Friday, October 5, 2007
The New York Times reports on disparities in infant mortality rates around the New York city area.
The infant mortality rate, a general barometer for public health which measures the number of children who die before age 1, was 12.5 deaths per thousand in 2006 and 11.3 deaths per thousand from 2004 to 2006 in Brownsville. Other communities with persistently high infant mortality from 2004 to 2006 include Jamaica East (9.1 per 1,000) and Central Harlem (7.9 per 1,000).
Over all, the city rate fell to to 5.9 infant deaths for every 1,000 births, down from 6 the previous year. It is lower than the national rate, which was 6.8 per 1,000 births from 2004 to 2006, the most recent number on record. In recent decades, the infant mortality rate has been decreasing across the country. However, in the last two years, progress has stalled in the Deep South.
From highest to lowest, the infant mortality rates of the five boroughs in 2006 are the Bronx (7.1 per 1,000), Brooklyn (6.0 per 1,000), Queens (5.3 per 1,000), Manhattan (4.2 per 1,000) and Staten Island (3.4)
A troubling and persistent phenomenon over the last decade is that infant mortality rates for black and Puerto Rican New Yorkers are more than double those for whites and Asians — a gap persists even when poverty is factored out. Infants born to higher-income black women died at nearly three times the rate of those born to higher-income white women.
Academics have sliced race and infant mortality relationship in a variety of lenses — historical, socioeconomic distress and even the impact of the New Deal. Some experts believe the stress of experiencing of racial discrimination may affect the health of black women.
No one seems to be too happy with the Presidential Veto of SCHIP. Paul Krugman takes a dim view of the matter. He states,
On Wednesday, President Bush vetoed legislation that would have expanded S-chip, the State Children’s Health Insurance Program, providing health insurance to an estimated 3.8 million children who would otherwise lack coverage.
In anticipation of the veto, William Kristol, the editor of The Weekly Standard, had this to say: “First of all, whenever I hear anything described as a heartless assault on our children, I tend to think it’s a good idea. I’m happy that the president’s willing to do something bad for the kids.” Heh-heh-heh.
Most conservatives are more careful than Mr. Kristol. They try to preserve the appearance that they really do care about those less fortunate than themselves. But the truth is that they aren’t bothered by the fact that almost nine million children in America lack health insurance. They don’t think it’s a problem.
“I mean, people have access to health care in America,” said Mr. Bush in July. “After all, you just go to an emergency room.”
And on the day of the veto, Mr. Bush dismissed the whole issue of uninsured children as a media myth. Referring to Medicaid spending — which fails to reach many children — he declared that “when they say, well, poor children aren’t being covered in America, if that’s what you’re hearing on your TV screens, I’m telling you there’s $35.5 billion worth of reasons not to believe that.”
Perhaps some people need to get out more often and see how people are actually living . . . . The New York Times editorial page notes further that Pesident Bush's rationale for his veto doesn't stand up to scrutiny. Frank Pasquale at concurring opinions has more thoughts and potential solution.
Thursday, October 4, 2007
The New Republic's Jonathan Cohn has a long interview with Senator Hillary Clinton on her views about health care. He states,
A goal of your plan is to make for-profit insurers change a lot of their business practices, like excluding people with preexisting medical conditions. But will that work? Is it possible to make them act more like non-profits?
It wasn't so long ago that we had a lot of not-for-profit insurance companies, as you may recall. There may be a relationship here that may be worth exploring. [Laughs]
This is a new business model and it may be that some will go back to being non-profit. It may be that profit will be realized by competition, on the basis of cost and quality. Because, remember, this is an industry that spends $50 billion a year excluding people either altogether by denying them coverage, or by denying them care that they need.
$50 billion is no longer going to be an expense to them, so this could actually provide the opportunity of a new business model for for-profit insurance.
The insurance industry is not going to name me "woman of the year" any time soon. But I think this is a business opportunity that some may understand and see.
The other piece of this, which I've talked about many times before, is that with the advances in our understanding of the human genome, and individualized genetically-based treatments, the model of our system may be out of date anyway. If your whole model is based on excluding for preexisting conditions, and we will find out that nearly all of us have such a genetically-based preexisting conditions, how do you have an insurance model that really is going to last beyond the next 20, 25 years?
There's a lot going on here that is, I think, pushing for some recognition that the insurance industry's model, as they have allowed it to develop, with rejection of not-for-profit health care, the transformation of not-for profits to for-profits, the increasing money spent on underwriting,
the double-digit profit margins--it may have provided short-term financial benefits for individual companies but it has been bad for the economy.
The entire interview is not very long and is an interesting read on her health care reform proposal and some of the obstacles it may face if she is elected.
The entire interview is not very long and is an interesting read on her health care reform proposal and some of the obstacles it may face if she is elected.
That is what the fight is going to be over. There are those ideologically who will cling to a for-profit model with no regulation. But, by doing so, they are really dooming millions more to both no insurance and underinsurance--and they are continuing to hobble the economy. And I think that's much more clearly understood today than it was 15 years ago.
Wednesday, October 3, 2007
Think Progress reports on the President's veto of the SCHIP expansion program:
Breaking: Bush vetoes children’s health insurance.
President Bush’s veto of an SCHIP expansion was only the fourth veto of his presidency. AP reports that the White House “sought as little attention as possible, with the president wielding his veto behind closed doors without any fanfare or news coverage.” House Majority Leader Steny Hoyer (D-MD) said that they have not yet scheduled a date for an override vote, but it could be “next week” or “the week after.”
Click on Think Progress link for video response from Families USA. Please be aware that some comments at the bottom of the Think Progress story contain strong language.
Interesting tidbit from Professor Jack Goldsmith's testimony yesterday about the"torture memos"-Turns out that the definition used torture came from EMTALA! Who knew . . . TPMmuckraker reports:
Much of Goldsmith's difficulties, of course, centered around his efforts to revise earlier Department memos defining torture, such as the infamous 2002 "Bybee memo" (named after Goldsmith's predecessor Jay Bybee) that defined torture as "equivalent in intensity to the pain accompanying serious physical injury, such as organ failure, impairment of bodily function, or even death." Goldsmith called that reasoning "severely flawed."
During today's hearing, Sen. Sheldon Whitehouse (D-RI) asked Goldsmith where that definition had come from. "It came from a health care statute designed to define the circumstances under which there was an emergency situation warranting health care benefits," he answered. He explained that "severe pain" is hard to define, and so the lawyers likely cast around for a way to define it -- but that the health care code probably wasn't the best place to look.
Here is the EMTALA statutory language:
"A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in --
placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part, or
"With respect to a pregnant woman who is having contractions --that there is inadequate time to effect a safe transfer to another hospital before delivery, or that the transfer may pose a threat to the health or safety of the woman or her unborn child."
Tuesday, October 2, 2007
The WorkplaceProfBlog updates us on a case involving Age Discrimination and Pension Plans in the upcoming Supreme Court term. It states,
The Supreme Court . . . granted certiorari in an interesting public pension plan case involving claims of age discrimination. In Kentucky Retirement v. EEOC, 06-1307:
[the] Petition involves a public employee retirement plan that includes normal and disability retirement benefits. A member who is eligible for normal retirement benefits based on attained age plus a minimum service requirement, or based on service alone, is not eligible for disability retirement benefits. Because age may be a factor in determining eligibility for normal retirement, it is an indirect factor in determining eligibility for disability retirement. Moreover, the calculation of disability retirement benefits is based upon actual years of service plus the number of years remaining before the member reaches retirement age or eligibility based on years of service alone; age may thereby be an indirect factor in determining the amount of disability retirement
The question presented is:
Whether any use of age as a factor in a retirement plan is "arbitrary" and thus renders the plan facially discriminatory in violation of the Age Discrimination in Employment Act?
Planning on a visit to Indianapolis this week, don't miss the interesting and informative symposium being held at the Indiana University School of Law - Indianapolis this Friday, October 5th. Entitled, "Wellness and the Law: State Governments' Role in Addressing America's Public Health Crisis." The program overview provides:
Across the country, state governments have found themselves faced with difficult decisions regarding proposals for wellness initiatives, health care policy, and laws to encourage healthy living. In Arkansas, debates have erupted over how to properly and safely monitor a child's progress fighitng obesity; the Governor of Texas has been sued for issuing an exceutive order mandating the HPV vaccination for girls; and Massachusetts has been unable to escape a political quagmire over its decision to institute universal health care. Here in Indiana, during the 20007 legislative cycle alone, the Indiana General Assembly explored proposals to raise the cigarette tax, ban smoking in car with children, and mandate that young girls receive a vaccine against cervical cancer.
- Our alum, Mary Hill, General Counsel and Deputy Commission to the Indiana State Board of Health, will be the luncheon speaker. Her address, Influencing Health and Wellness: The Power of Public Policy, will touch on, among other things, the role of women in influencing health policy in Indiana and across the nation.
- Dr. Frank Chaloupka, Director, University of Illinois at Chicago Health Policy Center, will be addressing the economies of taxing toward health .
- Dr. Russell Pate, University of South Carolina, addressing policies to promote physical activity and prevent obesity in children .
- Kevin W. Ryan and Joy Rockenbach, addressing Arkansas’s effort to use body mass index (BMI) as a political tool.
- Professors David Orentlicher and Eleanor Kinney will join Ellen Whitt, Governor Daniels’ Senior Advisor on Health Promotion and Special Projects for Indiana addressing Indiana’s legislative and policy efforts toward wellness.
- Samuel Derheimer, presenting his scholarship on the history and politics of compulsory vaccination.
- Sally Hubbard, presenting her scholarship on states’ efforts to encourage children's wellness through public education.
- Professor Cynthia Baker will be presenting her paper in progress, Bottom Lines and Waist Lines: State Governments Weigh in on Public Health Issues.
9:00a.m. - 4:00 pm
6.0 Hours of CLE Credit available
5.75 Hours of CME Credit available (see CME specifications)
There is a fee to attend this event.
Symposium Details: indylaw.indiana.edu/programs/Law_State_Gov
For more information contact Therese Kamm at (317) 274-8616 or firstname.lastname@example.org
Monday, October 1, 2007
The Diane Rehm show today will feature Jeffrey Toobin and Jeffrey Rosen discussing today's opening of the Supreme Court term and what we can expect to see from the Justices. Here is the overview:
On the first day of the Supreme Court's 2007/2008 term, two best-selling authors provide a rare, behind-the-scenes glimpse at the inner workings of the Court. They discuss how the personalities and philosophies of the Justices may influence how they rule on such controversial issues as voter identification, lethal injection, the rights of terrorism suspects, and executive power.
McClatchy News has a story addressing the potential causes for the differences in infant mortality deaths among various races in the United States. The article states,
A new series of studies from the Joint Center for Political and Economic Studies' Health Policy Institute, along with a small but growing number of neonatalogists nationwide, suggests that the stressful effects of racism play a role.
"That's the elephant in the room," said Michael Lu, an obstetrician-gynecologist and professor at the University of California at Los Angeles who studies disparities in infant health. "When we're studying racial disparities, for decades people have looked at stress and infant mortality without looking at the reasons for the stress."
Black infant mortality is a complicated puzzle that includes poverty, poor nutrition, inadequate prenatal care, teen pregnancy, heredity, high blood pressure, stress, obesity, low birth weights and prematurity. However, some neonatologists and child health advocates have pushed for more research to get behind the social reasons why these factors seem to take a higher toll on African-American infants than they do on other babies.
For the 600 black women in Atlanta who participated in a related study on the effects of racial discrimination on health, the reasons for their higher stress levels ranged from hearing white teachers comment on "those kids" to working extra long hours to win acceptance from white colleagues. "The pregnancy scares the life out of me because I am pregnant with a baby boy, and I know how black boys are treated in this society," one study participant told researchers from Spelman College and Emory University in Atlanta.
In his research, Lu and his colleagues found that the disproportionately higher number of fast-food restaurants and liquor stores, lower number of grocery stores and the higher cost of fresh produce in many urban, predominately black communities caused poorer pregnant black women to make stressful choices about what to eat and where to live. So did the higher crime rates in these communities and worries about sending children to poorly equipped, understaffed schools. Lu and other researchers see these factors as part of a trend of racial inequality that's stressful to some poorer black expectant mothers. . . . A PBS documentary, "Unnatural Causes: Is Inequality Making Us Sick," slated to air next year, explores the disparity in infant mortality and other ways in which racial and social inequality may affect health care.
The entire article provides insight and new understanding to a serious public health issue.
Sunday, September 30, 2007
Cliff Schecter finds a different sort of advertisement for a mate and asks what it says about our health care system. From his blog:
Me: Writer, artist, teacher ... mother of two almost-grown sons ... vegetarian (but you don't have to be). Loves animals (two large dogs and three cats), gardening, house projects. The beach. Books. Travel. Financially solvent except for absurdly expensive health insurance premiums and medical costs.
You: Age 45 to about 57. Canadian citizen living in Vancouver, B.C., or willing to relocate there. Cancer patient or survivor. Open-minded. Bit of a risk taker. Warm hearted but not clinging. Bald OK.
It's not your typical posting of someone looking for a date. Granted, Jeanne Sather is looking for love and a best friend, according to this posting on her blog, assertivepatient.com. But what she was suggesting on the post was that she would like to marry a Canadian man so she could gain access to that country's publicly funded health-care system. . . .
She estimates more than half of what she receives monthly in disability and child support goes toward her $800-a-month health insurance premium, and is still only a portion of what it costs to treat her disease. She said treating her cancer, which has now spread to her bones, is about $300,000 a year. She said she pays more than $20,000 of that out-of-pocket.