and Commerce Committee Ranking Member Frank Pallone Jr., D-N.J., charged that Republicans were capitalizing on CHIP reauthorization as a new way to sabotage the ACA. Pallone proposed changing the payment schedule of Medicare Advantage Plans to fund CHIP, but Republicans rejected that in the Rules Committee.

Written by LeisureGuy

9 December 2017 at 11:01 am

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