June 2, 2006
Health Insurance for the Young
Ezra Klein has written a terrific article concerning why young people often do not have health insurance. He states,
You know the stat — 46 million Americans uninsured. What you may only have guessed is how many of them are young. According to a new Commonwealth Fund study, 13.7 million young adults (ages 19-29) lack coverage. That’s an increase of 2.5 million since 2000. Even though we make up just 17 percent of the under-65 population, we’re a full 30 percent of the non-elderly uninsured. And we’re the fastest growing group, too. Hurray for us.
Of those who don’t attend college, nearly half will be uninsured during the year after high school. Among college graduates, two out of five will lose their insurance after leaving the university’s comforting embrace. It’s a problem that affects rich, upwardly mobile kids and poorer, less affluent ones alike, and it happens because we stand at the nexus of our parents’ coverage and deteriorating benefits for low-income and young workers.
Growing up, most of us have health insurance through our parents. But if you take a pass at college, you’re generally dropped as soon as you turn 19 — even if you remain a dependent. Or maybe you come from a low-income family and get your health care through Medicaid or the SCHIP. Unless you qualify for Medicaid as an adult (and childless young folks rarely do), you’re out of luck.
Of course, if you’re graduating high school, you’re probably entering the job market. What about employer-based care? Well, jobs for high school graduates are generally low-wage and transient, exactly the sort of workplaces least likely to offer health coverage. Sorry.
Meanwhile, say you went off to college. Good choice! You may have been kept on your parents’ plan, or gotten on the school’s insurance. But then you graduate. Tough day: You’re leaving the womb, etc. Now you’re working an internship or entry-level position. How likely is health care? Not very. My roomie is a paid research associate at a top think tank, but they don’t offer their RAs coverage. No wonder they favor universal health care — then they wouldn’t have to feel so guilty.
This hits at all levels. The low-income are worse off, to be sure, but studies found that two-thirds of young adults between 19-23 went without care for some period during 1996-2000. That’s because the number of people without coverage is just a snapshot at any given time. If you looked at the number of people who were without health coverage at point or another over a period of time, it affects even more people.
The upside, as you sometimes hear, is that we’re young, we don’t need coverage. After all, who needs Blue Cross when you’re invincible, right? Not quite. It’s true that young people are at lower risk for, say, cardiovascular disease. But 14 percent of us are obese. 3.5 million get pregnant every year (and you need pre-natal care). One-third of all HIV diagnoses are made among young adults, and we’re by far the most likely to limp, stumble, or get carried into an emergency room with some sort of physical injury.
Read the whole article, it is quite good. [bm]
Mapping Your Rights
Interested in where your state stands on reproductive aand sexual rights? You should check this newly released web site, Mapping Our Rights: Navigating Discrimination Against Women, Men and Families, which ranks states based on their level of protection for reproductive and sexual rights. The website is part of a project completed by Ipas, an international reproductive health organization based in Chapel Hill; the National Gay and Lesbian Task Force; and the SisterSong Women of Color Reproductive Health Collective. My home state, Ohio, ranked 50th - obviously we need to so some work here. It tied with South Dakota for that last place spot. New York and New Mexico tied for 1st. For more information on the methodology, please see Pandagon and thanks to them for the heads up on this informative website. [bm]
June 1, 2006
TV - Human Behavior Experiments
For those of you planning to watch some TV this evening, the New York Times provides a good review for Human Behavior, showing tonight at 9pm on the Sundance channel and Court TV:
People wonder how ordinary American soldiers, men and women, could have mistreated prisoners so barbarically at Abu Ghraib. "The Human Behavior Experiments," a documentary on both Court TV and the Sundance Channel tonight, suggests that actually it's surprising such things don't happen more often. . .
"Human Behavior," written and produced by Alex Gibney, who also made "Enron: The Smartest Guys in the Room," fills in some of the psychological blanks by illustrating how, in certain circumstances, people readily obey even far-fetched instructions. Most of all, the film shows how easily people lose perspective and basic decency when in the grip of a credible authority figure or even just a difficult group dynamic.
Old film taken from interviews with Dr. Milgram, who died in 1984, reveal a mild, slightly pedantic man with big glasses and a chin beard, who explains that the Holocaust made him want to understand better how it was possible for ordinary people to act "callously and inhumanely." He set out to study authority and explore, as he put it, "under what conditions could a person obey, when commanded, actions that went against conscience."
He devised a study in which subjects delivered what they thought were painful electric jolts to a fellow participant, merely because they were encouraged to do so by the scientist in charge who assured them it was necessary for a learning experiment. The film shows one middle-aged man balking after hearing what he thinks is the subject howling in pain (in reality it is a recording), but many more — about 60 percent — keep increasing the pain levels under calm but firm instruction from the experimenter, "Continue, please."
Dr. Zimbardo's prison study was even more shocking, if only because the students assigned to play guards were not instructed to be abusive, and instead conformed to their own notions of how to keep order in a prison: "Lord of the Flies" in sideburns and aviator sunglasses. The prisoners were blindfolded, stripped, assigned numbers and forced to wear skimpy hospital gowns and ankle chains. The guards were given handcuffs, whistles and billy clubs. The scientists received a shocking display of how, as one of them put it, "human nature transformed in a very rapid way in the face of a very powerful situation."
The abuse kept escalating until, on the fourth day, it turned into sexual humiliation. Prisoners began breaking down. Dr. Zimbardo and his team were so engrossed by the experiment that they too lost sight of reality. In the film Dr. Zimbardo recalls that it was not until his girlfriend visited the mock prison and threatened to break up with him that he snapped out of it and ended the study early.
The Stanford students knew they were taking part in a psychology experiment. Soldiers assigned to guard prisoners at Abu Ghraib were told that the survival of comrades on the front lines depended on whether they could break the prisoners. Dr. Zimbardo, who in 2004 served as an expert witness in the court martial of Staff Sgt. Ivan Frederick II, who was convicted of assault, indecent acts and dereliction of duty at Abu Ghraib, said he was "an ordinary good guy who gets into this place and is totally corrupted."
The documentary uses several cases, from the 1964 murder of Kitty Genovese, when 38 neighbors in Queens heard or saw parts of the fatal attack and did nothing, to a 2005 hazing ritual that killed Matthew Carrington, a 21-year-old student at California State University, Chico, to make a point about herd mentality: that people who might give help when by themselves will, among others, hold back and follow the cues of a majority. The person who goes against the group or defies authority is a rarity.
"It is the majority who conform, who comply, who obey authority," Dr. Zimbardo says. "And that's what nobody wants to hear."
That rule is certainly something most people prefer to forget. "Human Behavior" is a riveting, if unsettling, reminder.
May 31, 2006
Sex Gene Discovery
Your sexual desire or lack thereof could be in your genes, scientists announced today. The discovery might change how psychologists view sexuality.
The researchers found that individual differences in human sexual desire can be attributed to genetic variations. The study is the first to provide data to show that common variations in the sequence of DNA impact on sexual desire, arousal and function, the researchers said.
The scientists, at the Hebrew University of Jerusalem, examined the DNA of 148 healthy male and female university students and compared the results with questionnaires asking for the students' self-descriptions of their sexual desire, arousal and sexual function. They found a correlation between variants in a gene called the D4 receptor and the students' self-reports on sexuality. . . .
The research was led by Richard Ebstein and was published in the online version of the journal Molecular Psychiatry.
I am not quite sure what to make of this . . . . [bm]
Frontline AIDS Program
PBS's Frontline had a great episode last night that addressed the AIDS epidemic. The program is entitled, "The Age of AIDS," and will continue tonight. It provides a detailed overview of the AIDS virus and the manner in which physicians and others have responded to it. The introduction states,
On the 25th anniversary of the first diagnosed cases of AIDS, FRONTLINE examines one of the worst pandemics the world has ever known in "The Age of AIDS." After a quarter century of political denial and social stigma, of stunning scientific breakthroughs, bitter policy battles and inadequate prevention campaigns, HIV/AIDS continues to spread rapidly throughout much of the world, particularly in developing nations. To date, some 30 million people worldwide have already died of AIDS.
"It's a very human virus, a very human epidemic. It touches right to the heart of our existence," says Dr. Peter Piot, executive director of UNAIDS. "When you think of it, that in let's say 25 years, about 70 million people have become infected with this virus, probably coming from one [transmission] ... it's mind blowing."
The Frontline website provides additional materials and information. I have ordered Frontline tapes to use in my class and have found them to be extremely informative. The additional materials that can be found on the website add to the class and help provoke wonderful class discussions. [bm]
CMS Issues Quality Measures for OPOs
From a e-blast couresy of the Regulation, Accreditation, and Payment Practice Group of the American Health Lawyers Association:
The Centers for Medicare and Medicaid Services today announced "a final rule setting forth new quality measures and data reporting requirements that organ procurement organizations (OPOs) must meet to have their services covered by Medicare and Medicaid."
"The final rule contains three new outcome measures similar to measures recommended by many commenters, requirements for reporting of OPO performance data, and new and more objective criteria for selecting the winner of a competition for an open donation service area. There is also a new appeals process for OPOs that includes an OPO's right to request reconsideration from CMS. CMS received many comments on a proposed rule that was published on Feb. 4, 2005, resulting in substantial changes in this final rule."
CMS has not posted a pre-publication copy of the final rule, but the rule will be published in the May 31, 2006 edition of the Federal Register.
May 30, 2006
High praise from the AJOB blog for a recent publication:
I'm forever finding jewels that Rosamond Rhodes strings together in her various projects, from the APA philosophy of medicine newsletter to more complex collections like this special issue of the Mount Sinai Journal of Medicine on ethics in pediatrics, which contains at least four (that's as far as I've gotten) of the best articles on ethical issues in pediatrics I've read in years.
Kurt Hirschhorn, Ian R. Holzman, Daniel A. Moros, and Rosamond Rhodes
- Understanding, Avoiding, and Resolving End-of-Life Conflicts in the NICU
Arthur E. Kopelman
- When Parents Request Seemingly Futile Treatment for Their Children
- When Staff and Parents Disagree: Decision Making for a Baby with Trisomy 13
Linda B. Siegel
- An Exploration of the Ethical, Legal and Developmental Issues in the Care of an Adolescent Patient
Daniel Summers, Ivanya Alpert, Thaina Rousseau-Pierre, Mara Minguez, Simone Manigault, Sharon Edwards, Anne Nucci, and Angela Diaz
- Children as Research Subjects: Moral Disputes, Regulatory Guidance, and Recent Court Decisions
Loretta M. Kopelman
- Genetic Testing of Children for Adult-Onset Diseases: Is Testing in the Child’s Best Interests?
Mary Kay Pelias
- Why Test Children for Adult-Onset Genetic Diseases?
May 29, 2006
Cardiac Rehab Billing Prompts Settlement with DOJ & CIA
For allegedly billing cardiac rehab services with the CPT code for cardiac stress tests -- which, if true, would be a clear example of upcoding -- a Cape Cod cardiologist who was medical director of the cardiact center settled fraud charges with a $1.9 million payment to the government, according to the May 29 issue of AISHealth.com's newsletter. And no, not that CIA: the doc got saddled with a Corporate Integrity Agreement. The U.S. Attorney's office in Boston has a press release on the settlement. [tm]